Comprehensive hospital check ups for the elderly.

Multiple check ups could be carried out in one comprehensive visit. So many elderly people have several ailments such as heart, diabetes, hearing, eye problems, mobility, bladder and bowel, to name just a few. These entail several 6 monthly check ups. All at different times and possibly at different hospitals.

Surely, these could be carried out by a team of Doctors over one day, something similar to the  Schools Parents evenings, or a cars MOT.     

Why is this idea important?

Multiple check ups could be carried out in one comprehensive visit. So many elderly people have several ailments such as heart, diabetes, hearing, eye problems, mobility, bladder and bowel, to name just a few. These entail several 6 monthly check ups. All at different times and possibly at different hospitals.

Surely, these could be carried out by a team of Doctors over one day, something similar to the  Schools Parents evenings, or a cars MOT.     

European Working Time Directive (EWTD)

The introduction of the EWTD for UK doctors has been a costly disaster for patient safety and trainee education.

  1. The regulations were designed for Spanish lorry-drivers and are very inflexible.
  2. Although very long hours (>80/week) are associated with patient harms there is no evidence that reducing hours below, say, 56 hours per week are associated with improved outcomes.
  3. Cross-cover arrangements introduced on the back of EWTD mean that the doctor has very little knowledge of the patients he is looking after, a recipe for error.
  4. There is insufficient time for adequate patient handover, particularly during busy winter months.
  5. The direct exposure of trainee doctors to learning opportunities is greatly reduced as the same learning opportunities are divided between more doctors.
  6. Knowledge of trainees by supervising senior doctors is greatly reduced because of shiftwork patterns and the loss of the clinical team.
  7. Shiftwork patterns are known to be associated with increased rates of depression. Anyone with experience of jet-lag knows that it takes several days to recover afterwards.
  8. This lack of experience, expertise and knowledge of the patient by junior doctors means that more senior grades are becoming over-committed for routine activity.
  9. Most shifts have gaps, which are covered by locums of variable quality (c.f. Dr Ubani).
  10. The drop in income of junior doctors means that many are 'moonlighting' in neighbouring trusts as locums. This means that their hours are much the same as before, but they have to travel to and work in a strange unit. Both increase patient risk.
  11. The cost of locums has shot up. An average middle grade locum pre-EWTD cost around £40 per hour. Now it is £70 with a sign on fee of up to £20,000 for any medium-term locum. This is costing the health service a fortune.
  12. The change in designation of on call to mean that anyone resident (even if asleep) is paid as if working is very costly and not good value-for-money.
  13. The number of doctors in the NHS has trebled since 1979. On retirement from the NHS doctors in those days survived an average 18 months, so pensions could be generous. Now, with reduced hours and increased longevity, I would predict survivals of an average of 15 years. The pension bill will therefore increase by 30 fold (compound).

Why is this idea important?

The introduction of the EWTD for UK doctors has been a costly disaster for patient safety and trainee education.

  1. The regulations were designed for Spanish lorry-drivers and are very inflexible.
  2. Although very long hours (>80/week) are associated with patient harms there is no evidence that reducing hours below, say, 56 hours per week are associated with improved outcomes.
  3. Cross-cover arrangements introduced on the back of EWTD mean that the doctor has very little knowledge of the patients he is looking after, a recipe for error.
  4. There is insufficient time for adequate patient handover, particularly during busy winter months.
  5. The direct exposure of trainee doctors to learning opportunities is greatly reduced as the same learning opportunities are divided between more doctors.
  6. Knowledge of trainees by supervising senior doctors is greatly reduced because of shiftwork patterns and the loss of the clinical team.
  7. Shiftwork patterns are known to be associated with increased rates of depression. Anyone with experience of jet-lag knows that it takes several days to recover afterwards.
  8. This lack of experience, expertise and knowledge of the patient by junior doctors means that more senior grades are becoming over-committed for routine activity.
  9. Most shifts have gaps, which are covered by locums of variable quality (c.f. Dr Ubani).
  10. The drop in income of junior doctors means that many are 'moonlighting' in neighbouring trusts as locums. This means that their hours are much the same as before, but they have to travel to and work in a strange unit. Both increase patient risk.
  11. The cost of locums has shot up. An average middle grade locum pre-EWTD cost around £40 per hour. Now it is £70 with a sign on fee of up to £20,000 for any medium-term locum. This is costing the health service a fortune.
  12. The change in designation of on call to mean that anyone resident (even if asleep) is paid as if working is very costly and not good value-for-money.
  13. The number of doctors in the NHS has trebled since 1979. On retirement from the NHS doctors in those days survived an average 18 months, so pensions could be generous. Now, with reduced hours and increased longevity, I would predict survivals of an average of 15 years. The pension bill will therefore increase by 30 fold (compound).

