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13/08/2010
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NHS

The Government believes that the NHS is an important expression of our national values. We are committed to an NHS that is free at the point of use and available to everyone based on need, not the ability to pay. We want to free NHS staff from political micromanagement, increase democratic participation in the NHS and make the NHS more accountable to the patients that it serves. That way we will drive up standards, support professional responsibility, deliver better value for money and create a healthier nation.

  • We will guarantee that health spending increases in real terms in each year of the Parliament, while recognising the impact this decision will have on other departments.
  • We will stop the top-down reorganisations of the NHS that have got in the way of patient care. We are committed to reducing duplication and the resources spent on administration, and diverting these resources back to front-line care.
  • We will significantly cut the number of health quangos.
  • We will cut the cost of NHS administration by a third and transfer resources to support doctors and nurses on the front line.
  • We will stop the centrally dictated closure of A&E and maternity wards, so that people have better access to local services.
  • We will strengthen the power of GPs as patients’ expert guides through the health system by enabling them to commission care on their behalf.
  • We will ensure that there is a stronger voice for patients locally through directly elected individuals on the boards of their local primary care trust (PCT). The remainder of the PCT’s board will be appointed by the relevant local authority or authorities, and the Chief Executive and principal officers will be appointed by the Secretary of State on the advice of the new independent NHS board. This will ensure the right balance between locally accountable individuals and technical expertise.
  • The local PCT will act as a champion for patients and commission those residual services that are best undertaken at a wider level, rather than directly by GPs. It will also take responsibility for improving public health for people in their area, working closely with the local authority and other local organisations.
  • If a local authority has concerns about a significant proposed closure of local services, for example an A&E department, it will have the right to challenge health organisations, and refer the case to the Independent Reconfiguration Panel. The Panel would then provide advice to the Secretary of State for Health.
  • We will give every patient the right to choose to register with the GP they want, without being restricted by where they live.
  • We will develop a 24/7 urgent care service in every area of England, including GP out-of-hours services, and ensure every patient can access a local GP. We will make care more accessible by introducing a single number for every kind of urgent care and by using technology to help people communicate with their doctors.
  • We will renegotiate the GP contract and incentivise ways of improving access to primary care in disadvantaged areas.
  • We will make the NHS work better by extending best practice on improving discharge from hospital, maximising the number of day care operations, reducing delays prior to operations, and where possible enabling community access to care and treatments.
  • We will help elderly people live at home for longer through solutions such as home adaptations and community support programmes.
  • We will prioritise dementia research within the health research and development budget.
  • We will seek to stop foreign healthcare professionals working in the NHS unless they have passed robust language and competence tests.
  • Doctors and nurses need to be able to use their professional judgement about what is right for patients and we will support this by giving front-line staff more control of their working environment.
  • We will strengthen the role of the Care Quality Commission so it becomes an effective quality inspectorate. We will develop Monitor into an economic regulator that will oversee aspects of access, competition and price-setting in the NHS.
  • We will establish an independent NHS board to allocate resources and provide commissioning guidelines.
  • We will enable patients to rate hospitals and doctors according to the quality of care they received, and we will require hospitals to be open about mistakes and always tell patients if something has gone wrong.
  • We will measure our success on the health results that really matter – such as improving cancer and stroke survival rates or reducing hospital infections.
  • We will publish detailed data about the performance of healthcare providers online, so everyone will know who is providing a good service and who is falling behind.
  • We will put patients in charge of making decisions about their care, including control of their health records.
  • We will create a Cancer Drugs Fund to enable patients to access the cancer drugs their doctors think will help them, paid for using money saved by the NHS through our pledge to stop the rise in Employer National Insurance contributions from April 2011.
  • We will reform NICE and move to a system of value-based pricing, so that all patients can access the drugs and treatments their doctors think they need.
  • We will introduce a new dentistry contract that will focus on achieving good dental health and increasing access to NHS dentistry, with an additional focus on the oral health of schoolchildren.
  • We will provide £10 million a year beyond 2011 from within the budget of the Department of Health to support children’s hospices in their vital work. And so that proper support for the most sick children and adults can continue in the setting of their choice, we will introduce a new per-patient funding system for all hospices and providers of palliative care.
  • We will encourage NHS organisations to work better with their local police forces to clamp down on anyone who is aggressive and abusive to staff.
  • We are committed to the continuous improvement of the quality of services to patients, and to achieving this through much greater involvement of independent and voluntary providers.
  • We will give every patient the power to choose any healthcare provider that meets NHS standards, within NHS prices. This includes independent, voluntary and community sector providers.

