Having spent a bit of time up close and personal with the NHS recently, it’s given me some time to reflect on its nature.
Firstly, most people’s perceptions of it are I suspect coloured by their personal experience. Anecdote looms large whenever talk turns to doctors and hospitals – how could it not? I was seen, diagnosed and operated on within the space of a month. I was diagnosed by a top neurologist in a huge, clean, modern hospital and operated on by a team using groundbreaking ‘gamma knife’ technology in the same ward where Richard Hammond was treated following his near-fatal crash, despite having neither great wealth or fame. I’ve paid my dues through the tax system and been handsomely treated by a service blind to status or personal background.
But yet.
But yet. My story is just that: a story. In the bed next to me was David B of Pontefract. For 7 years he struggled to find treatment for leg pains that left him unable to walk – and therefore unable to work. So knowledgeable was he about his own condition after long years of pain that he had to correct the nurses’ medication charts for himself. Despite his erudition and knowledge and despite his articulacy it had taken 7 years to negotiate the system and get onto a neurology ward. His own brand of gallows humour certainly had a different colour to my own and when I left he remained undiagnosed, marking time on a cocktail of pain killers.
You pays your money, you choose your anecdote. On this basis the NHS could be either miracle or nightmare.
There’s definitely a problem associated with size. I think regardless of the source of funding – whether you’re a fully signed-up Tractor Production Operative straight outta 1940s Ukraine or a foaming Friedmanite free market fundamentalist – any organisation with 1.6 million employees and over 60 million ‘customers’ can’t be efficient.
Returning to anecdotes, I have sat through probably 12 – 15 different mini interviews with various medical personnel over the last few months. Every single one, without exception, asked me about allergies or existing medical conditions. Without exception every single one diligently noted my allergies (Penicillin, peanuts, cats) and medical conditions (asthma, recurrent oesaphageal bolus). I’ve been telling NHS personnel this for decades – shit, they diagnosed these things – and yet on every visit their collective memory is blank. Maybe Tommy Lee Jones and Will Smith turn up after I leave with a little memory-wiping light pen.
Where does this paper go? How come, in 2011, with all the wonders of technology and the sheer ubiquity of database systems does this information not follow me around with my NHS number?
It’s a small thing in my case, but returning to Dave B of Pontefract for a second the details of his daily medication were wrong. 3 different nurses did the rounds to deliver his pills. 3 times he patiently explained to each of them that their notes were wrong and that the 50mg dosage on their charts was insufficient. The information couldn’t even survive the end of a shift, much less the passage of years.
Another, less trivial anecdote. As I lay in my bed, near the nurse station, the ward sister/matron/overlord was engaged in a frantic paperchase with another ward. A 73 year old stroke patient had been sent from the Neurology ward to a different department for a scan. He never returned. Instead, this department had discharged him. Literally sent him out of the building: 73 years old, undiagnosed, suffering the after-effects of a stroke, onto the streets. Responsibility, communication and responsive action seemed notable by their absence – despite the best efforts of the person on the end of the phone.
So, you can read the runes of the anecdotes any way you like. But pull out to the wider picture, and the NHS fails by many measurable metrics. On the huge scale of things, the matter becomes one of aggregated statistics. And there the truth comes out. Survival rates for cancer are pitiably low – down there with the likes the Poland, despite the almost incalculable extra billions spent. For heart disease, witness our 20% greater death rate than nearby Germany. We have fewer hospital beds per head of population than poor, bankrupt Greece – despite spending 25% more per head of population.
The NHS is also deeply politicised – and this is because of the way it is funded. Some elements of the medical profession are militant. One of my nurses was on her last couple of days and was very vocal about leaving the NHS because of the changes coming up. The stupid, sci-fi dystopia TV screens attached by mechanical arms to the beds had Andrew Lansley’s stupid mug playing on rotation. All the nurses seemed to see him as some kind of Voldemort figure. Maybe he is. I don’t know. But politics have no place at the bedside.
Likewise, a friend of mine – a nurse – sprays her Facebook wall daily with polemic about ‘cuts’ and union activism. She is a believer in the NHS. It is often said that the NHS is the closest thing to a religion left in the country and this is both true and unpalatable. The goal of any health system is to save lives – not waste them in the name of “equality of access”.
Instead of looking rationally at what systems deliver the best health outcomes, we’ve spent 60 years exploring a cul-de-sac with apparently scarcely a glance at a map book.
