NHS whats happened?

[dave_s13]

Ian Geary said:

Brave Fart said:

Did anyone else watch last night's Panorama: "The NHS crisis: can it be fixed?"? I did, and it featured some initiatives that challenged the current model of healthcare.
...

The point is that such initiatives pay for themselves AND are better for patients.

I was just about to launch into why these initiatives are so hard to get going when you're on the back foot financially and operationally.


Then I saw this

Brave Fart said:

Resistance to change was a big problem in the NHS; I don't doubt him for one moment.

Ultimately, I don't know who has the answers.

I don't think cabinet level politicans have the depth needed for a genuinely paradigm shifting policy.

I don't think NHS trusts or public health bodies work well enough with the NHS to diagnose, and correct systemic issues.

I think medical staff would see the benefit, but it's wood for the trees with the current backlog.

As was noted on the other thread going into detail on the NHS, it has far fewer managers than it should for its size (Vs comparable private sector organisations).

Change costs money. Private sector would see it as an investment with a payback period. The NHS would just see the investment as the new baseline.

I work in community NHS, used to be clinical, now in clinical systems. The absolute blocker to change is simply capacity. We can design and implement a system/process but if there is no capacity from everyone ranging from admin, to clinician, to healthcare assistant to clinical systems to data analyst then making those changes either can't happen, fails or is excruciatingly slow.

I'm not sure people realise the the complexity behind a simple clinical process. It has to be designed, risk assessed and be reportable, or reported on. That takes a team of people to make happen. As a patient you'll only see the tip of that iceberg.

[Electro1980]

crankedup5 said:

K77 CTR said:

crankedup5 said:

The prescription item is Dulcolax which is a laxative to help me whilst I wait for my colonoscopy procedure. The doctor advised me to take this medication to help me. when I got to the pharmacy I was told that it is a prescription item.
The issue is not the cost but the service issues, it’s either available on NHS or it’s not.

You can buy dulcolax (bisacodyl) at tesco or over the counter

Indeed, but the point was t that I couldn’t get the product, it was the product is available on prescription and I qualify for free prescriptions.My/Doctor decided that although he recommended it he didn’t issue a prescription. if I wished to follow his medical advise I needed to pay for the medicine. I wasn’t aware Doctors could decide who should recieve free prescriptions?

That’s been the case for a number of years that doctors won’t prescribe over the counter medication except in exceptional circumstances. Part of the drive to reduce waste.

Amusing that one of the vocal critics of the NHS is moaning when reforms impact them.

Edited by Electro1980 on Saturday 25th February 17:21

[irc]

Assuming the missed GP appointments are midway through a session is it a huge problem GPd say the appointments are too short. So a missed appointment let's the doctor catch up if running late or spend a few extra minutes with a patient if needed.

Obviously people should turn up.

As an example of the NHS at its best, this month, my wife got a same day GP appointment for back pain with unusual symptoms. He admitted her the same evening. 6 days later she had seen two surgeonsin separate specialities, had an MRI scan and a spinal operation.

[Killboy]

crankedup5 said:

I went for my blood tests a local hospital, chatting to the practitioner who said that they had 30 no shows the other day. They have four practitioners, so much lost percentage.

Out of how many? I know stats doesn't seem to be your thing

[K77 CTR]

crankedup5 said:

K77 CTR said:

crankedup5 said:

The prescription item is Dulcolax which is a laxative to help me whilst I wait for my colonoscopy procedure. The doctor advised me to take this medication to help me. when I got to the pharmacy I was told that it is a prescription item.
The issue is not the cost but the service issues, it’s either available on NHS or it’s not.

You can buy dulcolax (bisacodyl) at tesco or over the counter

Indeed, but the point was t that I couldn’t get the product, it was the product is available on prescription and I qualify for free prescriptions.My/Doctor decided that although he recommended it he didn’t issue a prescription. if I wished to follow his medical advise I needed to pay for the medicine. I wasn’t aware Doctors could decide who should recieve free prescriptions?