Your comments (490)

  1. Fred Smith says:

    Will you listen or take account of my views? Here goes:
    GPs although they are skilled health professionals (generally) , they have a real conflict of interest – they are private (independant) contractors who contract their services to the NHS – giving them budgets to manage patient care will really need to have checks and balances – how will we know that they spend the budgets wisely (it doesnt necessarily follow that because they are Drs they will automatically spend it wisely!) They all have agendas, prejudices and preferences – I know of GPs who prescribe expensive drugs, who refer at the drop of a hat, and who keep on referring because they are afraid to make a decision themselves. So please be careful about giving economic power to essentially an unelected group of professionals particularly in this financially challenging times. Checks and balances, accountability and penalties must be included.
    The SHAs – did they ever have a role? Can they be abolished quicker? Savings made quicker?
    PCTs – they did some good but the quality of management is variable; and they are managed by an unelected Board, so I suspect greater accountability will be good.
    Patients, people – us – give us more power – get the PCTs and other NHS organisations to be more open and transparent – there are still too many decisions made behind closed doors – yet the NHS is owned by us the public as taxpayers. Why do we have to hear about decisions from our local NHS forced out of them by local papers? Often as a result of freedom requests? Too many managers and health professionals think that they own the NHS not the other way around – too many seem to feel put out when you ask them why such and such a decision was made, or what are the plans for x, y or z. How Mr Lansley are you going to encourage a truly open and transparent NHS, where if a patient says that they have concerns about a hospital or a GP or a nurse or a manager – or a service – the NHS will listen, and respond immediately to those concerns, and provide the information in full and in public. That will be the real touchstone of success.
    Can GPs be more accessible – telephone and email appointments -and why do i have to be registered with the one in my area?
    I really hope you think through what health boards are and will do. I think the inclusion of elected members is great. But, you’ll always hear the echo of feet from whitehall, so somehow you have got to get the balance between centralised (ie government) management and local accountability right.

  2. Harriet Ball says:

    Regarding the Cancer Drugs Fund:
    Cancer is a very important issue for the NHS, and also a very emotive one. However, the funding of cancer drugs should be about centrally analysed evidence of effectiveness, no less than is the case for any other health condition. This policy seems to be designed to avoid media outrage such has occurred in the past when a cancer suffer doesn’t get a drug that his/her doctor would recommend. Whilst such cases are tragic, this is no reason not to strive towards the highest standards possible within the constraints of the NHS, which will be achieved by relying on robust evidence (this is true regardless of how deserving the patients are). Ultimately, centralised bodies (informed by many doctors and scientists) are in a better position to decide which drugs to fund than are individual doctors. Surely if bodies such as NICE already exist to assess which drugs to offer, then the Cancer Drugs Fund can only be a bad thing by i) being an extra government body requiring funding and ii) giving patients drugs that have not met the standards set by NICE, in terms of overall benefit of the treatment (and that could actually have worse outcomes and side effects than other available drugs).
    Alternatively, if something about NICE is not working, then fix that, rather than trying to opt-out cancer sufferers from evidence-based care.

  3. Dr David Walter says:

    The NHS shoud be empowered to charge people admitted because of drug or alcohol abuse – introduce it slowly – 5% at first, and gradually increasing to 100% over say two years.

  4. Dana Fisher says:

    Hello. My local Hospital, Chase Farm is partially closing against residents wishes, and the consultation process is flawed. What guarentees will there be to reverse chase farm’s decision? As I am now really worried – our nearest A&E is North Mid and from my house (assuming there is no traffic) it will take 12 minutes. You need to administer clot-busting stroke medication within 8 minutes for it to have effect, and ambulance personnel cannot administer this. I am really concerned and let down.

  5. emma davison says:

    scrap NHS direct …what a waste of money .Every time you call the response is inadequate and you end up ringing the local out of hours service for better information .Also when you visit out of hours there is usually 2-3 receptionists sat around one taking calls ,one inputting patients data and another booking the few patients that are there.Surely there is no need to have 3? Also it irritates me that my partner ,a life time asthmatic since a child has to pay for the medication that inevitably saves his life .

