"We're on the brink of disaster" (Matthew Horwood/Getty Images)
It’s just before 8am on Monday morning, and my A&E department is heaving. I’ve been on-call all weekend — I’m shattered — but I don’t have time to dwell on it. Our traffic light system is a sea of red: red for staffing, meaning we’re low on doctors and nurses; red for capacity, meaning we have far too many patients; and red for acuity, meaning a terrifying number of those patients are severely ill. Some of them are dependent on a ventilator. Some won’t make it to the end of the day, let alone the end of the week.
The final traffic light is inevitable, then: red for flow, meaning far more patients are being admitted to hospital than being sent home. The bottom line is that, from a safety point of view, my department is stretched beyond capacity. The same is true for almost every A&E in the UK, at almost any given time. If my department is under this much strain in the height of summer, when there’s usually some respite, come October it’ll be Armageddon. Welcome to the frontline of British medicine.
During my 25 years of specialising in A&E treatment, training junior doctors and managing NHS trusts, I’ve witnessed how a decade of austerity has eroded every structure supporting our organisation. Brexit led to chronic staff depletion. Then came Covid, which put unprecedented stress on the service, but also provided a scapegoat for every pre-existing problem. To understand the state of our healthcare system, consider how it now spends over £2 billion a year on settling negligence claims. Even as a senior employee and stalwart supporter of the NHS, my advice to patients is this: forget it. Beg, borrow or steal to go private instead.
Outside my hospital in the Midlands, emergency patients are frequently triaged in the ambulance that collected them. They are having blood tests and X-rays inside that ambulance, supervised by the paramedic crew that brought them in. If their diagnostics come back favourably, following consultation with a doctor, they might be discharged without ever having left the back of the vehicle.
Even if those patients receive an acceptable standard of care, those ambulances are out of commission for up to nine hours. The turnaround in 80% of cases involving an ambulance should be 10-15 minutes for paramedics to unload, hand over and get back on the road. It doesn’t matter if it’s one, five, 10 or 15 ambulances stacked up outside a department. That’s one, five, 10 or 15 ambulances that can’t respond to the welter of emergency cases we face every day. And it costs lives. Last year, Prof Kailash Chand OBE, a 73-year-old former head of the British Medical Association, died after suffering a cardiac arrest; his son claimed the celebrated doctor would have “almost certainly survived” if an ambulance hadn’t been delayed. More recently, Dr Katherine Henderson, president of the Royal College of Emergency Medicine, admitted that she would consider calling a taxi or driving a loved-one herself if they needed to get to hospital, rather than call an ambulance.
And I can understand why: we’re on the brink of disaster. As a consultant, I am alerted every day to cases in my hospital and beyond that suggest the service, not just A&E, is at breaking point. Breast cancer sufferers had critical mammograms cancelled due to the pandemic. Nine out of ten NHS dental practices are not accepting new adult patients. GPs are quitting in droves. An unwell father-of-two waits 20 hours in A&E, refusing to leave until he gets a blood test, which ultimately reveals he is suffering from terminal leukaemia. A patient who, during lockdown, had his blood pressure managed remotely finally discovers his problem isn’t high blood pressure: he’s got a brain tumour.
Why do we accept this in a modern healthcare system? People have been raising the alarm for years — Health and Social Care secretary Steve Barclay among them. How, then, has Barclay now found himself facing a public health crisis? The answer is straightforward: because senior management and civil servants routinely gaslight clinicians whenever we flag up critical issues to do with resourcing, bureaucracy and waste. We point out that countless lives are being lost unnecessarily because of systemic breakdown. Shoulders are shrugged. Charges of “oversensitivity” are levelled at us. Meanwhile, the small number of six-figure-salaried civil servants who oversee our organisation of 1.4 million people continue to hold us in contempt.
None of this is sustainable. Overcrowding in departments providing urgent or emergency care kills in all sorts of ways: delays, errors, omissions, duplications. It’s impossible to run a system in major incident mode indefinitely. Backlogs are mounting. The pressure is so great that more and more doctors are retiring early or going part-time. Typically, at this time of year, many make themselves unavailable rather than work backbreaking shifts on high-stress wards. We offer between £80 and £100 an hour to locum doctors, the NHS equivalent of supply teachers, but still my department can’t fill shifts.
It’s not just the problems within the healthcare system that have caused this crisis. The terrible failures of Britain’s social care system also have knock-on effects. In a medium-sized hospital like mine, there are between 60 and 80 patients who don’t need to be there. But there’s nowhere else for them to go. Just as mental health patients wind up in jail for want of psychiatric care, the elderly wind up languishing on hospital beds in corridors because social care is in an even worse state than the healthcare system. On one recent Saturday night, for instance, a psychiatric patient came in for treatment. When I asked how he was doing the following Tuesday, I was told he was still on the ward, occupying a bed, because there wasn’t a psychiatric bed available in the region.
Our end-of-life care sums up how shameful the situation is. There are patients in hospitals up and down the country who we know are about to die. They receive anticipatory medication — medication that stops secretion, discomfort, pain and nausea in the final hours of someone’s life — but not much more. They are dying in cubicles in A&E departments, denied privacy and dignity in death, with loved ones allowed neither the time nor space needed to grieve. But in a hospital, staff have to prioritise patients in need of urgent care over those in the final hours of their lives. Imagine saying your last goodbyes to your mother, partner or child while in the next cubicle a doctor is frantically trying to resuscitate a cardiac arrest patient. It is inhumane, uncivilised and entirely without dignity.
