How to fix the NHS: Your ideas

Last week Lord Nigel Crisp, the former chief executive of the NHS, gave The Big Issue his prescription for the UK’s ailing health service (magazine article pictured below).

He set out his radical plan for a prevention-based model – one that moves away from dependence on hospitals, to a community-based approach focused on creating better health for all of us.

It’s an exciting and revolutionary idea that’s generating debate and making us think about how we treat our cherished health service.

We asked you to respond with your experiences and bright ideas on how to rebuild the NHS. Here’s how you want to make sure it’s fighting fit for the next generation…

June Emerson, musician, 79
We of the pre-war generation have a completely different perspective on health from that of today. We oldies remember when personal health was a private matter, and a visit to the doctor a rarity. I remember only one childhood visit, when I was about six. When I was 13 there was the necessity of vaccination against smallpox. When in my 20s I had some treatment for hay fever allergies.

I remember having a ‘well-woman’ check-up sometime in the 1990s, and another about three years ago. I know I’m lucky but at no point did I feel that the government or the NHS had to inform me how to live. Now in my 80th year – and no medication needed – I feel light, free and extremely privileged. Brought up to be independent as far as health is concerned, I’ve cost the NHS very little, like many others of my generation. But unfortunately we’re on the way out.

At no point did I feel that the government or the NHS had to inform me how to live

Anya de Iongh, blogger, 28
I think that we could all benefit if self-management is better supported for people with long-term health conditions. Self-management support is about helping people and their carers to develop the knowledge, confidence and skills to manage the impact that their health has on their day-to-day lives.

The NHS needs to link up better across services that can support this, so people are able to get support and access services that are already out there and doing great work, without relying on luck to find out about it. It requires much more efficient admin systems. It’s the least sexy part of the NHS, and without a Royal College of Admin People there isn’t anyone to champion it. But poor admin can let down even the best clinical care, and creates enormous frustrations.

Douglas Hall, retired, 70
I would suggest a strategic change should be considered – a change in the law to enable assisted suicide for the few individuals who would want to end their suffering and challenge society’s drift toward endless continuation of life.

Such a change would include a robust regulatory process to ensure the relevance, authenticity and independence of the person’s choice. Such regulation could be produced through dialogue with the relevant authorities and by examining those rules already in place where assisted suicide is legal. Let’s get real, and acknowledge a true prescription for prevention of suffering for those who might want to confront the emotion of a death to end their misery.

Alan Taman, campaigner with Keep Our NHS Public, 60
The NHS isn’t being paid enough: it’s being starved of funds. NHS staff are feeling the brunt of that. The NHS is in deficit by close to £4bn. What has it got under this government? Insistence that more cuts, disguised as ‘efficiency savings’, are made, and denial there is even a problem. The NHS is being starved of cash while being asked to cut more. Lives are going to be avoidably lost because of that: know that is real.

The third step is to see what is really happening as private companies out-bid NHS services for work the NHS does best – because they are better at bidding. Then as soon as they get the contract, it’s cut, cut, cut: staff, quality, services. Private is NOT better: not when it comes to health and social care.

Dr Andrew Furber, Director of Public Health at Wakefield Council
The NHS does a fantastic job, but every institution has scope to improve. The first thing I’d like to see the NHS do differently is to be more responsive to local health needs. People living in poorer communities and those who are vulnerable because they may be homeless or have poor mental health tend to be less well supported. They are more likely to receive emergency care and less likely to benefit from the routine care those from more affluent communities enjoy.

Secondly I’d like to see the NHS do more for their own staff. 1.7 million people work for the NHS in the UK and many are exemplars of healthy living. But too often this is despite their employers rather than because of their support. Help for staff to stop smoking, manage their weight, eat healthily, be physically active and control stress should be the norm. Finally the NHS needs to play more of a part in regenerating their local economy.

I’d like to see the NHS do more for their own staff. 1.7 million people work for the NHS in the UK and many are exemplars of healthy living

The NHS may repair us when we are ill, but health is created by having a good job, enjoying a decent income and living in a safe home. By buying locally, employing locally, offering work experience to local kids and employing apprentices, the NHS can make a significant difference to the things that underpin our health and wellbeing.

Tom Lawrence, consultant, 41
Accident & Emergency wards deal with all kinds of cases. At one extreme, they handle life-and-death emergencies. At the other, I have been advised by NHS Direct to go to A&E for an eyelash stuck in my eye. With such a range, including many referrals from other health practitioners, it’s not surprising A&E wards are under such pressure.

In 2014 I had a severe abscess. My dentist wanted me to go to hospital and contacted a specialist in their maxillofacial department. The taxi took me straight to A&E. There was a long wait in the reception area, followed by utter chaos “backstage”, with doctors constantly being called from one job to another. It emerged that all I needed was a basic drip of painkillers and antibiotics, followed by an x-ray. These could have easily been done in another department, but I ended up waiting ages for both, in severe pain, getting light-headed and stressed. By contrast, the maxillofacial ward turned out to be an oasis of calm.

When I asked why the dentist had sent me to A&E, I was informed that it was hospital policy to “triage” all patients through A&E. As a patient, this policy seems ludicrous – it creates a bottleneck just at the point where emergencies are dealt with. What could be an alternative? Here’s a suggestion: supplement the A&E department with an admissions department, to carry out a rapid assessment of whether each non-scheduled admission is a genuine emergency. If so, they are immediately passed through to the A&E department next door. If a patient is not a genuine emergency, a further assessment is carried out as to what their immediate needs are and which department should provide it. For more, read here.

Norman Lamb MP, former Minister for Care and Support

There is a strong economic case for ending neglect of mental health services, in terms of the long-term savings to society that are possible. Back in the summer of 2014 I reached the conclusion children’s mental health services were dysfunctional. Not enough investment was going in, and the incentives to provide useful services were often wrong.

Our 2015 government report, Future in Mind, was a blueprint for modernisation. We asked every part of the country to develop a transformation plan for mental health services, and focus on better prevention. To my great frustration, some of the money committed to this work was not made conditional, so some of it was spent on other things in the NHS. The money should have been made to work harder to drive transformation.

I welcome Prime Minister Theresa May speaking passionately about mental health but I don’t feel the detail of what the present government wants to do goes anywhere near meeting the scale of the problem. We can make real changes. But there is still a gap between rhetoric and reality.

I don’t feel the detail of what the present government wants to do goes anywhere near meeting the scale of the problem

NHS can’t deal with the high levels of people…only option is to put cap on number of people allowed (to) use NHS…drastic but maybe where we need to go?
James Bayley

Loving an institution is no help. When South Staffs NHS trust failed and let people die in pain, the local papers campaigned to keep it open. What failure would you need to close any part of the system?
John Gilligan

When I was a girl and if we fell over, Mum would rub us down, put on a plaster and tell us to get on with it – after having a cuddle though. Now they rush them to A & E.
Betsy Bragger

Raise tax on superrich to cover cost. Reinstall bursaries for student nurses. Fire Jeremy Hunt as his relationship w/ NHS is toxic
@nutupdate

Start by getting Jeremy Hunt out…
@marcella_golan

Stop spending money on it. Spend the money on #prevention #education rather than the cure @magigdog

Stop the methadone and heroin replacement treatments. They don’t work.
@AlienReacher

Spend the money on #prevention #education rather than the cure

Prevention is important with the #NHS, but @LordNigelCrisp doesn’t seem to realise the scale of the #NHScrisis with funds & staff.
@cpnStarkiller

More funding (for NHS)
@EastDulwichMum

Make it compulsory everyone who uses NHS says thank you to the staff. Non judgemental and top service every time.
@Paolo090908