Drunk or Drugged in A&E

Vast amounts of NHS resources are spent on treating people who have injured themselves or others through alcohol or drug use especially in A&E.  Others who have been injured or are sick through no fault of their own have their waiting times increased. There is often the unplesantness and danger for staff and members of the public in the presence of intoxicated persons. Financial contribution towards treatment ahould be levied on those whose injuries or illness have obviously been caused by intoxication.

Why is this idea important?

Vast amounts of NHS resources are spent on treating people who have injured themselves or others through alcohol or drug use especially in A&E.  Others who have been injured or are sick through no fault of their own have their waiting times increased. There is often the unplesantness and danger for staff and members of the public in the presence of intoxicated persons. Financial contribution towards treatment ahould be levied on those whose injuries or illness have obviously been caused by intoxication.

NHS – taken out of politics

Place its long term strategy in the hands of a trust, like the BBC.  Medical experts at the helm supported by key skills in running the other areas such as financial planning etc.  This body should report to Parliament – via a balanced select committee,not the government.

Long term policy objectives and funding available clearly has to be agreed – but then this is no longer a political football and the emotive arguements on which hue of governement we choose.   All genuine politicians care for the welfare of their fellow citizens, no matter which party they are in.

Why is this idea important?

Place its long term strategy in the hands of a trust, like the BBC.  Medical experts at the helm supported by key skills in running the other areas such as financial planning etc.  This body should report to Parliament – via a balanced select committee,not the government.

Long term policy objectives and funding available clearly has to be agreed – but then this is no longer a political football and the emotive arguements on which hue of governement we choose.   All genuine politicians care for the welfare of their fellow citizens, no matter which party they are in.

Why the purchaser provider split has destroyed the NHS

It is time that government had the courage to accept that the internal market in the NHS has been an inefficient, expensive and, above all, inhumane failure. This is a sacred cow that has made a lot of people very rich, but cost the public a ridiculous amount. I have been a GP for more than 20 years in very deprived areas. There is an assumption in management circles that computer generated data is more infallible than the pope, but each time my practice has been presented with data on prescribing or referral activity and asked to explain our shortcomings, we have found that the data is flawed. The idea of continuing with this sort of flawed data tools is a nonsense.

It is essential that we move to system where provision of health care does not depend on who can provide most activity numbers at the lowest cost. Instead, we need to have a clear and transparent health needs assesment in each region and then employ directly the professionals needed to meet  If we do not do that, we are letting down the people of our nation. Now, after 20 years of the internal market, elderly people are rightly terrified of being admitted to hospital and therre is no confidence at all in out of hours or emergency services.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Why is this idea important?

It is time that government had the courage to accept that the internal market in the NHS has been an inefficient, expensive and, above all, inhumane failure. This is a sacred cow that has made a lot of people very rich, but cost the public a ridiculous amount. I have been a GP for more than 20 years in very deprived areas. There is an assumption in management circles that computer generated data is more infallible than the pope, but each time my practice has been presented with data on prescribing or referral activity and asked to explain our shortcomings, we have found that the data is flawed. The idea of continuing with this sort of flawed data tools is a nonsense.

It is essential that we move to system where provision of health care does not depend on who can provide most activity numbers at the lowest cost. Instead, we need to have a clear and transparent health needs assesment in each region and then employ directly the professionals needed to meet  If we do not do that, we are letting down the people of our nation. Now, after 20 years of the internal market, elderly people are rightly terrified of being admitted to hospital and therre is no confidence at all in out of hours or emergency services.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Stop the N.H.S being held to ransom.