Conspiracy theorists like to believe that the collapse of the NHS is being engineered by design, that the Tories are ripening it for privatisation. But I don’t believe that what is happening is planned; it’s incompetence, neglect, underinvestment. It isn’t organised; it’s chaos.
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SubscribeOne of the greatest problems with NHS reform is that to the average voter universal healthcare and the NHS are the same thing, when they are obviously not. The NHS is the organisational structure we chose to deliver universal health care, something which is not unique to the United Kingdom but enjoyed throughout most the developed world, often to a much higher standard than the NHS delivers.
But try explain this to the voting public and they’ll look at you like you’re trying to explain quantum physics to a cat. The narrative is now so embedded that NHS=Universal Healthcare, that no politician can challenge it.
Similarly with public service broadcasting and the BBC.
The problem is that the NHS WAS fit for purpose in 1945, but health care and what is possible, and expected, in the form of medical interventions have changed enormously since then, whilst the structure of the NHS is essentially the same, bar some tweeks around the edges. There is a need for an urgent re-think about how the health service is organised and delivered, and most importantly it needs to stop being used as a political plaything, the parties need to get together, sit down in private and thrash it though, coming up with a costed and timed way forward. I’ll put my two-pennies-worth in – we need to stop relying on importing medical staff, it is short-sighted and immoral. The cap for medical students needs to be raised, even if that means cutting the number of students in other subjects who, in all honesty, will never pay back their loans, this money can be used to fund doctors’ and nurses’ training, Extraneous staff should be sifted out (I expect we know who they are – DEI anyone?), and I’m sure that there are many other changes that could be made, including some charges, with any means-tested exemptions. I realise that means-testing is a controversial subject, but it is ridiculous that, for example, all over 60s regardless of ther economic circumstances, get free prescriptions; this could at least be raised to the state pension age. I know that there are arguments that it’s more expensive to do means-testing than it is to give it to everyone, but once means testing has been done the results could be used for all other benefits, it doesn’t have to be repeated, although it would need to be re-visited at intervals. The important thing is we can’t go on as we are the NHS is falling apart, what people want is universal, genuinely affordable medical care, preferrable free at the point of use.
I’d go as far as taking certain things off prescription altogether. if it can be bought over the counter for less than a prescription charge even if you qualify for free prescriptions. It annoyed me immensely seeing people come in for prescriptions for 32 paracetamol, knowing that the dispensing charge would make it more expensive to tax payers than simply buying it over the counter. I also include calpol, nappy cream and nit lotions too!
Could not agree more -you can get paracetamol for about 25p! Last time I ventured into my surgery – about a year ago, there was a large poster stating all the conditions they will not deal with – mostly sensible but one or two which could be a precursor to serious issues. Currently there are 300,000 people awaiting cancer screening/treatment whilst the NHS is spending over a million pounds on woke ‘diversity’ programmes such as rainbow picnics! you couldn’t make it up!!!!!!!!!! Too many useless managers who are paid enough to buy private healthcare, provided by the same doctors who are contracted to the NHS!
Yes you can get 16 paracetamol for 25p. That for me is 4 days supply. Should I have to go out to a different shop every 4 days to buy the 100 I need over a month because no pharmacy will sell me 100 at a time in case I want to kill myself!?
I also have to take other painkillers and antinflammatories in order to get up in the morning and get to work to pay my taxes so we can have free health care at the point of delivery.
We need to stop and think about what treatments should actually be free. How much do we spend on one patient in terms of treatment? And stop throwing money at managers, doctors and nurses simply because they demand it!
My wife takes 8 paracetamol per day…..every day and I have to wander around pharmacies and supermarkets buying them because of the buying limit which varies from shop to shop. The pharmacist in the local Asda asked me to ask the GP to prescribe!!
We always have a 500ml bottle of Oramorph in the house so if she wanted to kill herself she wouldn’t need the paracetamol. Honestly it’s a joke.
The list of other medication is a long as your arm and the amount we have after a new delivery from the pharmacy would kill the street.
My wife needs an aspirin every day after recently suffering a mini stroke after covid. She wouldn’t dream of getting them on prescription for this very reason. However, there are many people who couldn’t even afford the 32 paracetamol you mention
Many people? Come off it.
I know one personally
Couldn’t afford 50p for a life enhancing treatment ?? You exaggerate but, I, like your wife, would never have the state pay for my aspirin (but do be sure that her GP is aware shes taking them, even the Enteric versions)
And, ANY treatment to correct surgery, etc done abroard. You paid to go abroard so don’t expect the NHS to pick up the pieces because you didn’t factor in aftercare or problems.
Are contraceptive pills still free? I am out of touch but if they still are, that should be stopped. Cosmetic surgery is another procedure which should be strictly monitored.
I am also dubious about the cost in surgical time and NHS resources taken up with collecting and transplanting organs, unless it can be shown that the procedure is likely to prolong life for a reasonable time..
I believe 3% of NHS money is spent on preventative medicine. It sounds good but I wonder if it is well spent. For example adverts, which have no effect and visiting homes to take surveys and suggest changes to lifestyles could be throwing money away. Also it seems to be generally agreed that 2 out of 3 positive results with breast cancer screening would not develop into full blown cancer (I heard this on a Radio 4 programme and I believe it stemmed from a Swedish survey) and I was sent all the paraphernalia for a stool sample although I had no symptoms of bowel cancer. It was purely based on age.