  6. C Griffiths says:

    Please bring back local maternity units. My husband and i moved out of London when i was pregnant, and one of the things that put us off South Hertfordshire was the fact that all maternity wards had been centralised to just one hospital; i.e. 3 units had been shut and replaced by one ’super’ unit. Instead, we moved to South Buckinghamshire, and were lucky to have a wonderful local maternity unit. To our horror, this has now been shut in favour of another ’super hospital’. For our second child, i will now have a 35 minute car journey to the hospital. How on earth was this allowed to happen??? 30 years ago, you were kept in your very local hospital for 10 days after giving birth to allow you to recover and get to know your new baby without other distractions. These days, you travel for miles only to be thrown out with scant pain relief only hours after giving birth. It’s appalling.

  7. Gwyndaf Parri says:

    Do it right or not at all. Good health care is expensive, yet most people have gone into the habit of expecting everything for free. With the system we have, all of us have to suffer terrible medical care for the sake of those who don’t want to pay for their medical care.

    When I recently went to see a specialist on the NHS, he saw me for all of 30 seconds. I received no advice about my condition – I find that you really have to ask (the right questions) to find out what you might need to know. I know I shouldn’t complain too much because I chose to see a specialist on the NHS, but I would much rather put my NI money towards a proper private insurance.

    My American wife is very shocked with the UK healthcare system. For someone who is used to paying and seeing proper healthcare by companies who are motivated by competition and the need to keep their customers happy, being suddenly dependent on the NHS makes her feel like she’s in a third world country.

    What I’m basically saying is, privatise the NHS!

  8. Marc says:

    I escaped the NHS in 2006 after the previous government decided to meddle with doctor’s training and threatened to separate me from my wife. Thankfully we moved to a country where our work is more appreciated. We now work as GPs in a system that involves user-pays charges that are reasonable and affordable for all and waivable for people who truly cannot afford to pay. The result is luxuriously long appointment times that allow me to listen properly to patients and build proper relationships over time. We also manage to keep a great number of patients out of hospital by providing extended services such as dealing with minor injuries/fractures, minor surgery, and providing intravenous drugs and in-hours close monitoring of patients. We also provide out-of-hours on-call services for our population and this is definitely a much valued service.

    The NHS can no longer survive by providing free at the point of care services and it would be entirely reasonable to introduce charges for primary care services.

  9. Kate says:

    Nurses are currently treated in the press in the main as though they are underpaid and the hero’s of the NHS – Is this really true? Would a patient satisfaction survey back this view up? I believe most people enter into the profession caring and dynamic people, my experience is most nurses operate with their hands tied behind their back. Memo’s I see are constantly telling them what they can’t do, some of which I see compromise patient care. This must be a nightmare working environment. Nurses should be empowered and motivated to do their best. When every individual is operating at their best is when you’ll see the best results. I suspect it’s the strong union keeping nurses in their boxes which is resulting in poor job satisfaction and poor patient care. Please tackle the unions.

    I would also like to see mental health prioritized. You should also look at patient confidentiality in mental health cases. For example when some-one suffers from depression with suicidal thoughts currently the NHS does not work with the family. In this particular case the family are the treatment, their very presence prevents the suicide. The NHS is in fact preventing treatment when it keeps things from the family. On the same point, hcp training needs to be improved. When a sufferer of depression says they are better and no longer want treatment, that is the very point they need more. It’s no good canceling their treatment because the asked, what they mean is stop coming to visit and give me time to kill myself. No problem to the NHS, dead people don’t cost anything, and they asked for the treatment to be stopped so it’s their own fault I suppose. However suicides have massive impact on families for generations which will have a cost impact to the NHS and must be prevented.