There is a great deal of money wasted on drugs produced in the U.S.A and sold to the NHS at a price that in no way reflects the costs it accrues in its research and development but more in a price that the market will bare. i suggest that the U.K funds its own non-profit making drug development agency synthesizing many of the drugs that our most acute patents depend on therefore rendering N.I.C.E redundant.

Why is this idea important?

There is a great deal of money wasted on drugs produced in the U.S.A and sold to the NHS at a price that in no way reflects the costs it accrues in its research and development but more in a price that the market will bare. i suggest that the U.K funds its own non-profit making drug development agency synthesizing many of the drugs that our most acute patents depend on therefore rendering N.I.C.E redundant.

Charge anyone needing hospital treatment caused by excessive drinking.

It is against the civil liberty of a taxpayer to fund treatment for people who have a choice either to drink to excess or not.

If they choose to get themselves into a life threatening state of inebriation, they should rightly receive treatment, that's just.  But it's unjust that the rest of us should pay for it.,

The person needs to be given a proper bill for treatment.  Given an invoice for £2000 on leaving, they may think twice before going quite that far a second time.

Why is this idea important?

It is against the civil liberty of a taxpayer to fund treatment for people who have a choice either to drink to excess or not.

If they choose to get themselves into a life threatening state of inebriation, they should rightly receive treatment, that's just.  But it's unjust that the rest of us should pay for it.,

The person needs to be given a proper bill for treatment.  Given an invoice for £2000 on leaving, they may think twice before going quite that far a second time.

The Government amend application processes for completing & registering Lasting Power of Attorney (both Property and Financial Affairs & Health and Welfare) AND that registering these should be free

To radically overhaul and simplify the application process for completion of both types of Power of Attorney. Members of the public should be involved in each stage of the redesign so that forms are easy to understand, even where complex pieces of information are being given. To also look at additional ways that these can be completed, examples include allowing online completion of the documents with ‘pop up’ clear help boxes at each section. On-line operator support in completion to explain certain terms. The ability to save forms online and return to them several times. Where these forms repeatedly require the same information, once entered, the information should populate/complete all the relevant sections throughout the entire form.

The registering of the documents should also be free, not least because of the financial savings common use of these Power of Attorneys would bring to the NHS and Social Services in managing and supporting the care needs of people who become incapacitated.

Why is this idea important?

To radically overhaul and simplify the application process for completion of both types of Power of Attorney. Members of the public should be involved in each stage of the redesign so that forms are easy to understand, even where complex pieces of information are being given. To also look at additional ways that these can be completed, examples include allowing online completion of the documents with ‘pop up’ clear help boxes at each section. On-line operator support in completion to explain certain terms. The ability to save forms online and return to them several times. Where these forms repeatedly require the same information, once entered, the information should populate/complete all the relevant sections throughout the entire form.

The registering of the documents should also be free, not least because of the financial savings common use of these Power of Attorneys would bring to the NHS and Social Services in managing and supporting the care needs of people who become incapacitated.

Scrap NHS Dental appointment red tape

I am totally confused as I have had to wait 5 months to get an appointment at my local dentist. You now have to phone a NHS department (?) to get an appointment. This has taken 5 months (with a chipped tooth)! It is clear that this unnecessary department do things that we all could do ourselves, e.g. pick up the phone or walk to the dentist to make an appointment (simple – how it always was). So now it seems that well paid NHS administrative operatives need to do this for us (bizarre)! When I asked the NHS operative why he needed to do this for me – he explained that it was because the dentists' don't want to be involved in appointment booking! If a NHS department has to be involved then they should do that behind the scenes (general NHS administrative duties). We are all capable of contacting a dentist – what else needs to be done? The appointment booking process seems to be pointless. I say scrap the department and put those operatives into the laundry or kitchen department – where they will serve more of a purpose.

Why is this idea important?