One must be assured that this is not all based on resisting job losses.
Even without spending a penny on means testing, if people were told ‘the cost of this prescription is X, but if you can’t afford it, you can have it for free’, a lot of us would pay. Not everyone, maybe not every time, but still enough to represent a substantial saving.
Kind of like museums and gardens that often have a “free” day. They ask you to pay something. But if you can’t, you still get in.
I’ve long proposed that the full retail cost of a prescription be clearly printed on it
You could add an insurance-based scheme such as they have on the continent. In France for example you receive a certain proportion of healthcare from the state (ie through general taxation) and the rest you top up through private health insurance. They appear not to have a crisis-ridden system we do.
There is a terrible weakness amongst the English to hold onto institutions way beyond their point of use. The NHS is one such. The sheer pressure of events has now compelled us to act because we’ve been reluctant to grasp the nettle earlier.
I agree. There are many models that can be looked at but the only one that is ever mentioned is the US one, and this terrifies people into sticking with what we have.
I’m a consultant surgeon in the NHS. I am convinced that my department could deliver a better, more convenient and cheaper service if it was a private company led by myself and consultant colleagues instead of managers with no clinical insight or responsibility. The NHS now is inflexible and unimaginative. It may have been right for the 1940s but not now. We need to move to continental model with much greater insurance coverage.
Nice to have a suspicion I’ve had for many years confirmed by someone who actually knows .
Bismarck system anyone…..?
I absolutely agree with you, take the politics out of the equation
I have always differentiated between “health” and the NHS.
The author talks about “a decade of austerity”. I’ve just checked. In the 10 years to 2020, NHS spending increases by 20%. Above inflation. The population of England and Wales increased by 6.6% in that time.
As you say, the NHS is the structure through which health care is delivered in the UK. Other countries do it better. We should seek to learn lessons. It is more than likely that the admin structure is denying the front line clinicians the resources they need.
Quite. There was never austerity in the NHS. It is hard to take an article – or author – seriously with such a fundamental error. I ask again – does anyone proof read these articles ?
Bismarck system ?
We’ve been sold the idea that there are precisely two possible healthcare systems. The NHS as it exists now, or the US system as it exists in the fevered imagination of a Guardian columnist.
The Dutch system is infinitely better. Some health insurance that is affordable and the rest is free. My sister & her family live there. Doctors continued to see patients face to face throughout,nurses too. Dentists invested in strong new air filters and continued to treat people. Our bureaucratic,monolithic system has needed surgery for a long time now and similar changes to those in Europe is way overdue. Our death rates from many serious illnesses that aren’t covid are going to be catastrophic due to not seeing GPs and the vaccine injured have barely been registered as yet. The Depopulation agenda is roaring ahead with insufficient staff and hospital beds caused by lockdowns,GPs in hiding, focus on ‘diversity managers’ and seemingly no will to fix it by our inept, complacent politicians.
That is because at one level the NHS is like a religious cult for some of its supporters. It is clearly fundamentally fragile if anyone questioning it is denounced as a heretic (as often happens). It is our very own one party state.
Schrödinger’s cat?
The NHS’s decline started with Heath’s implementation of the Salmon report in the early 1970’s. This introduced non-medical managers and that bureaucracy has ballooned ever since with an unnecessarily huge chunk of the NHS budget.
Then Kenneth Clarke’s privatisation of NHS services destroyed the ethics of in-house services such as immediate post-operation sterilising of instruments etc WITHIN the theatre complex by use of autoclaves – ie: massive steam pressure ‘cookers’ – whereas now, used instruments etc are sent out to a private company for cleaning with every chance of sterility being compromised outside the theatre suite or are simply disposed of – regardless of costs. Also, every ward had its dedicated cleaning staff and a ward clerk to deal with paperwork so medical staff could concentrate on patient care.
Then ‘all must have degrees’ has robbed the NHS of a large supply of caring, compassionate people who could make wonderful nursing staff under supervision and solve many staffing issues on wards.
As for career progression: none for auxillary services such as clinicians etc., no matter how good a degree and experience they have.
So why has no health minister dealt with these issues?
Why has no Health Minister dealt with these issues? Because Health Ministers are generalist politicians and not managers. They don’t understand the detailed problems and solutions and the civil servants for the most part are not going to point them in the right direction. In any case they are only in post for a short time.
in any case it requires a detailed knowledge of the system and people involved. There are undoubtedly plenty of competent people in the NHS, who, given a free hand, could greatly improve things, but it would involve stepping on a lot of toes, and the competent people would also have to be good at bureaucratic politics which is how you rise in any bureaucracy. Being good at bureaucratic politics normally means that your focus is not actually on better service to the front line and patients.
Small is beautiful. Our monolithic, bureaucratic NHS is modelled on the Soviet system: collectivism gone mad.
All true: When I was a houseman in 1975, We had a beds officer. We were supposed to call him when we could find beds for patients in A/E. He could never find a bed and the empty beds all appeared at 9.00pm when the day staff went home, and the night staff were honest about how many beds were free. The joke was that his role was expanded with two assistants, and they still couldn’t find any beds. It’s time someone reprinted Parkinson’s Law – it’s a great read and you can find it online easily.