Should they prescribe you paracetamol too?

[Riley Blue]

pquinn said:

Given the quality of the booking system a lot of missed appointments can be because people just didn't get notification they were meant to go, or some detail like the date was wrong if they did get it.

Every patient who has registered their mobile number at my practice receives two reminders by text, one a week before and one the day before. If they can't attend they can cancel the appointment by texting 'cancel' in reply to either text but many can't even be arsed to do that.

[voyds9]

dave_s13 said:

I work in community NHS, used to be clinical, now in clinical systems. The absolute blocker to change is simply capacity. We can design and implement a system/process but if there is no capacity from everyone ranging from admin, to clinician, to healthcare assistant to clinical systems to data analyst then making those changes either can't happen, fails or is excruciatingly slow.

I'm not sure people realise the the complexity behind a simple clinical process. It has to be designed, risk assessed and be reportable, or reported on. That takes a team of people to make happen. As a patient you'll only see the tip of that iceberg.

During Covid many optometrists became certified to triage minor eye conditions (as the hospital weren't taking them) so extra capacity has been generated there. (Now some hospitals have taken this back in house)
Cataract surgery and laser capsulotomy are now done at private clinics for the NHS, extra capacity found.

Another problem I see is the short termism of the NHS pilot projects. Money will be foound for a 3 year project, it will take 12 months to implement it, 6 months to train people another few months to refine the system when it doesn't work. Then a few months later it ceases as it's run out of funding.
We've had this with health ambassadors, child screening, diabetic screening and I expect the same for the latest scheme wellbeing.

[M1AGM]

Riley Blue said:

chemistry said:

Killboy said:

What percentage of people don't turn up for a booking?

Approx 1 in 20, apparently:

https://www.nationalworld.com/health/patients-miss...

Last month, at the practice I go to, 23,178 appointments were offered, 1,092 were DNAs (Did Not Attend).

I was down as a DNA for a follow up with a consultant last March at Hull General. I knew that I was due a follow up around that time so after another week or so of waiting for ‘the letter’ to attend I rang the hospital and was told I has missed my appointment and was down as a DNA. When I spoke to the bookings team they let slip that they had been having IT issues, lots of letters had not been sent out, and loads of appointments had been missed. Nobody thought to ring the patients to let them know or check. The consultant had days sat with no attendees, had to put on extra surgeries to cover the backlog (these was time sensitive follow ups). Myself and all those others who experienced this were undoubtedly included in the stats for DNAs.

[Sheepshanks]

crankedup5 said:

Indeed, but the point was t that I couldn’t get the product, it was the product is available on prescription and I qualify for free prescriptions.My/Doctor decided that although he recommended it he didn’t issue a prescription. if I wished to follow his medical advise I needed to pay for the medicine. I wasn’t aware Doctors could decide who should recieve free prescriptions?

Maybe he didn't realise you got free prescriptions so thought he was saving you money?

Or it's simply, as another poster suggested, they've been told not to prescribe over-the-counter medication.

Why couldn't you get it?

[fiatpower]

Riley Blue said:

Every patient who has registered their mobile number at my practice receives two reminders by text, one a week before and one the day before. If they can't attend they can cancel the appointment by texting 'cancel' in reply to either text but many can't even be arsed to do that.

Amazed they managed to get an appointment. 3 days in a row I called at opening time just to join a massive queue and when I finally got through got told sorry no appointments, try again tomorrow. Turn up in person and get told you need to call up as that’s the only way to book.

[Electro1980]

M1AGM said:

When I spoke to the bookings team they let slip that they had been having IT issues, lots of letters had not been sent out, and loads of appointments had been missed. Nobody thought to ring the patients to let them know or check.

They probably did think to ring, but didn’t have the people to do it.

[Riley Blue]

fiatpower said:

Riley Blue said:

Every patient who has registered their mobile number at my practice receives two reminders by text, one a week before and one the day before. If they can't attend they can cancel the appointment by texting 'cancel' in reply to either text but many can't even be arsed to do that.

