NHS............good & bad points.

[Dave7]

Bear with me on this one
Over the 3 years we (NHS & me) have been fighting this bladder cancer I have generally had good service but every now and again some 'members' (maybe the system) really annoy me..........some examples..........
1) pre operation number 3 I went to give the required blood sample. Had only been home one hour and they phoned to say......"sorry, but the nurse forgot to put your name on and we don't know which one is yours". I had to go back next day for another one.

2) pre operation number 4 I give yet another blood sample and......b****er me if they don't mess that one up.........I had to go back again next day
(don't forget it costs £3.00 to park plus loss of half a day).

3) I went in for operation number 4..........I had to be there for 07.00. Went through all the questions with 2 nurses then the anaesthetist. Got gowned up then sat there until 17.00 when they came to say "sorry-we have run out of theatre time, you will have to go home and wait for another appointment. (had the op 3 weeks(ish) later.

4) Had a scan which showed a kidney problem.........this on the Saturday. By Monday I had seen the Doctor and had a blood sample taken. By Wednesday I had the results.......BRILLIANT.

5) Wednesday just gone I had a 14.50 appointment re' results of the scan. I arrived at 14.20. At 15.50 we were notified they were running one hour late. At 16.15 my name was called out...........I had been sat there for 2 hrs 30 minutes.
The specialist (poor guy looked knackered) said........"TBH I'm not sure why you are here".
Any way he looked at the scan results, found the problem and told me I need a Renal-gram plus a camera into the kidney as they had found a problem with it.
THEN..........next day (Thursday) I got a phone call to ask.........."can you come in tomorrow for the Renal-gram". BRILLIANT
So that is where I am off to in 30 minutes.
I really appreciate our NHS and consider us very fortunate. Sometimes it is BRILLIANT but as I say......just sometimes it can make you swear ....a lot

 

[fossyant]

Was really well looked after with my extended stay. Outpatients though, shocking. Physio none existent.

 

[swee'pea99]

I'm sure I'll provoke howls of indignation, but I suspect both pros and cons have the same root cause: the ethos of a public sector organisation. Failure and incompetence are tolerated and covered up for in a way that would simply not happen in any open market institution; at the same time, people within the organisation will very often 'go the extra mile' because they're not doing it just for the money.

I recently had something come up that meant I'd miss a scheduled appointment. I rang up to tell someone. Of course I couldn't get to speak to any someones, but I was able to leave a voicemail, which I did - full details, NHS number, date & time, the whole bit. I asked for the msg to be acknowledged (having played these games before) but of course no such acknowledgement arrived. So I rang again, leaving the message again, again with full details. Needless to say, no acknowledgement arrived. The day of the appointment came and went. Shortly after I received a terse letter taking me to task for my failure to turn up and warning me that any future such failures on my part would be considered a hanging offense. I wrote, describing what had happened, but have heard nothing. I have no doubt whatsoever that the letter has been chucked and the system remains the same.

I am sure that when my rescheduled appointment comes around and I get to be seen, it will all be dealt with with consummate professionalism, and it won't cost me a penny. And I'm not undervaluing that at all. But I still say that cockups like that shouldn't happen, needn't happen, and wouldn't happen if the competitive pressures of an open market applied.

 

[JoshM]

I think if you need emergency or time critical care then the NHS is pretty bloody good. Unfortunately it is underfunded and overstretched, and as a result we spend our time fire fighting which results in some patchy routine care.

 

[PK99]

The reality is that the day of the District General Hospital is over. We need to look at new models of delivering care... but there are too many vested interests in maintaining the status quo.

My view is that secondary care currently delivered by DGHs should be split out. There's six main strands:

1. Elective Surgical Care
2. Routine Medical Care and Long Term Conditions
3. Care of the Elderly
4. Cancer
5. Maternity
6. A&E and urgent care (both surgical and medical)

In my view, both Elective Surgical Care and Routine Medical Care/Long Term Conditions should be stripped out of most DGHs and put into discrete units that provide only these services. This will allow them to provide high quality services in a timely manner - and it will free up capacity in the DGHs for other things. Most medical conditions and LTCs don't need the full facilities of the DGH and could be provided in these sorts of discrete units easily. And I don't have an issue with this care being provided by the independent sector either - as long as it is free at the point of use and the quality is there (and the reality is the IS doesn't have anything like the quality issues that the DGHs do).

t.