“The answer is straightforward: because senior management and civil servants routinely gaslight clinicians whenever we flag up critical issues to do with resourcing, bureaucracy and waste. We point out that countless lives are being lost unnecessarily because of systemic breakdown. Shoulders are shrugged. Charges of “oversensitivity” are levelled at us. Meanwhile, the small number of six-figure-salaried civil servants who oversee our organisation of 1.4 million people continue to hold us in contempt.”
This is a problem with far too many of our organisations. They have been captured by a bureaucratic blob. Money is constantly called for but doesn’t fix it because the money goes to meet bureaucratic needs. A lot of money has been pumped into the system but the bulk of it has gone to fatten administration rather than the front line personnel. We want doctors and nurses but get Diversity Directors and other highly paid clogs on the whole system. As the author says when “critical issues to do with resourcing, bureaucracy and waste…shoulders are shrugged…the small number of six-figure-salaried civil servants who oversee our organisation of 1.4 million people continue to hold us in contempt.”
It is hard to see who has the critical will and ability to unclog the system that needs a virtual enema. If the Conservative party politicians can’t or won’t change things Labour, the party of the Blob, certainly won’t.
The biggest problem with re-vivifying public services is indeed the Blob. Whenever someone tries to improve matters they find the Blob automatically resists them. The Blob is the furniture sitting on top of the carpet you are trying to move.
My suggestion? Pick a non life threatening service and defund it as an example to the others. I’ll suggest the BBC. Then once you have gone around defunding the various services (or making provision by other means) diary a repetition of the exercise every generation or so to ensure that the careerist don’t take control again.
This constant BBC bashing is very tiresome. It is one of the genuiniely world-class institutions that this country possesses and respected all round the world, and is very popular in the UK even among Conservatives. Pick on something else.
It’s very tiresome because the BBC is still incapable of introspection. No matter how good once was other means of entertainment and education now exist.
Which institution do you think should be first?
Use your own name, Gary . And get back to Match of the Day.
Agree 110%. As for all these Diversity and Inclusion Directors, we should get rid of the lot of them. A similar problem now bedevils Higher Education.
It’s exactly the same with Higher Education. A bloat of highly-paid administrational staff who, in order to justify their income, need to constantly keep frontline workers busy with new and pointless initiatives.
We often talk about Tory and Labour policy, but fail to mention the silent ideology which is Managerialism. Not only does Managerialism quash innovation and practical solutions, it also ensures that a lot of public money is siphoned off for private gain or wasted on fluff like DEI which is really just a tool to enforce conformity on an increasingly recalcitrant workforce.
It would be an idea if those who are trained in our medical system were made to agree to pay off their loans by working IN the system for say 5 years post qualification (with suitable pay of course) to ensure that there ARE enough doctors & other clinicians to treat the sick before they run off to lucrative private practices here or abroard.
When I complain about the NHS my son in law who is a lefty tells me that the NHS has been rated top or near the top of any health service in the world. He’s talking about the Commonwealth Fund Report which does indeed rate the NHS highly. At the same time a few years ago the OECD said that the British Health service was the worst of any developed country apart from the US. But the Commonwealth Fund report looks at different aspects of health. One of those aspects is “Outcomes” which to me seems quite important. This is to do with things like outcomes in cancer treatment and infant mortality. In this aspect the UK comes bottom apart from the US.
Still, I’m sure if the Commonwealth fund looks again it will say “Well UK, your diversity ratings are off the scale so we’ll rate you excellent”. A bit like the old joke about the surgeon talking to the widow. “Well Mrs Jones the operation was a success but unfortunately the patient died”.
Lefty son in law. My worst nightmare
Time for new thinking. Not this hackneyed special pleading from doctors. The NHS was ringfenced from austerity, so it can’t be underfunding. Let’s talk about GPS and their insistence on not working evenings and weekends while their patients need them and their colleagues in A & E are overwhelmed.
It’s a shame that you singled out. GPs. I am a GP. My practice had intentionally returned to face to face appointments with your own registered GP because evidence shows that this approach is best for patients and the doctor. We have evening and weekend surgeries.
I recognise everything that the article writer says, the breakdown of the ambulance service was truly shocking when it began about a year ago but it has become normalised now.
At least there is now increasing awareness of the shocking state of acute services, what is almost entirely hidden is the reduction in care for older people whilst we have an ageing population.
“The nation” needs to pay for elderly care somehow, the best would be a Japanese style elderly care insurance.
The comments section after any NHS article demonstrate that the arguments around the NHS are always toxic and highly politicised, it’s almost impossible to have a reasonable discussion, even with friends, about what needs to be done to help us all, patients and clinicians alike.
The NHS and social care need to be apolitical and properly funded, even if that means a different, more European model.
I wish I was in your GP practice. My GP operates largely with locums between 8 and 5.30 on weekdays only.
One of the problems a GP friend has highlighted to me is that a large proportion of GPs are women who tend to work part time and the male GPs end up having to fit in with their schedules and they tend not to be business minded.
The other problem, which the Treasury could fix, is the low cap on the size of pension that GPs can accumulate before being taxed at a penal rate on any withdrawals. The result is to effectively discourage older GPs carrying on or putting in the hours.
’Women who work part time’ is not the issue. Not being prepared to pay for sufficient staff to fill the number of doctor-hours required for the number of patients on the books is.
Employees of any kind do not need to be ‘business minded’ and it could be argued that the fact that GP practices are run as private businesses, rather than as directly employed NHS satellites, is the fundamental problem.
However, many GPs wanted to control their own finances; I know a number of GPs who were delighted when they were given the opportunity to do so, it is only now theat they are complaining.