Amazed they managed to get an appointment. 3 days in a row I called at opening time just to join a massive queue and when I finally got through got told sorry no appointments, try again tomorrow. Turn up in person and get told you need to call up as that’s the only way to book.

I can book by phone, in person, via the practice's website or by using one of three phone apps. At the moment not all types of appointments are offered on-line (there have been men turning up having booked smear tests) but practice management are working on it.

[Ian Geary]

dave_s13 said:

Ian Geary said:

Brave Fart said:

Did anyone else watch last night's Panorama: "The NHS crisis: can it be fixed?"? I did, and it featured some initiatives that challenged the current model of healthcare.
...

The point is that such initiatives pay for themselves AND are better for patients.

I was just about to launch into why these initiatives are so hard to get going when you're on the back foot financially and operationally.


Then I saw this

Brave Fart said:

Resistance to change was a big problem in the NHS; I don't doubt him for one moment.

Ultimately, I don't know who has the answers.

I don't think cabinet level politicans have the depth needed for a genuinely paradigm shifting policy.

I don't think NHS trusts or public health bodies work well enough with the NHS to diagnose, and correct systemic issues.

I think medical staff would see the benefit, but it's wood for the trees with the current backlog.

As was noted on the other thread going into detail on the NHS, it has far fewer managers than it should for its size (Vs comparable private sector organisations).

Change costs money. Private sector would see it as an investment with a payback period. The NHS would just see the investment as the new baseline.

I work in community NHS, used to be clinical, now in clinical systems. The absolute blocker to change is simply capacity. We can design and implement a system/process but if there is no capacity from everyone ranging from admin, to clinician, to healthcare assistant to clinical systems to data analyst then making those changes either can't happen, fails or is excruciatingly slow.

I'm not sure people realise the the complexity behind a simple clinical process. It has to be designed, risk assessed and be reportable, or reported on. That takes a team of people to make happen. As a patient you'll only see the tip of that iceberg.

Thanks for posting that - I lose track of what threads I post in.

I work in finance, and similarly, any changes to (financial) systems have way more under the surface than is seen by users.

Clawing time out of an understaffed business as usual team to do it is very hard.

Still not really sure how the government should move forward with "fixing" the NHS. The news all about pay at the moment, but it might go back to waiting lists / perma-crisis by spring?

[turbobloke]

Ian Geary said:

dave_s13 said:

Ian Geary said:

Brave Fart said:

Did anyone else watch last night's Panorama: "The NHS crisis: can it be fixed?"? I did, and it featured some initiatives that challenged the current model of healthcare.
...

The point is that such initiatives pay for themselves AND are better for patients.

I was just about to launch into why these initiatives are so hard to get going when you're on the back foot financially and operationally.


Then I saw this

Brave Fart said:

Resistance to change was a big problem in the NHS; I don't doubt him for one moment.

Ultimately, I don't know who has the answers.

I don't think cabinet level politicans have the depth needed for a genuinely paradigm shifting policy.

I don't think NHS trusts or public health bodies work well enough with the NHS to diagnose, and correct systemic issues.

I think medical staff would see the benefit, but it's wood for the trees with the current backlog.

As was noted on the other thread going into detail on the NHS, it has far fewer managers than it should for its size (Vs comparable private sector organisations).

Change costs money. Private sector would see it as an investment with a payback period. The NHS would just see the investment as the new baseline.

I work in community NHS, used to be clinical, now in clinical systems. The absolute blocker to change is simply capacity. We can design and implement a system/process but if there is no capacity from everyone ranging from admin, to clinician, to healthcare assistant to clinical systems to data analyst then making those changes either can't happen, fails or is excruciatingly slow.

I'm not sure people realise the the complexity behind a simple clinical process. It has to be designed, risk assessed and be reportable, or reported on. That takes a team of people to make happen. As a patient you'll only see the tip of that iceberg.