I am totally confused as I have had to wait 5 months to get an appointment at my local dentist. You now have to phone a NHS department (?) to get an appointment. This has taken 5 months (with a chipped tooth)! It is clear that this unnecessary department do things that we all could do ourselves, e.g. pick up the phone or walk to the dentist to make an appointment (simple – how it always was). So now it seems that well paid NHS administrative operatives need to do this for us (bizarre)! When I asked the NHS operative why he needed to do this for me – he explained that it was because the dentists' don't want to be involved in appointment booking! If a NHS department has to be involved then they should do that behind the scenes (general NHS administrative duties). We are all capable of contacting a dentist – what else needs to be done? The appointment booking process seems to be pointless. I say scrap the department and put those operatives into the laundry or kitchen department – where they will serve more of a purpose.

Abolish NHS Direct & Scrap The National NHS IT Programme.

As someone who works in the NHS I strongly believe that NHS Direct should be abolished. I'm convinced it's just another level of bureaucracy that costs the country billions of pounds a year.

Also, the NHS National IT Programme should be stopped in it's tracks. A system extremely unuser friendly. Already years behind schedule, billions of pounds over budget. A complete & utter waste of time & resources. A crackpot idea from the beginning. Any hospital, such as my own, which is already lumbered with this load of junk, should be able to get rid of it & return to the perfectly adequate systems that were already in place.

Why is this idea important?

As someone who works in the NHS I strongly believe that NHS Direct should be abolished. I'm convinced it's just another level of bureaucracy that costs the country billions of pounds a year.

Also, the NHS National IT Programme should be stopped in it's tracks. A system extremely unuser friendly. Already years behind schedule, billions of pounds over budget. A complete & utter waste of time & resources. A crackpot idea from the beginning. Any hospital, such as my own, which is already lumbered with this load of junk, should be able to get rid of it & return to the perfectly adequate systems that were already in place.

Tackle over population

We should tackle the high breeding rate of the human population and not reward people for every child they have.

People should be limited to having no more than 2 children, and it should be recognised having children is a responsibility not a right.

We should not enable people to have further children on the NHS.

Why is this idea important?

We should tackle the high breeding rate of the human population and not reward people for every child they have.

People should be limited to having no more than 2 children, and it should be recognised having children is a responsibility not a right.

We should not enable people to have further children on the NHS.

Stop NHS ‘Tourists

Thousands of 'tourists' visit the UK each year merely to exploit our free healthcare.

When I go overseas I take out health insurance and expect to pay for any treatment I may require.

Charge non-UK residents for their medical requirements and perhaps the NHS won't have to make such drastic cuts – and perhaps it will then become easier for UK taxpayers to get the teatment they require – and pay for.

Why is this idea important?

Thousands of 'tourists' visit the UK each year merely to exploit our free healthcare.

When I go overseas I take out health insurance and expect to pay for any treatment I may require.

Charge non-UK residents for their medical requirements and perhaps the NHS won't have to make such drastic cuts – and perhaps it will then become easier for UK taxpayers to get the teatment they require – and pay for.

Abolish NHS Pharmaceutical Services Regulations 2005 preventing GP’s from dispensing NHS drugs to patients living within 1.6 km of the Surgery

Abolish the amended NHS Pharmaceutical Services Regulations 2005 that prevent GP’s from dispensing NHS drugs to patients living within 1.6 km of the Surgery dispensary if a new Chemist opens in the same village.

Why is this idea important?

Abolish the amended NHS Pharmaceutical Services Regulations 2005 that prevent GP’s from dispensing NHS drugs to patients living within 1.6 km of the Surgery dispensary if a new Chemist opens in the same village.

Cap NHS salaries from £30k not £21k

21k is not a large salary to survive on, especially for single people, so why start capping small salaries within the NHS? 30k on the other hand is a good amount to survive on even if you are single, so why are those on small/average salaries being penalised?

Why is this idea important?

21k is not a large salary to survive on, especially for single people, so why start capping small salaries within the NHS? 30k on the other hand is a good amount to survive on even if you are single, so why are those on small/average salaries being penalised?