I'm having an ACL reconstruction at just such a stripped out unit next Wednesday. SWLEOC.

In the 1990s the waiting time for elective orthopedic work like hip's and knees was years as urgent care commanded theatre time over elective. 4 local health authorities set up the dedicated elective orthopedic centre at Epsom to address the problem. I was able to time my entry into the system to pretty much ste the date of my op as the 18 week target is pretty much always met.

No junior doctors only consultants from surrounding Hospitals spending a day a week at swleoc, specialist consultant on site 24/7 365 days a year. An Admin and booking system that has been better than flawless and my choice of consultant - top guy in the field.

On site physios are specialist in post op orthopedic rehab

Etc etc

I was given two options on dates, one at SWLEOC or last month by the same consultan at a local private hospital used to cover "overflow".

So I agree, the DGH model is broken as medical care now splits into too many divergent specialities, far better to centralise and focus.

 

[colly]

I have no knowledge of the real ins and outs of the NHS and I suspect neither do 90 odd percent of the population. What's good. What's bad. How it actually functions ( or not as the case may be).
Most of us can only speak from what little interaction we have with the service. If you have a dreadful time that will pretty much colour all your judgements as will having all your needs met in a fast efficient and timely manner.
Fortunately, to press I have only had need of medical treatment on rare occasions. 12 or 15 years ago it took me 9 months and five visits each of nearly two hours to be told the lump under my knee was only water and it would dissipate naturally. It was time consuming and bureacratic, a hoplessly ineffective, disorganised system.

More recently I attended my GP with a persistant cough. Nothing to worry about but a chest X-ray required 'just in case'. I thought, as before, it would be the same old long drawn up process .
Not a bit of it. She tapped away on the computer, said I could call at the local hospital ( which by chance is just across the road) give my name to the receptionist in the radiology Dept. and it would be done there and then. Sure enough I walked over and within 20 mins was wandering out again. " Two days later a text arrives to say all clear.
How it should work. It was brilliant.

So good points are things must have improved enormously. Bad points, it won't be the same for everyone.

 

[marinyork]

In addition to Reg's prescription for DGHs, I think it's essential to end the sub contractor status of GPs and make them all employees of the NHS. This would iron out the huge range of salaries and help in the recruitment of newly qualified doctors to boost their ranks. The notion of a senior partner earning £250,000+ while a salaried GP in his (or her) employ getting less than £50,000 for probably a high workload, is patently unfair. I would also cut back the inspection regime which, IMO, adds very little value while taking a huge amount of time. Revalidation (set up as a result of Shipman - bad case makes poor law) should be scrapped as it is hugely onerous and lets so much bad practice go by.

The key issue though is to fund properly social care and make sure that elderly people who don't need to be in hospital find somewhere suitable to be cared for. I hate the term 'bed-blockers' as I feel it puts the blame on the poor soul who in many cases has been let down by the state.

Plenty of other reasons why it would potentially be good to bring GPs into the fold. At the moment GP surgeries can stick two fingers up at their patients and not offer EPSr2 which for some patients creates a mindboggling waste of their time when collecting repeat prescriptions. At the other end of the scale other surgeries have been on it for a long time. This will be resolved not that far into the future, but is indicative of vastly varying regimes that make not much sense but it will be repeated in the future with other things again and again and again. Being an NHS contractor causes almost identical problems in my workplace - varying pay and unforeseen consequences.

Primary care and how repeat medication is dealt with is probably one of the biggest weaknesses in the system. There are patients who are overmedicated, there are those that don't take their medicines and unused medicines get chucked out on an industrial scale. The politicians won't sort it out anytime soon, when I went to see my MP the only thing she was interested in was how the NHS could reduce its drugs budget and was very interested in how this could be reduced. I told her as a legislator she could change the law and not only that but that was the primary purpose of her job and she was left temporarily speechless someone would tell her that rather than what she wanted to hear. No one wants to talk about more co-payments, no one wants to talk about raising the free prescription age from 60 to something higher.

 

[srw]

I'm sure I'll provoke howls of indignation, but I suspect both pros and cons have the same root cause: the ethos of a public sector organisation. Failure and incompetence are tolerated and covered up for in a way that would simply not happen in any open market institution;

Oh yes? Have you tried talking to a utility or getting a parcel delivered or travelled by train recently?