Thanks for posting that - I lose track of what threads I post in.

I work in finance, and similarly, any changes to (financial) systems have way more under the surface than is seen by users.

Clawing time out of an understaffed business as usual team to do it is very hard.

Still not really sure how the government should move forward with "fixing" the NHS. The news all about pay at the moment, but it might go back to waiting lists / perma-crisis by spring?

A couple of recent ideas offer food for thought, and some optimism.

Locally a trial proved to be successful clinically and financially which involved putting certain patients' home heating on prescription, it seemed a stretch to be financially worthwhile but the evaluation said it was, apparently, and if I heard correctly it's about to go out on a wider basis. The other was the 'home wards' idea where vid/cctv and other tech allow patients to be treated and monitored at home rather than in hospital, and again iirc supported by specialist nurse practitioners who are trained and qualified to issue prescriptions (possibly some restrictions but can't remember). There's a chap nearby whose heart is in constant contact with a hospital / specialist team 24/7, mobile phone type tech I think.

Edited by turbobloke on Saturday 25th February 19:49

[Murph7355]

Electro1980 said:

And how many people who do need to be seen would be put off until it is too late and it costs much more to treat?

Who knows.

Somewhere between none and a couple of million people a year.

But if we carry on the way we are, a whole lot of people who need help aren't going to get it.

In fact, how many people aren't getting help soon enough now because of the way things are done?

We need to try things that have never been tried before... Same old same old results in the same.

[Whoozit]

M1AGM said:

I was down as a DNA for a follow up with a consultant last March at Hull General. I knew that I was due a follow up around that time so after another week or so of waiting for ‘the letter’ to attend I rang the hospital and was told I has missed my appointment and was down as a DNA. When I spoke to the bookings team they let slip that they had been having IT issues, lots of letters had not been sent out, and loads of appointments had been missed. Nobody thought to ring the patients to let them know or check. The consultant had days sat with no attendees, had to put on extra surgeries to cover the backlog (these was time sensitive follow ups). Myself and all those others who experienced this were undoubtedly included in the stats for DNAs.

Mrs Whoozit is a consultant in a clinical specialty. The state of the admin department (who are supposed to book appointments, send letters, fill slots etc.) is so bad she personally checks the status of every patient coming into and out of her clinics to double check someone else is doing their job. She doesn't get paid for these additional several hours a week which are necessary to keeping the service running.

Management have no answer to this. When it's brought up as a critical issue in every clinical review meeting, they look like hooked fish. I have a smidgen of sympathy at the rate of turnover in the admin department, however if the hires can't even follow a documented procedure there is something wrong with the hiring, training or both.

[djc206]

Whoozit said:

Mrs Whoozit is a consultant in a clinical specialty. The state of the admin department (who are supposed to book appointments, send letters, fill slots etc.) is so bad she personally checks the status of every patient coming into and out of her clinics to double check someone else is doing their job. She doesn't get paid for these additional several hours a week which are necessary to keeping the service running.

Management have no answer to this. When it's brought up as a critical issue in every clinical review meeting, they look like hooked fish. I have a smidgen of sympathy at the rate of turnover in the admin department, however if the hires can't even follow a documented procedure there is something wrong with the hiring, training or both.

Both my mother and grandmother have needed to see ENT consultants lately several weeks apart. They were both sent letters with a phone number on which they dutifully phoned to be told it was the wrong hospitals phone number. The guy on the other was bloody rude to both of them but I can’t blame him for his frustration when he spends all day answering the phone to people who should never have been told to call him. How hard is it to the put the correct phone number on a letter? Or rather how hard is it to correct the incorrect phone number on the letters going out when it’s noticed that it’s incorrect? Apparently very as I said this error still hasn’t been corrected after several weeks. st show.