How can part-time workers NOT be an issue? I run a business that is open during office hours. All staff are full time and work those hours. If we had to cover the opening times with a patchwork of part time people, I suspect it wouldn’t be possible, and not just for financial reasons..
Right, so the solution to a problem of spiralling cost and diminishing output is people with less relationship to efficiency, effectiveness and productivity?
It is by that private business approach that many practices such as mine are thriving , both , for the staff and patients .
My experience of A &E is limited to pre-covid visits when I had a chest pain and another time I blacked out and thought I might have cracked my thigh bone. The ambulance was prompt but I was struck by the sheer amount of time taken up by the drunk and mentally ill when I had my chest pain. On neither occasion did any of my visits resemble the frantic pace of US TV drama depiction of Emergency work rather everything proceeded at a leisurely and unhurried pace.
I also remember attending a school rugby match before covid where one of the boys lay in agony having dislocated his knee for about an hour waiting for an ambulance for a hospital 5 minutes away until his parents sensibly loaded him into a car to take him to hospital – so problems with the ambulance service doesn’t appear new.
I usually get the bus to the hospital (assuming I am in a condition to do so) which takes about as long as I would be waiting for an ambulance to arrive,,,,,,then get told by the triage ‘person’ that I can’t be that bad if I could get their under my own steam. I then lifted my skirt to show him the bloodsoaked towel I had fixed in place to enable me to be able to travel ‘under my own steam’
How many GPs in your surgery work full time? In the UK as a whole it is 24%, and almost certainly reducing.
Many people during covid stepped up. As a profession GPs stepped back, and have continued to do so, and this will be measured in deaths, pain and anxiety across the UK population, albeit with regional and local variation, like Dr Fox’s practice maybe.
If you are a GP working a comfortable 3 day week, time to step back up. You have a duty. Medicine is a calling.
One problem is that their pension pots will grow too big, and they’ll face huge tax bills. That would be really simple to address buy making contributions voluntary over a certain level. I think that the problem may be that the NHS pensions scheme is a giant Ponzi scheme with current contributions paying existing pensioners.
Why do GPs get an NHS pension when they are private contractors?
I hate to even bring this up since I am a female physician myself, but part of the reason for the decline in productivity from physicians over the past few decades is, imho, due to the feminization of the work force. Women tend to (on average) work fewer hours, take more time off for family reasons, and retire earlier than their male counterparts. I’m not judging, just stating a statistical fact that we will have to plan for if we are going to keep our healthcare systems functioning.
Good to read that . My own GP practice (in a small seaside town) has never ceased from face to face consultations although very many of us patients have welcomed the opportunity of a telephone or video call first in order to be triaged as to the necessity.
Further, all nurse and back office staff have been easily reached .
I puzzle why practices have differed so much in the covid response…
I’m afraid underfunding is still a major part of it. Whilst few would argue that it has become too top heavy as an organisation, it still receives less taxpayer funding than it needs. Germany spends an extra 20% per capita on their service, and France slightly more but it’s health system doesn’t fund doctor’s visits and numerous other services that a free in the UK. It needs both reform and funding, unfortunately it’s unlikely to receive either
It seems to me that neither GP salaries nor pensions are underfunded. Some GPs are doing their best (see Matthew Fox’s comment above – bravo!) but my own GP’s practice seems to be staffed by a bunch of opportunists who have used Covid as an excuse to hide behind locked doors, and whose clinical incompetence is exceeded only by their ineptitude at dealing with simple administration.
It is wrong that A&E departments are having to pick up the slack where GPs have let their patients down – I thought the article (excellent as it was) let the GP sector off very lightly.
I have noticed, however, that the support of some parts of the medical profession for GPs is failing. It used to be the case that no doctor would ever criticise another for any reason, but I recently heard a hospital consultant describe GPs as a bunch of cowards over Covid – the comment was on the lines of “I didn’t get the chance to lock the doors and hide – I had to climb into PPE and do a stint on a Covid ward, even though that is not my area of expertise.”
In other areas, of course, the profession sticks together. I often watch – and am appalled by – the TV programme “The Bad Skin Clinic”. On so many occasions someone presents at the (private) clinic and is given a diagnosis and a cure, having been given neither by their NHS GP or hospital – and never a word of criticism. Or a suggestion that a trip to a lawyer might be in order.
Of course, you can sue for negligence, but not necessarily for incompetence…………..
Are you suggesting that GPs don’t deserve their high wages? It’s a highly skilled job that involves years of training, and one of which there is a shortage of workers, so the basic laws of supply and demand ensure that it’s well paid. Slashing their salary would simply make the shortage worse.
Not at all. I am merely suggesting they should perform to a higher standard.
John, it’s hard to perform to a higher standard when the system you’re working in is collapsing around you. The more it deteriorates the more inefficient one becomes in trying to put out an increasing number of fires
Your point is superficially convincing, but I would like to point out that medicine is a profession, and each practitioner has a personal responsibility to use their skills to an adequate level (hopefully ‘to the best of their abilities’ means to an adequate standard). Within the last year, for example, I have been prescribed by my GP with a drug which caused severe side effects, and which a hospital consultant confirmed to me should never have been even considered for anyone with my condition and symptoms. (Frankly, when I checked, Dr Google knew that – why didn’t my GP? In future, I will be relying on Dr Google in preference to what the numpty with the stethoscope says!)