Of course if any politician dares to speak of ‘reform’ the land trembles to the sound of marching feet and the refrain of “we don’t want to end up like America!” as if there were only a binary choice between our system and theirs.
Now I’m no expert in the provision of healthcare, but it seems pretty obvious that Specsavers do a better job of eye care than the NHS did or could manage on its own. I get regular, cheap eye tests and have dabbled with various styles of glasses and contact lenses down the years – always at friendly price points and with a convenience it’s hard to imagine anyone a GP ever delivering.
It also seems pretty clear that with even relatively small subscription fees that schemes like the Leeds Hospital Fund (now sadly subsumed into some conglomerate in the modish fashion of the age) have managed to offer superior levels of service than the NHS can by itself.
The answer would appear therefore to lie in the model adopted by most of the world: compulsory health insurance, with a minimum guaranteed contribution by the state and top-ups according to each individuals needs, wants and financial circumstances. That such a suggestion is beyond the pale in polite conversation tells you what you need to know about the mythic status of the NHS. In its current form, it has been a heroic failure.
Look on my works…
[29] “There is the fact that the NHS budget has been rising by more than inflation each year for many years – and faster than average salaries” – it’s true spending has gone up, but can you name a single developed country where expenditure on health has gone down – and if you can’t what is the point you are trying to make (other than health care costs more than most people would like to pay for it).
I can’t name a single country where expenditure has gone down, no, but then I didn’t say I could. I was just pointing out that healthcare is getting more expensive, and that therefore we should be looking at how the costs can be managed more effectively. I don’t think a system funded entirely from taxation and managed by politicians will achieve that.
I have often had the same thought, what about the penaitts in all of this? As with other chronic diseases penaitts are often very knowledgeable about their condiionand to exclude them is to omit a very important dimension besides causing me to suffer a few shivers of apprehension for the future.I have often wondered if there is a longterm plan to replace doctors with nurses.The paient is acually powerless to change he policy in their GP’s Practice so it matters little whether he patient considers one or the other to be more well informed.In any event, to be able to judge this means that we would have to be better-informed than either.I have reservations about Nurses taking over from GPs. They may be able to concentrate more on the disease itself and keep up to date wih the constant changes etc but might it not be dangerous to treat diseases in isolation like this.? It is natural for penaitts with a chronic condition to attribute all symptoms to that condition .One would hope that a Gp would be able to see the wider picture, but I realise that this is not always the caseI worry a little about the quality of some of the nurses in Practices now just like those in Nursing Homes who seem to be able to rise to the rank of sister so much more quickly than those in hospitals,Unless nurses have a great deal of experience [not always the case} they are far less likely than experienced doctors to treat penaitts as individuals .I suppose Nurses replacing Doctors is the logical conclusion of what we have seen over the last few years _I find it frightening.I have known one Nurse Practicioner and cannot believe that she had the intelligence or education to replace a doctor. Maybe if the system changes in the future this could work but in the meantime I feel threatened by it. I have found it a matter of great concern lately when Gps in my pracice show themselves to be almost ludicrously afraidto enter into into any discussion and avoid any mention of my diabetes on the grounds that the nurse attends more courses . There is obviously no chance whatsoever that we will move towards a more holistic system.It will definitely not be patient-centred.
I feel the changes are too quick. There has been litlte input from grass roots from the beginning. Far too much money is spent on changing the NHS for changes sake and, money is not spent at the interface of patient/practitioner -there are too many managers. It is right to devolve to local level but to invest in private health care ie.g via the choose and book system- is unethical and sets a precedent for using private providers when clearly the investment should be in local NHS services. The public should be encouraged with self care instead of visiting the GP/wal-in centre/OOH centre/A and E for things which quite clearly are minor and self limiting. GP’s should not be forced into inviting pateints 3 times for annual reviews for QOF- you are enforcing widespread waste- there are the same persitent non attenders. these are just a sample of my thoughts.
May I please convey my gratitude to Mr. Paul Latimer, and team, following my total right hip replacement on the 6 May. It has given me freedom of movement to get around after 35 years of arthritic growth and restriction. I gather it was a long and awkward procedure. Since the op, I have not felt anything in the way of pain or discomfort. I hope the same team will be assigned to undertake the replacement of the left side in about four months time. My thanks, also, to all the day and night staff on ward 8B, who looked after me during my short stay. Thank you all.