[Killboy]

Whoozit said:

M1AGM said:

I was down as a DNA for a follow up with a consultant last March at Hull General. I knew that I was due a follow up around that time so after another week or so of waiting for ‘the letter’ to attend I rang the hospital and was told I has missed my appointment and was down as a DNA. When I spoke to the bookings team they let slip that they had been having IT issues, lots of letters had not been sent out, and loads of appointments had been missed. Nobody thought to ring the patients to let them know or check. The consultant had days sat with no attendees, had to put on extra surgeries to cover the backlog (these was time sensitive follow ups). Myself and all those others who experienced this were undoubtedly included in the stats for DNAs.

Mrs Whoozit is a consultant in a clinical specialty. The state of the admin department (who are supposed to book appointments, send letters, fill slots etc.) is so bad she personally checks the status of every patient coming into and out of her clinics to double check someone else is doing their job. She doesn't get paid for these additional several hours a week which are necessary to keeping the service running.

Management have no answer to this. When it's brought up as a critical issue in every clinical review meeting, they look like hooked fish. I have a smidgen of sympathy at the rate of turnover in the admin department, however if the hires can't even follow a documented procedure there is something wrong with the hiring, training or both.

You know what will fix this all! Fining people who DNA!

[Sheepshanks]

djc206 said:

Whoozit said:

Mrs Whoozit is a consultant in a clinical specialty. The state of the admin department (who are supposed to book appointments, send letters, fill slots etc.) is so bad she personally checks the status of every patient coming into and out of her clinics to double check someone else is doing their job. She doesn't get paid for these additional several hours a week which are necessary to keeping the service running.

Management have no answer to this. When it's brought up as a critical issue in every clinical review meeting, they look like hooked fish. I have a smidgen of sympathy at the rate of turnover in the admin department, however if the hires can't even follow a documented procedure there is something wrong with the hiring, training or both.

Both my mother and grandmother have needed to see ENT consultants lately several weeks apart. They were both sent letters with a phone number on which they dutifully phoned to be told it was the wrong hospitals phone number. The guy on the other was bloody rude to both of them but I can’t blame him for his frustration when he spends all day answering the phone to people who should never have been told to call him. How hard is it to the put the correct phone number on a letter? Or rather how hard is it to correct the incorrect phone number on the letters going out when it’s noticed that it’s incorrect? Apparently very as I said this error still hasn’t been corrected after several weeks. st show.

After both wife and I have unfortunately needed to have a series of interactions with a couple of hospitals it’s little short of amazing that they manage to get anything done. But it constantly amazes us how there’s often hordes of nurses and admin staff standing around chatting.

I also find their lack of respect for our time infuriating - even in the nearby hospital only losing half a day is a result, and for the other one, a 2hr round trip, it’s even worse.

[crankedup5]

Electro1980 said:

crankedup5 said:

K77 CTR said:

crankedup5 said:

The prescription item is Dulcolax which is a laxative to help me whilst I wait for my colonoscopy procedure. The doctor advised me to take this medication to help me. when I got to the pharmacy I was told that it is a prescription item.
The issue is not the cost but the service issues, it’s either available on NHS or it’s not.

You can buy dulcolax (bisacodyl) at tesco or over the counter

Indeed, but the point was t that I couldn’t get the product, it was the product is available on prescription and I qualify for free prescriptions.My/Doctor decided that although he recommended it he didn’t issue a prescription. if I wished to follow his medical advise I needed to pay for the medicine. I wasn’t aware Doctors could decide who should recieve free prescriptions?

That’s been the case for a number of years that doctors won’t prescribe over the counter medication except in exceptional circumstances. Part of the drive to reduce waste.

Amusing that one of the vocal critics of the NHS is moaning when reforms impact them.

Edited by Electro1980 on Saturday 25th February 17:21

I’ve been an active supporter of NHS for years, decades, first time I needed services I found the G.P. service lacking. So I don’t know why you deem me to be a vocal critic, of course I have criticised my G.P service as it has not delivered a good service for me.
What are ‘exceptional’ circumstances based upon ?