SCRAP CPA and ‘Non CPA’ DOCUMENTATION

Nhs workers have to fill in reams of paperwork for every patient and every contact. The paperwork ranges from moderately useful to useless/inappopriate to ridiculous. Practitioners can't select useful stuff and bin the rest. Every patient has to have everything.

The same documentation has to be used by extremely diverse professionals treating diverse groups. For example, the paperwork has lots of stuff on risk – appropriate for some seriously mentally ill people, but has to be used if treating a mildly anxious 6 year old. The forms aim to be exhanustively inclusive: hence the 'religion' box offers the options of 66 possible religions including Divination., 4th Way, Satanism, Voodoo, Free Daism – but not Buddhist or Catholic…. And 180 languages – not including Cantonese! Important relationships include 'polygamous partner' – but not Godparent. My point is not to make the form even more exhaustively inclusive, but to illustrate the idiocy nof trying to capture every possible answer in a tick box.

These tick boxes are trivial but they point to the ideology:

1) Professionals cannot be trusted to do assessments and make their own minds up about what to ask, and how to guide the assessment. Everything is reduced to a box.  

2) For Gawd's sake don't offend anyone by missing anything out!!

Why is this idea important?

Nhs workers have to fill in reams of paperwork for every patient and every contact. The paperwork ranges from moderately useful to useless/inappopriate to ridiculous. Practitioners can't select useful stuff and bin the rest. Every patient has to have everything.

The same documentation has to be used by extremely diverse professionals treating diverse groups. For example, the paperwork has lots of stuff on risk – appropriate for some seriously mentally ill people, but has to be used if treating a mildly anxious 6 year old. The forms aim to be exhanustively inclusive: hence the 'religion' box offers the options of 66 possible religions including Divination., 4th Way, Satanism, Voodoo, Free Daism – but not Buddhist or Catholic…. And 180 languages – not including Cantonese! Important relationships include 'polygamous partner' – but not Godparent. My point is not to make the form even more exhaustively inclusive, but to illustrate the idiocy nof trying to capture every possible answer in a tick box.

These tick boxes are trivial but they point to the ideology:

1) Professionals cannot be trusted to do assessments and make their own minds up about what to ask, and how to guide the assessment. Everything is reduced to a box.  

2) For Gawd's sake don't offend anyone by missing anything out!!

The Price of Medication

The governments of England, Scotland and Wales and Northern Ireland should have parity in what they charge for drugs, and whether they supply them or not on the NHS.

Why is this idea important?

The governments of England, Scotland and Wales and Northern Ireland should have parity in what they charge for drugs, and whether they supply them or not on the NHS.

Review the ORCON target for ambulance services

The ORCON target for ambulance services, which requires an ambulance to arrive within 8 minutes of the time of the call, is expensive, and, taking into account the effects of the costs of meeting it on other aspects of the ambulance service, it is unclear as to whether meeting the tight 8 minute has any clinical benefits for the service overall, compared with the original 19 minute target set in 1974.

A full evidence-based review of ORCON should be commissioned, and unless objective evidence can be produced that meeting the current ORCON target has net clinical benefits, taking into account the effects of meeting it on other aspects of the ambulance service, it should be scrapped, or replaced by a more realistic time target that is selected for optimal benefits to the overal population of patients.

Why is this idea important?

The ORCON target for ambulance services, which requires an ambulance to arrive within 8 minutes of the time of the call, is expensive, and, taking into account the effects of the costs of meeting it on other aspects of the ambulance service, it is unclear as to whether meeting the tight 8 minute has any clinical benefits for the service overall, compared with the original 19 minute target set in 1974.

A full evidence-based review of ORCON should be commissioned, and unless objective evidence can be produced that meeting the current ORCON target has net clinical benefits, taking into account the effects of meeting it on other aspects of the ambulance service, it should be scrapped, or replaced by a more realistic time target that is selected for optimal benefits to the overal population of patients.

Smoking ban law: amendment

Amend the current Health Bill to:

1) permit smoking in "public indoor spaces well ventilated and extracted, clearly divided and defined", also in the case of pubs or other locations where food or drink is served, a businesses compliance to ventilation is to be monitored/enforced by Environmental health officials.