  10. Pete says:

    I work for the NHS and would like to see the massive waste of public money stopped we have so many office staff shuffling bits of paper most of which are not needed but are there so statisics can be forwarded to various Buracratic bodies to keep yet more manages happy ,
    There are Senior managers managing managers, supervisors that couldnt run a bath, and minimal front line staff who struggle to cope the work loads they are given,
    minimal cleaning staff under pressure because they work for a contract company who are trying to maximise profit at the expence of staffing numbers and cleanliness, unnessary administration costs because one department is being rented/leased to another Trust, and different departments renting floor space from different Trusts all of which have administration costs added to them and huge amounts of staff to administer them. This situation is totally mad as we are suppose to all work together for NHS or has someone forgotten that, its not a business in competion with each other its a public service payed for by the public for the public to use, This does not include overseas health migrants,
    That doesnt make me racist just realistic, it cant carry on the way it is going..
    We have employed outside energy consultant companies payed massive money to tells us that leaving a window open over night cost money, things like this are basic managers responsibilitys,
    one thing we must not let happen is to sub-contract car parking to companys like NCP any revenue should be come back the the hospital and the prices should be kept low
    as none of us go to hospital unless we really have to, this is not a pleasure sport or shopping trip for fun !!
    If you doubt the waste in our NHS one of our floors was refurbished at a cost of 20 million pounds and the beds and wards were never used or slept in then due to a change of plans by the managment, then 2 years later the whole lot was removed and dumped, then refurbished into offices !!! this is only one of many similar wasted projects i have witnessed. I have friends in the NHS in other parts of the country and it appears to be excactly the same elsewhere.
    nice work if your a builder.
    Lets not kid ourselves the NHS is a fantastic organisisation and has plenty of funding its just Grossly mismanged if it were a private company it would have been Bankcrupt along time ago.. as for the amount of money that has been wasted on private consultant companys, it does make one wonder why the NHS has any of its own recruited managers at all !!

  11. Adrian Brown says:

    What is meant by “health quangos” and “administration” ?
    The amount of paperwork (or database entry in the modern world) that clinical staff are expected to complete is often massively over-duplicated but a great deal of admin is to alleviate the demands on those staff.
    It is important to differentiate the managerial functions from the supervisory as senior nurses are finding their posts threatened with cuts as they have attained what is seen as a “management” level and yet they provide clinical supervision, a clinical voice in managerial decisions and more.
    Yet we currently have unnecessary tiers of senior systems managers and where there used to be one resource shared by health services, there are now often several smaller organisations with the accompanying additional bureaucrats.

    The idea to allow freedom of choice in GPs is a good move, especially in urban areas where people are often restricted by where they have to work. It would be useful to also include a review of the health (GP) versus social care (postcode) conflicts that occur in these areas.
    Furthermore, intelligent commissioning suggests multi-borough services for London (relatively easy travel) and yet I have a situation today where I travelled through six boroughs each with their own duplicated tertiary services (with less need for rapid access for all clients). This could facilitate your commitment to counselling – eg one double size service would require fewer systems people for the same number of therapists etc

    You mentioned elsewhere that hospitals will be “Made” to share anonymous information with police. This has been starting for some time, and should be given a standard structure to prevent yet another duplication across multiple boroughs, towns and regions. The same applies to many social care and health service systems such as referral processes and databases. While IT people and managers can get on with this, when clinicians are not involved the systems fail.

    The involvement of independent and voluntary services in care provision comes with a massive impact on the NHS which trains staff that benefit other agencies. Schemes should be explored that encourage those agencies to contribute financially to training of nurses, doctors and other professionals.
    A condition of training in the NHS should be that the qualified worker commits to working in the NHS for a reasonable time after (and this should apply to all agencies that assist people into training).

    Finally, and most importantly, people should NOT be allowed to ignore their own responsibility in health issues. If the government – with medical and other professional advice – identifies a cause of our health problems we should expect them to inform people often and clearly. This is not the “Nanny State” this is information we can (and do) choose to respond to or ignore. People should be able to expect their wider health issues to be cared for and asked about when they seek health interventions.

  12. Alex A says:

    Dear Coalition Government,

    PRIMARY CARE-
    Charge £5-£10 per consultation of a GP- will avoid no shows and time-wasters, exempt low income, offset prescription charges with these charges.

    Re-negotiate out of hours contract- currently a joke

    SECONDARY CARE- where to start!
    Scrap clauses of patient charter- every patient is entitled to see a doctor regardless of query if patients desire. Some A&E departments have ‘regulars’ that attend 200-300 times per year. Doctors / nurses and paramedics are powerless to prevent this blatant waste.