I work in a profession myself, and there are two aspects to it : one, to maintain and exercise an adequate level of technical skill (which really is not dependent on whether ‘the system’ is collapsing or not.) Two, to manage and administer ‘the business’ which is more difficult, I admit, if the system is falling apart.
If you look at Malcolm Fox’s comment above (and Colin Barrow’s comment below), there are GP practices managing to deliver a good service in spite of what is going on elsewhere. If they can do it, why cannot more of them? Why can’t most of them?
What is totally unacceptable is where a GP practice is a shambolic organisation (unanswered letters, unfilled prescription requests etc.) and the clinicians working in it are failing to deliver adequate levels of clinical care, even in the unlikely event that you do come face to face with a doctor.
It is not my field (I do not work in the law) but the criminal law system is, if anything, even more broken down than medicine. Nevertheless, I would hope that individual lawyers are not making anything like the level of basic technical errors that seems to be the norm in medicine. (My elderly mother-in-law was told by one GP – admittedly a locum of ‘foreign’ extraction – that shingles is caused by the same virus that causes the common cold. Well, he got the ‘virus’ bit right.)
Going back to my original point, if you are in a profession, you make sure that what is under your control is carried out to a high standard, and what is not under your control is managed.
I sometime wonder if GP’s have amended the Hippocratic oath from “First do no harm” to “First do f*** all.”
I agree with you that the NHS isn’t underfunded. But I don’t think it’s fair to pin the blame on GPs. Actually, most of all NHS funding goes to hospitals- I can’t give you the figure but it used to be 90 % when I was in it. Waste, excess of non clinical staff, paying over the odds for drugs, and one she hasn’t mentioned, health tourism, all deserve scrutiny. But they won’t get it under a system that’s free at the point of use and funded by the taxpayer. It can’t be said often enough- it’s the system that’s the problem. We need to switch to social insurance as they have on the Continent.
It’s social care that is underfunded leading to bed blocking. Address health and social care workforce shortages – sufficient medical degrees for all those clever keen applicants available now. Stop treating junior Dr’s like slaves. Give more funding to local authorities to pay fair cost of care to care homes and home care so they can pay competitive wages not minimum wage zero hour. Give a voice to the staff to recommend changes. Sort out pension issue.
Bismarck system ?
yes please !
I recently moved to a new GP practice in London. The old one had receptionists triaging patients, locked doors, no face to face appointments for months, calls missed, the usual litany. The new one does everything as it should. Calls returned by doctors, tests on time. Reliable and caring. A Ford not a Rolls but hey. Same system. Same funding. 200 metres away. The difference? It’s management. The doctors who run my new practice care about their customers. They are proud of it. This, for me, is where it starts and finishes. A&E is the manifestation. The disease is in primary care.
Absolutely agree and delighted to say that my practice is the same . If our two not remotely connected practices can achieve this why not all ?
Just to add, for a senior clinician to be advising via this article that people shouldn’t go to A&E is irresponsibility of the highest order, and suggests a serious lack of judgment on her part. Possibly a majority of the UK population can’t afford private healthcare, and even if they could, our private healthcare systems aren’t geared up towards mass treatment, let alone in an emergency situation. Where do you see signs for “Private A&E” anywhere?
I have experience of working in the NHS including on the frontline; my daughter was a Registrar in Paediatric A&E at a major children’s hospital until recently (she’s now on a medical ward) and despite the usual pressures associated with the role, coped well enough and didn’t report any undue strains other than what she’d anticipated. No-one’s saying the NHS isn’t past being ripe for radical reform (i could write several essays on it) and the managerialism described by others is the most serious issue holding it back – yes, even above funding – but to even suggest that a patient in dire need of urgent attention shouldn’t bother is actually unprofessional.
I thought exactly the same thing. “Don’t go to A&E” I suspect is principally there as a clickbait headline, but it’s is an obvious nonsense and seriously undermines what might have been a worthwhile article on such an important topic.
All depends on what you understand by A&E.
In the proper meaning of the word(s) Accident & Emergency should be just for that – but due to the collapse in GP services A&E is bunged up with people not there for Accidents and Emergencies
Its not just a failure of social care at the exit side – its a failure of primary care on the entry side
There are (or at least used to be) some private minor injuries clinics (obviously not enough)
For many people the option of driving to a private clinic (hospital minor injuries cliic, or GP) is the best – when I had a heart problem a while back my private GP saw me that afternoon and referred me to a private hospital that fitted a stent the following day (and BUPA picked up the tab for the hospital part).
I’m happy with the recommendation people avoid A&E if its not an Accident or Emergency.
This is a very good observation. I’ve had a depressing spell of close interaction with the NHS in recent years (first my father with terminal cancer then myself with a bad infection requiring multiple operations and ongoing treatment), and the simple fact is that A&E is no longer the preserve of Accidents or Emergencies.
Significant portions of the entire health system now run through A&E. GPs told my late father to just go sit in A&E for ailments they couldn’t diagnose / solve over the phone, same with his oncologists. The same was told to me repeatedly last summer during the worst of my illness. Nurses even give you tips on how to game the system and get ahead of the wait at A&E now.
The system has lost any sense of rationality or structure. Patients are just thrown willy nilly at the one “open” pathway to more advanced treatment, and all too often that now means overnight stays on A&E benches for a terminally ill man seeking relief.
