The NHS can be fixed
The crammed hospital waiting room I wrote about a few days ago need not be a feature of the modern NHS.
A major cause of logjams like that was the New Labour renegotiation of GPs’ NHS contracts that did away with the obligation to provide 24/7 service. This was such a wonderful deal that last year GPs threatened to strike over the proposal to make them work 9-5 on Saturdays and up to 8 p.m. on weekdays.
Retired GP Dr Vernon Coleman says he used to be part of a five-person practice where each colleague accepted a night shift once a week and did a weekend stint once every five weeks. Hardly back-breaking and even more doable today when the average number of GPs in a group consultancy is over five (36,572 doctors in 6,495 practices) - and locum arrangements could be made for the smaller outfits.
Primary care should be just that - a front line that deals quickly with less serious cases, freeing hospitals for the harder ones and for clinical investigations. Instead, we have to see hospital consultants working like four-armed Shiva throughout the watches of the night. The stress on staff is bound to multiply errors and increase the likelihood that good practitioners will start to consider working in some other country where pay and conditions are much better.
Pre-Covid lockdown/WFH/Just Send Us The Money we could have walked in to our group GP practice and got an appointment, maybe even be seen there and then, instead of being sent away again to go online or wait on the phone. The GP could have taken a look, prescribed and provided antibiotics - there is (or was) an on-site pharmacy - and if there was a need for a scan could have booked it for us, just as the hospital did last week.
Actually, with all the money poured into the GP system - plus the fortunes they made on government-initiated mass screenings and jabby magic - I don’t see why some of it couldn’t be used for in-house investigations, instead of farming them out to labs and hospitals with long waits for results to come back. We’re not the only country to be behind the curve: a 2019 study found only 15% of primary care centres across Europe had access to in-house abdominal ultrasonography. How many group GP practices have X-ray machines or the ability to do blood analysis?
Maybe GPs could be on-site, too, instead of sharing the BMJ’s enthusiasm for working as a ‘digital GP.’ Only one in four of GPs works full-time; the average time commitment is just over three days a week.
Hospital management needs more attention, too. NHS managers - 2,000 of whom are on six-figure salaries - do the nine-to-five yet I wonder whether they couldn’t learn from the efficiency of supermarket managers who seem much more acutely aware that ‘retail is detail.’ If I may offer another personal example:
A member of my extended family recently had a mild stroke. His life was saved - full marks for that - but part of the treatment was painkillers that coshed him so that when he came to he didn’t know where he was and would try to pull out tubes and get out of bed. The staff at QEHB kept a close eye, but when he was moved to a hospital closer to home his care notes specified that there should be a member of staff seated by his bed at all times. This didn’t happen, the patient woke up and got out of bed, falling onto his already weak knees and hurting them. His wife who is herself a nurse asked why the hospital hadn’t actioned the care package given them; they replied that they expected to be informed of such things by the family!
Where, in this instance and so many others, is the NHS manager who should be ‘putting the stick about’? For £200,000 a year I would expect constant patrolling, supervising and questioning, not office-based spreadsheet-watching; I would hope to see less of knots of nurses around the computer desk and more Nightingales offering the attentive personal TLC that does so much to accelerate healing - or did, before nursing ‘professionalisation’ screened out the less academic types who weren’t afraid to get their hands dirty.
Some say the NHS should be privatised; others, that it has been deliberately crippled to make the privatisation of medicine seem preferable. In my view that would be inviting the vampire across the threshold - when pharma companies inflated the cost of insulin in the USA many diabetics died trying to make their medication stretch out further. In 2015 a hedge fund manager cornered the market in a drug and increased the price from US$13.50 to $750 per pill; his later jailing was for unrelated offences, though morally this gouging should have been one. Two-thirds of US personal bankruptcies are because of medical debts; goodness knows how many others die because they can’t even get the credit in the first place, or are afraid of it.
The NHS has already been Nosferatu’d with debt - hospitals still owe £54 billion on PFI charges. A nice little earner for the money men and in Birmingham the ownership of the new QE - an award-winning design that looks like three rolls of Polo mints - will revert to its private/public NHS Foundation Trust in 2046.
Health services should be a public amenity, not a business goldmine. They just need managing better and it doesn’t help to have devolved responsibility for them from the Government and Parliament to the quangocracy that seems to have replaced our hereditary ruling class. The historian David Starkey has remarked recently that our multiple constitutional crises are owing to the progressive delegation of Parliament’s powers (only one of which was the disastrous entry into the EU.)
Brexit was just the first step. It’s long past time for the Mother of Parliaments to suck that power back up, make Ministers fully and directly responsible and interrogate them ruthlessly on the floor of the House of Commons.
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