 

[Dave7]

Oh yes? Have you tried talking to a utility or getting a parcel delivered or travelled by train recently?

Have to agree with that sentiment.
This is not possible but if it could be run like a smaller private business....then it would improve things.
3 weeks ago I was sent for "an urgent" blood test. From the moment the specialist gave the instruction to my GP to actually having it done was just 4 hours. THEN.......3 days later I phoned the GP for the results. I was told "we dont get them....you must phone the consultant". I immediately did so and was told "no...your GP has them". Phoned the GP back to be told "your consultant instructed this....he has them". Phoned the consultant with that message and was told "no....REALLY...your GP has them".
Phoned the GP and was told "oh sorry....they are here. It says sayisfactory".
The words p***s up and brewery xome to mind.

 

[marinyork]

The words p***s up and brewery xome to mind.

Stuff gets 'lost' all the time on a daily basis in GP surgeries. They are called prescriptions and prescription requests. It comes about from a vast system that has bizarre ad hoc ways of attempting to manage it.

One of the frustrating things is the technology, because GP surgeries were very late adopters in some cases it has led the public to having queries for things like appointments and opening hours being done on the phone or in person which is a very inefficient way of doing it. It leads patients to thinking they MUST talk to a person which leads to their prescription phone line being swamped, which then leads to the phone line being limited hours (say 1hr a day) and then that doesn't work so is closed completely which then screws over those few that may need the phone because too many people have got so used to it doing it on the phone. It's going to still take years yet to retrain perceptions of patients.

 

[srw]

Have to agree with that sentiment.
This is not possible but if it could be run like a smaller private business....then it would improve things.
3 weeks ago I was sent for "an urgent" blood test. From the moment the specialist gave the instruction to my GP to actually having it done was just 4 hours. THEN.......3 days later I phoned the GP for the results. I was told "we dont get them....you must phone the consultant". I immediately did so and was told "no...your GP has them". Phoned the GP back to be told "your consultant instructed this....he has them". Phoned the consultant with that message and was told "no....REALLY...your GP has them".
Phoned the GP and was told "oh sorry....they are here. It says sayisfactory".
The words p***s up and brewery xome to mind.

Every large and complex organisation is the same, I suspect - and the NHS is one of the largest and most complex. As successive Health Secretaries have discovered, instructions still need to be enacted. And if enough people think your instructions are rotten they'll just ignore them. Which in the case of successive Health Secretaries is probably a good thing....

It gives me all the more respect for Bevan and Attlee.

 

[Andrew_P]

Purely from my recent experiences, there are people who have made a career out of walking around with a bit of paper in their hand or a folder. Overstaffed at reception level. Consultants use it to continue their education and quietly get private work or worse still refer their private clients back to their NHS list where they can This has happened to me on both counts the former was not strong enough but I felt a little bait had been dropped and the latter I got an appointment to the same Consultant but within the NHS. Not one area has ever seemed over worked MRI scan waited 5 weeks for appointment. 3.30pm 2 maybe 3 scanners 1 other person and me I walked straight through from reception to preparation to needle to scan. Same with a CT scan.

Nearly every clinic the consultant has their favourites and leaves everyone else to under graduates and registrars. The favourites have that air of knowing the consultant and gives me the feeling they are private patients that have been referred back to the NHS by the consultant for part of their treatment.

 

[Levo-Lon]

The wife has just had 2 breast cancer opps, 10 out of 10 for Peterborough Hospital..

 

[MarkF]

I work in the NHS, it needs to be privatised, the underlings have nothing to fear and the clinical professionals have nothing to fear, it's the in-between where all the waste is, bods who are paid huge salaries (to administer funds) just in case private business poaches them (ha ha (not funny) as if).

 

[screenman]

At the eye clinic I attend there is an ever changing sign that reads something like, 27 people have not kept appointments this week meaning 12 hours have been wasted. So how come I am normally kept waiting for a hour or two after my time, if all the other's had turned up would my wait be longer.

When I point out why area's are dirty and the staff say it has been like that for ages, who is doing the job wrong.

Generally I think some staff try harder than others, much the same as anywhere else.