Great. You can afford private health care. The majority of people cannot. Maybe that could be one answer. People like you pay for your health are while people like me get it free at the point of delivery. Except the people I know who could go private because why should people like me get it free! So maybe some treatments should be paid for at the point of delivery? Or some treatments just don’t happen? But that is deemed unfair and why shouldn’t tax payers get everything for nothing. It’s a mindset change that is needed in GB, not just England!
I thought exactly the same Steve. I’m not sure if the doctor who wrote this pieces isn’t trying to drum up some business. Certainly if they work for the NHS then when they should probably be disciplined. Imagine any other employee of any other organisation coming out and saying such things about that organisation. It would be gross misconduct. To have doctors and gross misconduct in the same thought is a worry
The fact we have an increasing population and some of the most unhealthy people on the planet probably doesn’t help.
What a disappointing article, especially on such an important subject. Few people would deny that the NHS faces major issues, nor that a rocky winter lies ahead. Unfortunately, the writer offers no possible solutions (beyond, it’s implied, yet more money) nor any original perspectives.
The main cause, apparently, is a “decade of austerity”, which is odd given that NHS spending was always ringfenced – spending only ever goes up – albeit you could make the point that insufficient investment and/or reform of related sectors like social care does have a knock-on effect.
And staff shortages are “due to Brexit”. Are they? So there were no staff shortages before then? And yet, as recent data shows, there are actually now more immigrant workers in the UK than before Brexit (slightly fewer from the EU – but only slightly – the shortfall in any case being more than made up by many more non-EU immigrants). This willingness to blame Brexit I suspect sheds more light on the writer’s political leanings than it does on reality.
And, for pity’s sake, drop the “gaslighting” thing. A dramatic-sounding term that all too often, in reality, means something like, “people saying things I don’t agree with and I don’t like it”. Surely, on such an important topic as healthcare, we need a healthy and wide-ranging debate uninhibited by allegations of malice.
What sort of healthcare system does the UK really need in the 21st century? As other commenters have pointed out, it’s possible that a funding mechanism first devised in the 1940s is no longer fit for purpose. Unfortunately, the insistence of treating the NHS as a quasi-religion, and criticism of it as socially unacceptable and politically toxic, is inhibiting the debate we really need to have. “A bit more money” is not going to cut it in the future – indeed, it hasn’t for a long time now.
Very well said. I, like the vast majority in the countr,y want a health service that works for both patients and medical staff, we want a service with universal access that doen’t bankrupt us if we are inflicted with a serious accident or chronic ailment, we want timely and effective treatment. Some areas of te country do indeed have all the above benefits, but too many do not and they deserve a good service as they pay for it too. It is probable that the NHS is under funded with respect to what we expect it to do, but that is not the only problem, and merely throwing more money at the NHS without identifying where the problems lie will not suffice to provide the world-class service that the people of this country want.
Some of the problems in discharging older people lies in the scrapping of small local hospitals and those convalescent homes who took patients while they recovered from treatment until they could go home. I think it was the Labour government who scrapped these, created new smaller hospitals with huge debts to keep servicing, and the opened migration floodgates without any corresponding growth in services or places to live
I had a fascinating chat with my GP about Brexit whilst waiting for the results of some tests she had done. She said that she had had to go for a half day training for some equipment they were now using because they couldn’t source the existing ones from Germany any more. The new ones were supplied by a commonwealth country. So I asked what the problem was as they could only be used for one thing which she was a specialist in. Well they came in a foil packet now instead of the box which she was used to. Did they work I innocently asked…Oh yes they are very good. Well, were they more expensive than before…No, they were actually a lot cheaper she replied. So what, exactly, I pressed was the problem with them…especially a problem that requireda half-days training to explain how to use them to an expert? Oh nothing really we just had to be taught about them so we could ask any questions & give our comments!!!! I kid you not, this really happened.
Staggered
Not staggered. This tells you all you need to know about NHS system purchasing – the cheaper option may have been there all along. Spending other people’s money on things for other people – as Milton Friedman noted this is the quadrant where yopu don’t care about quality or price.
I don’t understand why there has been so little mention of the NHS in the Tory leadership election. Almost everyone knows someone or has a family member who either works in the NHS or has need of its services so we know what a mess it’s in. Just look at GP services. It’s as if we are still in the middle of the pandemic.
Why would either candidate go near such a toxic subject?
Unfortunately it is engineered to collapse – its a completely unsustainable organisation but as the national religion no politician will take the problem on for fear of being accused of ‘privatisation’.
Go private ? Fine if you can afford it, I have spent over £3000 on private consultations/MRIs/spinal injections, but now face a two-year NHS wait for spinal surgery as £12,000 for private surgery is not possible. And GP appointments – don’t make me laugh, they only work part-time and getting past the gatekeeper receptionists is enough to cause mental health issues – my last attempt involved 200 redials starting at 8am to be told NO appointments left. My guess is that the best way to get medical attention is to rock up in Dover in a dinghy and it is immediate. I would not dream of asking for a prescription for anything I could self-treat but I won’t approach my GP now even for serious issues – let nature take it’s course. To add insult to injury – if as I am – you are at the mercy of NHS Wales then you are the subject of a double whammy.
Not a single mention in this essay of the millions of migrants and their descendants which are partially responsible for this state of affairs.
Whenever I look at the King’s Fund statistics I’m always surprised that the use of the NHS continues to rise at a per person level – at an individual level, people make more visits to the doctor than they used to, and we have more visits to A&E. Why are people going to health services more?