    Head of Nursing, Director of Nursing, Nurse managers, physiotherapy managers, occupational therapy managers, do the public realise the HUGE cost to the tax payer these titles represent, plus do little to no clinical work.

    Oh and one last thing, when was the last time you looked at the evidence base for “Bare below the elbows” and no watches/rings. Millions of pound have been spent promoting these from one paper from a polytechnic in London. By the way, vast swathes of scientific evidence exist that more cleaners reduce infection rates- unfortunately we cant afford them- all the money has gone on “Bare Below the elbows” posters!

    Best Wishes,

    An Insider.

  13. Richard Trevorrow says:

    What will the coalition do about the grossly unfair situation regarding who is and who is not exempt from prescription charges. Someone with diabeties does not have to pay but someone with Cystic Fibrosis does. This needs sorting out.

  14. sylvie wren says:

    I think GPs are hugely overpaid for the work they do. Essentially they act as gatekeepers to more specialised services, blocking or allowing access to consultants. I would much prefer a system like that on the continent, where you can book an appointment with a particular consultant yourself, often choosing which one you want from the phone book.
    One in three people who go to a GP do not get a diagnosis for what has ailed them enough to take them to the GPs in the first place. This makes the GP seem more like a hindrance to getting treatment than a help; a blocker to more detailed knowledge; at best an ameliorator of symptoms rather than finding the cause.

  15. julie Corbett says:

    commissioners like PCT need to go back to core business and not involve themselves in earning and learning, buy yachts or co-sponsor schools

    world class commissioning is a nonsense and needs stream lining to get back to a 7 day a week health service.

  16. Jonathan Creed says:

    I think we should take an example from the private sector, as a self-employed person, I know that there were considerable savings in purchasing in large quantities of stock. Instead of each hospital having to source their stock individually, put out to tender, the supply of the whole of the NHS/NHS Scotland. The sheer scale of savings would be considerable. (I used to be a stock controller in a large company.) Also ask the people on the front line for their input, they are the ones who have to deal with the products and the patients. A product may be bought because it is cheaper, yet the product may not last as long as the more expensive product, so the ’saving’ is really more expensive. As a sub-postmaster for the last eight years, I know how to save money!!

  17. belinda tilley says:

    I really hope that homoeopathy will remain as an healthcare option on the NHS. It is the first choice of many, many people because of how well it works, often when all other medical efforts have failed.

  18. donald law says:

    I agree with the BMA that NHSD should be reduced to an internet based resource. Having worked in the Out of Hours Service for GPs for the last 6 years, and seen and heard the exaggerated claims of what the telephone service could offer; which usually culminated in the nurses amployed passing over responsibility to the doctors, it has become obvious that NHSD only delays patients reaching health professionals who are prepared to make decisions. The alogrithims used are to restrictive and those using them too timid to think for themselves. With the increased sophistication of the internet, the information patients want can be easily accessed without the need to wait for up to 6 hours for a nurse not to make a decision.
    The cost of employing G grade nurses not to take a decision is ludicrous,

  19. Ian says:

    IVF under NHS
    When money is short, when population is already too large (for country size/resource consumption), when people with real serious illnesses are not getting proper treatment (e.g. cancer drugs “too expensive” until cases go to court), how can anybody justify providing IVF under the NHS.

    Were there loads of money, were our population not the size it already is then maybe, but under our current conditions “difficult decisions” need to be made to stop providing IVF under the NHS. Of course it is sad when people cannot have babies, but so is lots of stuff and why should others pay for a few who want something their biology has made “not possible”. There are many aspects to life and people affected either pay for IVF themselves, adopt or get on with other rewarding aspects to a full life.

    No justification for everybody paying when NHS is already stretched.

  20. Naz M says:

    My NHS Plan: Scrap NHS Direct, put more money into GP services, give GP’s the power to control budgets, Keep A&E open. Scrap polyclinics – waste of money and duplicate NHS services. Reduce the level of management in the NHS, administrators, scrap wasteful IT systems. Renegotiate prescription costs with drug companies.

  21. Naz M says:

    My NHS Plan: Scrap NHS Direct, put more money into GP services, give GP’s the power to control budgets, Keep A&E open. Scrap polyclinics – waste of money and duplicate NHS services. Reduce the level of management in the NHS, administrators, scrap wasteful IT systems. Renegotiate prescription costs with drug companies.