2) require homeowner/resident to inform companies scheduled to perform lawful work within the property (maintaince for example) that the property is smoked in.

Why is this idea important?

Amend the current Health Bill to:

1) permit smoking in "public indoor spaces well ventilated and extracted, clearly divided and defined", also in the case of pubs or other locations where food or drink is served, a businesses compliance to ventilation is to be monitored/enforced by Environmental health officials.

2) require homeowner/resident to inform companies scheduled to perform lawful work within the property (maintaince for example) that the property is smoked in.

Minimise NHS bureaucracy

NHS cards with complete medical history,  swiped in and out for all activities. Works in tandem with database/or reduces the need for it.

Also does away with endless succession of people involved in appointments and assesses health options and possible future conditions.

Why is this idea important?

NHS cards with complete medical history,  swiped in and out for all activities. Works in tandem with database/or reduces the need for it.

Also does away with endless succession of people involved in appointments and assesses health options and possible future conditions.

Replace GP’s by Highly Trained Nurses

Replace GP's by highly trained nurses. Using current GP salaries, the nation could benefit from at least twice the number of highly trained nurses who can perform the job of a GP. This will ensure a much improved service at local health centres. The nurses could also be on call.

Why is this idea important?

Replace GP's by highly trained nurses. Using current GP salaries, the nation could benefit from at least twice the number of highly trained nurses who can perform the job of a GP. This will ensure a much improved service at local health centres. The nurses could also be on call.

Free the NHS from ‘Performance Indicators’ and the tick-box, target driven culture

The NHS has become obsessed with targets and perfomance indicators. And no wonder, because failure to meet targets, or poor results when the perfomace indicators are audited leads to extra hassle for managers who get massive grief about it from above, and ultimately results in  cuts to budgets. Yet these targets or performance indicators are often extreely poorly related to quality of clinical practice.Often they INTERFERE with quality of clinical practice. Some real-life examples from personal experience: our service has been criticised for failing to ask the marital status of our patients – which is a performance indicator for our trust. We work with 5-15 year olds! an A&E doctor moved an aggressive adolescent patient on a section who was AWOL from another hospital onto a general paediatric ward, even though we all agreed she and the other patients were safer is she stayed on A&E till staff from her inpatient psychiatric unit could fetch her. She3 was moved despite the risks because if she had stayed on A&E she would have breached a waiting time target. Attendance at Mandatory training is another performance indicator even though most mandatory training is a pointless waste of time as the training is only margininally related to your role – or is totally unrelated. It costs a fortune to monitor these targets. The targets are merely proxy indicators for good quality care and they are poorly related to quality of care. You can deiver great care and meet zero targets, or dreadful care and meet all your targets. Stafford hospital got great results on their performance indicators while patients were dying in their droves. Scrap them!

Why is this idea important?

The NHS has become obsessed with targets and perfomance indicators. And no wonder, because failure to meet targets, or poor results when the perfomace indicators are audited leads to extra hassle for managers who get massive grief about it from above, and ultimately results in  cuts to budgets. Yet these targets or performance indicators are often extreely poorly related to quality of clinical practice.Often they INTERFERE with quality of clinical practice. Some real-life examples from personal experience: our service has been criticised for failing to ask the marital status of our patients – which is a performance indicator for our trust. We work with 5-15 year olds! an A&E doctor moved an aggressive adolescent patient on a section who was AWOL from another hospital onto a general paediatric ward, even though we all agreed she and the other patients were safer is she stayed on A&E till staff from her inpatient psychiatric unit could fetch her. She3 was moved despite the risks because if she had stayed on A&E she would have breached a waiting time target. Attendance at Mandatory training is another performance indicator even though most mandatory training is a pointless waste of time as the training is only margininally related to your role – or is totally unrelated. It costs a fortune to monitor these targets. The targets are merely proxy indicators for good quality care and they are poorly related to quality of care. You can deiver great care and meet zero targets, or dreadful care and meet all your targets. Stafford hospital got great results on their performance indicators while patients were dying in their droves. Scrap them!