Outside the marginals

a commentary on the politics that followed the UK 2010 election

The health of the NHS

Basically not good, and for the elderly – in many places – diabolical.  But is this the inevitable result of wanting Swedish style public services but not being willing to pay Swedish style taxes?

Problems (to this observer who has had to effectively project-manage the final decline of both parents) seem to include:

  1. GPs now having an exceptionally cushy number – many seem to view themselves as having an office job working 9 to 5 with no obligation to visit people in their homes.
  2. The Out-of-Hours doctor service is not just a joke, but in many cases is a liability.  Doctors are expected to attend within 5 hours, have no access to notes and have no familiarity with the patients that they see.
  3. Doctors “in the community” (GPs and Out-of-hours) seem to think that if someone is ill, their job is to call an ambulance and ship them off to hospital.
  4. Doctors seem frightened of physical contact with their patients; many seem aloof.  Holding the hand of a sick elderly person, gives them comfort and enables the doctor to sense temperature and pulse.  Sitting back with arms crossed and not taking notes does not generate confidence. Many of the elderly (who in their early years – pre NHS – would have paid for the doctor) have a keen sense of “value” and are left feeling cheated – “he did not even examine me”; “he was not interested”.
  5. Community Health (District Nurses, Community Physiotherapy, Mental Services etc.) in many places seem to be near non-existant.  An elderly person can be discharged from hospital with a need for physiotherapy to regain mobility (and independence and quality of life etc.) but onto a 12 week waiting list.  12 weeks later that need is much greater and the individual may have had a further fall and be back in hospital.
  6. Hospitals now seem to be mega-factories to process the ill and in many cases they fail.  If there are local “hospitals” they often have no medical cover overnight, meaning that if someone in such hospitals is taken ill, they are shipped in the middle of the night to the “local” A&E so that a doctor can see them.
  7. If you arrive by ambulance you may end up being queued in the ambulance parking bays (Norfolk recently had all their ambulances waiting for patients to be taken into A&E)
  8. If you take yourself to hospital you are faced with parking charges – and with “pay and display” you have to be clairvoyant and know how long you will have to wait in order to pay the right amount and avoid being privately clamped.  It is unwanted added stress.  If visiting you may pay for 2 hours, but then find your relative is fast asleep so you leave after 15 minutes.
  9. In some hospitals (fortunately not all) there is strict job demarkation and all emissions (actual or potential) are the responsibility of care assistants, with nurses responsible for manning the nurses station.
  10. There is age discrimination in some hospitals – if you are over 75 you are considered lucky to be alive.  You are kept in bed and “commoded” when necessary – if you have not soiled the sheets waiting for the call-bell to be answered.  So if you were able to walk unaided before admission, you won’t be able to after six weeks in bed (and community physios will not be available to restore mobility when you eventually escape).
  11. They do not understand that families are now geographically dispersed (a result of getting on your bike to search for work etc.) and struggling to maintain employment, yet a GP could tell me to make a 1000km round trip to take my wheelchair bound parent to an outpatient appointment, and a ward sister (in 2011!) could ask me if I had a young unmarried sister who could look after an infirm parent.
  12. When the NHS gives up because they have reduced their patient to an immobile incontinent depressive, they then tell you to “put them in a home” and make it very obvious that your parent is no longer welcome and will only get “minimal attention”.  Finding a place in a good home at short notice when you have never done it before is a daunting challenge.  The only advice I got (from a ward sister) was to “go in and sniff; if it does not smell of wee it is probably good enough”.
  13. If you use the PALS system to try to improve your parents care – don’t, it only makes the nursing staff act more frostily towards you.

My experience was not at Stafford or any of the named failing hospitals.  I don’t know how they can fix the “nominally good”, let alone the bad.

We need to consider whether we pay a fair cost for our healthcare.  Saying the system need to be more “American” is not a solution.  All systems fail at the edges; in a health system like the NHS the failure happens within the NHS; in privatised systems the failure happens (unseen) in the homes of those who cannot afford treatment.  That does not make the American model better.  I would rather pay more through taxation – and have the security of a good system being available and not having to worry about being able to maintain insurance cover or having funds to pay for healthcare.  I also feel more comfortable if my fellow citizens have equal access to healthcare.