  22. Isabel says:

    Stop NHS abortions – if women want one, they should pay for it. You should also implement the law on abortions – which has strict guidelines, which are now never adhered to! Sex Change ops should be privately funded , not on the NHS, and IVF should be limited to two tries. UK residents shuld not be allowed to bring over their foreign relatives for free operations on the NHS, as happens now.
    Cut out much of the management , the many meetings, the ‘non jobs’ and the central data base, which will be open to abuse and hackers.
    But please DO NOTconsider charging for visits to the GP! In countries where this happens, people die of cancer and other serious diseases, because they ‘put off’ seeing their GP.

  23. Bobby Stodel says:

    I agree that we should reduce the number of quangos and hospital administration workers. We should not cut back, but rather should spend more on mental health care.

  24. Liz Kingdom says:

    Reluctantly I feel that the NHS as it is currently constructed can no longer be afforded. Over the past 60 years since it was established s much has changed – people’s expectations and huge strides in medical technologies mean that the service is now expected to offer medical interventions far greater and extensive than was probably envisaged at the time. There are also demands from a society that has massive problems with drunkeness and subsequent hospital treatment being demanded . Alongside this the huge increase in obesity-related diseases put another pressure on the service which I do not feel can be sustained.

    I think we have reached a stage where we need to consider compulsory health insurance for all – with some form of safety net for those who for whatever reason cannot afford it.

  25. Pam says:

    For the NHS to be cost effective strategic changes need to be made. Cut NHS direct ( the phone lines, not the website). It has never been shown to be effective. Cut Choose and Book – does it really work in practice??
    Maternity and A&E services need to be bigger to provide the safest , most effective care – we cant afford to staff all of the units that are currently open. We often have 2 medium sized units a few miles apart struggling to find enough staff and employing expensive locums and agency staff.
    Strengthen NICE and have a frank national debate about what we can and cannot afford. No IVF on the NHS for example.
    Get people who want home births to pay a top up fee for the increased cost of the additional mdwifery care they need
    Insist that managers have some sort of qualification in management – not simply ex clinical staff who move from one ineffective project to the next. The NHS needs fewer, but better managers.
    Renegotiate the juniors contract away from the unfair and expensive banding system – currently trainees can work very different hours but get paid the same because they are in the same band. It might give back some flexibility into their jobs.

    Merge PCTs to make them big enough to be effective. Get one national CRB sytem that everyone wouldnt need to reaply every time they change job within the NHS.

  26. LEE says:

    We urgently need new equipment, such as RADIOLOGY to be prioritised, current equipment is constantly failing and we are repeatedly told there are other more urgent requirements (like expensive artwork, fancy brand new buildings etc) – let’s get the basics right first.

  27. Ruth says:

    There is no point throwing any more money at the NHS along with targets. The current climate removes more and more money from patient care as hospitals and PCTs employ people to manage the reaction to the targets and the collection of data to report back to the Dept of Health and create other ‘project jobs’ employing more people to look at how to deal with the targets. These people in my experience are often experienced health professionals who would be better used in direct patient care which they were originally trained for, if more people were involved in direct patient care, you wouldn’t need more targets.

  28. Mrs.Josephine Hyde-Hartley says:

    If we want to free NHS staff from political micromanagement, increase democratic participation in the NHS and make the NHS more accountable to the patients that it serves can we kindly remind everyone concerned that all citizens, by virtue of our wonderfully generous ( largely unwritten) and therefore flexible UK constitution, may be pleased to continue to act within the (God given and/or scientific) capacity of private, dignified, autonomous individuals who, given decent public services, are supremely capable of being responsible and accountable to and for ourselves (and those we’re legally responsible for) first as we go about the business of health ie making personal decisions and keeping careful note of the decisions we may make privately and/or confidentially with those registered to do the same.

    P.S In my view there are too many apparently unregulated bits of paper pretending to be “consent” forms flying about the broader public/government and even voluntary sector services. We could do with some help from the government to get rid of all these please.

  29. Sarah Bernard says:

    My recent various dealings with the NHS suggest that many workers are ill informed, the admin procedures very sloppy and therefore inaccurate, and there is a general lack of empathy and care for the patient. NHS is great for emergencies but for chronic problems it is appalling and does not deliver unless driven by the patient or their carer. Needs total restructuring.