Dare any party try to contemplate advocating higher taxes to fund specific targeted increases in budgets in return for abandonment by healthcare professionals of demarkation lines and other restrictive practices?

And I have not started to consider the need for integration between health and social care …

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6 thoughts on “The health of the NHS

  1. Very interesting and timely issue. The NHS has truely hit a brick wall, the media coverage recently has been detrimental and quite rightly so. The need to address this lack of care is of highest priority and you’re right your list of issues is merely the tip of the iceberg.

    I really agree with the fact that GP’s have a fear of physical contact, laws, legislations, health and safety have all extinguished the essence of human contact and support. Like you say, holding the hand of a lonely, pain ridden elderly patient could be more security than you and I could even imagine. It is almost as though genuine compassion has died a death.

    I’d be really interested to hear your views on my take on the NHS conflict structure. http://newtonsnotions.wordpress.com/2013/03/19/conflicting-patient-care-standards-is-the-u-k-becoming-a-victim-of-disregard-of-basic-human-rights/

  2. My GPs work 8 to 8, how many hours do you want your GP to work then?
    BTW, I manage a large GP surgery.

    • 8 to 8 is a little more (about an hour a day) than I used to work in industry – which breached the Working Time Directive! Continuous 8 to 8 even five days a week probably impairs judgement.

      However, most professionals that I know do not believe that their working day should be just 9 to 5 – to a large extent it is determined by their clients’ needs.

      My bind is the attitude that I found with the GPs on whose lists my parents were (two separate practices). Both parents had severely impared mobility (neurodegenerative for one and a result of hospitalisation and immobilisation for the other). Both found it next to impossible to get the doctor to visit, saying they should get a taxi into the surgery during surgery hours.

      In my observation the “new” GP contract vastly improved the working conditions of GPs (and probably their salaries), but seemingly at the expense of patient care. If it was really necessary I propose (“I would rather pay more through taxation” – above) that it should have been done at greater taxpayer expense (and at the time I was a higher rate payer).

      Providing a medical service is not 9 to 5 (we cannot be ill just during working hours). The out-of-hours services that I have observed (both where I live and where my parents lived) seems totally inadequate compared to “getting out” the “on call” local GP (who might at least know of the local chronically sick). The out-of-hours doctors (who cover from 5pm to 9am, and all weekends – 128 hours per week compared to “your GP’s” cover of 40 hours per week) seem to know nothing of the patients they visit (or their conditions) and often had no choice (in the circumstances) but to take the safety-first line of calling an ambulance and shuffling the problem off to hospital. Spending more on the GP service may even cut down the costs of night-time ambulances and A&E services never mind the costs of the out of hours service.

      I suspect out-of-hours calls were hated by GPs as being thoroughly disruptive of home life – but until recently you accepted that as part of the job when you chose general practice – just as agricultural vets used to accept they would have to assist with difficult calvings in the cold in the middle of the night.

  3. Re Ambulance waiting times (point 7 in the OP):
    BBC News Website reports (2 April 2013) Tent set up as ambulances queue at Norfolk and Norwich

    A major incident tent had to be set up outside a Norfolk hospital because ambulances were left to queue outside the A&E department for hours.

    The mobile treatment area was set up at the Norfolk and Norwich University Hospital after 15 ambulances had to queue up on Monday.

    The East of England Ambulance Service said each vehicle had to wait for up to three hours to hand over patients.

    The hospital said demand at the A&E department had been high.

    I associate hospital tents with war zones and third world disasters. Is this a “reasonable contingency” for our under-strain NHS or an illustration of just how fine we are cutting things? I can understand a restaurant being prepared to queue patrons or even turn some away, but a hospital is not discretionary spending (however much the government may wish it was).

    To a degree we are “all in this together”; this hospital covers the constituency of health minister and North Norfolk MP Norman Lamb (I trust he – as a Lib Dem – does not have full private health cover and relies on the NHS).

  4. Pingback: Clinicians for the Elderly at Home | Outside the marginals

  5. You are ill informed. Unfortunately your view accords writhe the politicians and the Daiy Mail. If you do get what you wish for you will wish you hadn’t.

    Sorry only rediscovered this blog

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