  30. Kevin says:

    We should push forwards with super fast broadband fibre to the home, to provide 100MB bandwith would allow all the office based workers to fully work from home reducing transport on the roads. this speed is required to provide video calls it would also match office networks so could run all tools used in offices. Offer FE and HE schools and NHS internet services to again reduce travel. this would uncongest our roads and reduce CO2 from both cars and office buildings whist providing more brown site land for conversion from offices to homes in numbers that would bring house prices down.

  31. Dr Angus Macleod says:

    I would urge the new government to opt-out of the European Working Time Directive. As a practising physician in the NHS I have seen first hand the adverse consequences of the reduction in working hours to a 48 hours week under the EWTD.

    Instead of improving doctors’ work-life balance as intended, it has led to many doctors working a higher proportion of time out-of-hours hours and antisocial shift patterns. In most cases the total amount of work has not lessened, but the time in which to do it has decreased, which has resulted in unpaid overtime work. I have huge concerns about the lack of time to train good quality doctors given the reduction in working hours.

    Not only has the EWTD caused problems for doctors, but patient care is adversely affected with the potential for problems to arise with extra handovers between different shifts and lack of continuity in patient care.

  32. Vincent says:

    Instead of cutting nurses within the NHS, why not cut office staff, employ more nurses (of whom are on less pay) and show them how to manage and share the office work between eachother effectively 2 jobs for the price of one, with the bonus of more nurses within hospitals to deal with patients!
    This will cut waiting times & costs!

    Establish a worthy communication between Parliment and the common man and find out what they think, as we can’t all afford BUPA like you MPs!

  33. Jane says:

    I believe in the NHS and the free use of it by UK citizens. However, as a family we have private health insurance. This is partly paid for out of taxed income and also taxed as a benefit in kind to my husband. Why not abolish taxation on private health cover, by using this cover over the past year we have saved the NHS over £10,000. I do not want the safety net of the NHS abolished but why peanalise those who save it money!

  34. TimF says:

    I believe the government should act to save costs in a gloriously mismanaged health service. Local powers and financing should be restored to clinical providers and not bureaucrats. The inability of the NHS to act in a timely fashion still exists.

    Local ambulance and fire services should be combined to save the costs of duplicated admin, training, facilities, properties and should operate as a single service.

  35. Chris T says:

    I have seen a huge expanse of staff in the NHS, but when one realises that whole new areas have musheroomed over the years, its not surprising. IT (wasn’t there in the past), full incident reviews (didn’t happen in the past), equality and diversity managers(wasn’t there in the past), PALS (wasn’t there in the past), information governance Wasn’t there in the past), data protection……….. The list goes on. The only way that you could could “back office staff” would be to to remove alot of legislatative policy that forces the NHS to have these roles. Its harder said than done, in fact I think its probably easier to remove clinical roles than the “back office staff”. An example would be the introduction of payment by results into mental health….how many “back office” would this require to run (alot), scrap it and get back to good quality care and treatment.

    As for too many managers…thats a nonsence, that has become a throw away statment to solve all the ills of the NHS.

  36. Fred says:

    “This country needs to decided what care it wants to be free at the point of access and accept that we cannot afford every kind of care. ”

    What wise words. Thank you Patricia Hann – and for all that you’ve done and continue to do.

    We cannot ring fence the NHS and – worse – say it continues to have its spend increased in real terms when it is such a big component of Government spend and we have such a large deficit. This is unfair to those other areas which have to bear disproportionate constraints on spending.

    As health treatments get more expensive we can’t keep pretending that we can take more out of the system and pay less in (i.e. taxes go down).

    Why not make an annual health MOT compulsory and tell people who not taking responsiblity for their lifestyle and so increasing their risk that they are going to have to pay for treatment later. So the safety net catches the unfortunate not those who have chosen to contribute to their own ill health.

    People who are picked up drunk or who have accidents whilst drunk have to pay for their treatment. If they can afford the alcohol in the first place they can afford to pay for the cost of clearing up the mess they create.

    Little things make a difference. Get people to pay for hospital meals. They would have to pay to feed themselves at home. Then they would have a basis to complain if they didn’t get reasonable food. Maybe it would force standards up?

  37. Stacey says:

    These are not the usual topics given when asked how to improve the NHS but still should be looked at:

    1] Enable the patient to be the SOLE keeper of their medical records IF THEY CHOOSE, even if they have to agree to a waiver against bringinig medical claims if they lose the documents. Medical records rightfully belong to the individual, they should not be classed as the property of a Secretary of State!

    2] It has come to my attention that each hospital department in each hospital produce their own websites and documentation to give to patients for a given procedure (e.g. breast biopsy). This not only involves a lot of duplication of work, it can mean that patients are given different information depending on the hopsital they attend. So at one clinic they might get good advice and at another it may be quite poor (I speak from experience). Surely it would make more sense to produce these documents centrally, whilst leaving room for individual hospital branding and phone numbers. This approach would save a lot of money, would enable the very best advice to be made available and would mean that if errors in that advice were found, they could be rectified at one central point. It would also free up doctors to treat patients. Just a thought.

    3] Teach the support staff about patient confidentiality. This includes when they speak to patients at reception desks or anywhere other people can hear. I’ve lost count of the number of times they’ve breached my confidentiality verbally.

  38. Catherine Beer says:

    Said this on ‘public health’ but better-said here… invest and expand community and cottage hospitals. These are invaluable for delivering frontline services rather than the centralised mega-hospitals. Ringfence pioneering medical research and the provision of new drugs for cancer and other major diseases at all costs.

  39. Walter Morauf says:

    Why do the NHS-consultants distrust the diagnosis of the GPs??

    If they would trust then they would make a double appoint ment, when a patient is referred to them.
    From the referal they should be able to anticipate a certain amount of time for more detailed investigation and allocate it just one or two days after the first visit.

    This would have two very big advantages, A ) they themselves would need to read the patients history only once to make an informaed diagnosis. B ) The patient will know straight away, when the scan, ultra-sound, ECG,… willtake place and so reduce his/her anxiety about the process. It will also enable him/her to arrange early for company or transport as needed.

  40. Laura says:

    Please, please, improve services for mental health.

    Research has shown that most mental illness is best treated through a combination of medication and therapy. So why are the NHS’s therapy services so poor?

    Please introduce a regulatory body for therapists, and only allow therapists who have been approved by that body to work for the NHS (it’s important to be aware that there are many different kind of therapy and therapist, but we need to make sure that they follow some sort of code of practice, and are accountable should they mistreat their patients).

    In many cases, therapy offered by the NHS is practically useless. For people with severe mental illness and/or complex personal issues, therapy sessions limited to just a few weeks is of very little use. If the NHS can’t afford to provide the kind of therapeutic support that people need, then what needs to be done is find other ways to get this support to people. One thing you could do is limit NHS-offered therapy to those people whose problems a psychiatrist believes could be alleviated by a few weeks or a couple of months of therapy – make sure that what you can do is delivered to the people who will benefit from it most.

    Other places where people can receive therapy and counselling are in their place of work or study. Offer incentives to universities and employers to make therapy/counselling available to their students and employees (many institutions do this, but nowhere near all of them). Another place where therapists could be placed is somewhere like the Job Centre. The unemployed are vulnerable to stress and mental illness, and of course the Job Centre could get help to people who don’t work due to illness (especially mental illness). If you spread the funding for therapists across the funding for health, education and employment, then it’s less of a burden and also helps to get the facilities out into the community where people can access them more easily.

    Another thing to do would be to help mental health charities such as MIND provide what support they can. MIND already provides free counselling in many parts of the country; it has the system and the knowledge set up, it just needs to be helped to expand.

    Finally, provide funding for those students studying accredited courses in counselling and therapy, just as you provide funding for people studying nursing and medicine. Get more people into the profession.

    There are untold thousands of people in this country whose lives are affected by mental illness. People who are unable to work, and have to claim benefits. People whose poor attendance and/or erratic behaviour causes them to lose job after job. People whose illness means they have to aim lower, and will never reach their potential. People being rushed to hospital as we speak, having done serious damage to themselves. And people who couldn’t be saved. Every year, thousands of people succeed in taking their own lives, and many thousands more attempt suicide.

    Please take some positive action to improve the lives of the mentally ill.