For instance, are we gumming up doctor’s surgeries with more and more preventative and diagnostic tests which would be better done by dedicated units for efficiency? Perhaps it is bureaucratic job requirements for formal sick notes which force people to the doctors? Perhaps we just have more maladies than previous generations?
Some countries like Sweden charge a small token fee for visits as a dissuader for minor ailments – would that help reduce unnecessary demand?
A number of years ago, the Australian government proposed just such a fee, with the usual exemptions for the elderly, those on benefits, etc – until a prominent conservative economist pointed out that it was precisely those groups which populate GPs’ waiting rooms.
I blame the doctors. They keep defending the monolithic nhs model . It’s a model that can never work for 68m people . We need the German/French model . Far far better treatment and outcomes and no NHS monopoly model. If doctors told the truth that there are far better delivery models the public would support change .
The UK has a number of critical systems which are inelastic and respond very slowly to increased demand.
House building is one of them (due to the lack of space to build around the places people want to live).
The NHS is another. If you import the population of Manchester every year, you need as many experienced nurses, doctors, beds, machines, orderlies etc as there are currently in Manchester.
It is impossible to keep up.
My idea – as I have said here before – is to re-introduce the cap on net immigration to halve the number of new house built in the previous year. So in 2022 it should have been 88k.
This will bring some respite to health care providers too.
Never been any different no matter what Government is in. During the seventies, I took my small son to A & E to have stitches in his forehead and we waited all day until early evening. During the Blair years of Labour Government, a relative was detained in prison before a mental health facility could be found for him. The NHS is in a continuous state of crisis. Other European countries manage to run a functioning, efficient health service.
How much money is enough?
If you spent every penny of the gross domestic product on healthcare, you would still have people dying from curable diseases. Partly because we are now able to cure so many more health-related problems & partially because we have let millions into this country who will never be able to pay their way so the demand is far to great for basicneed. Then you have the non-health issues such as removal of tattoos – because the person who paid to get them done is now embarrassed by their younger self’s decision. Treatment to enable people to have children which is often NOT a medical problem. Viagra so that men of a certain age can have fun rather than just accept that some things need to change when you get older, shall I go on? Somebody has already mentioned the cost of things like aspirin & paracetamol being prescribed rather than people having a basic first aid kit at home to deal with minor problems like headaches & buying items like this for themselves. And heaven forbid if a child falls over & cuts his knee, mum can’t just wash the dirt out, put some antiseptic cream on it and a dressing, it now requires a trip to A & E where said child will be rushed through ahead of someone possibly having a heart attack. stroke!
Indeed I was that man HA and seriously delayed at a&e by children with bumps and cuts! Always had PHC but they too are in crisis. Now faced with severe heart damage and a shortened lifespan! Sadly all preventable if GP social care and health screening was anywhere near up to the job.
Prevention is always better than cure!
Hmm, the call for more resources is a frequent one. The wife of a friend was a senior physiotherapist at a major hospital here in S Manchester. She was utterly dismayed by the fact that, regardless of any flu type outbreak, there were never fewer than 35% of her colleagues off sick.
I would imagine that post covid matters have got worse, not better.
Are you saying that personel with flu should go to work in hospitals where, I assume, most people are ill, possibly with immune compromised systems or are elderly or frail?
Of course I’m not saying that people should go hospitals when infected.
My point is that absenteeism is rife when there is No flu!
Repeated and widespread absence is linked to the repetitive and unsatisfying nature of the work.
Couple this with 6 months off on full pay and any enquiries as to cause deemed as ‘bullying’ and your superiors are not accountable for clinical outcomes anyway then you can see why things are as they are.
Anyway, who cares if physio is delayed…..?
This is life in the public sector, Linda, I know, I’ve been there.
My apologies, I misread your post.
As a senior physio she’d be responsible for staff absence management. Given that the NHS has a sickness absence rate of 4 to 5 %, her team sounds quite unique.
This is not a funding problem, it’s an allocation of funds problem. The NHS is choosing to spend money on things less important than A&E. The NHS is funded by £190 billion per year, or roughly £2800 per person in the UK. Other countries manage more with less.
If they paid me my share of that I could go back to having private insurance again where it took a day to book my MRI not the 6 month wait for an NHS one.
I’m sorry that this caring passionate public servant and many like her has had these experiences. I’m not sure, however that the root cause can be blamed on incompetence of anyone who works in the system. A major cause is a lack of political will due to the vagaries of public opinion. There are many examples but two jump out:
1. 25 years ago Michael Powers wrote ”audit society”. He lamented the growth of formal scrutiny, checking people and demands for accountability and control having gone too far, undermining operational capabilities and costing more than the potential risk at stake. His fears have come true and our pathogenic lack of trust in our public servants has created a monstrously expensive industry, limited creativity, disillusioned professionals and significant risk that goes unmanaged. Politicians must get a grip and ensure the nhs’s primary role is patient care, not backside covering.
2. Most healthcare is spent in the last year of life. Our system is compelled to maintain life at all costs. Is this what we all want? I can’t afford to live forever. If it’s my time to die in my dotage, I want to go on my own terms with dignity. It shouldnt be for us to endure excessive unnecessary treatment just to feed the healthcare industrial complex. Let’s embrace realistic medicine and legalise euthanasia and not force people to build their private suicide kit as part of retirement financial planning.
On your second point – where I live in the US, PAD (physician assisted death) is legal, but requires a terminal illness and some sign-offs. It’s comforting to know that’s possible if one needs it, but in practice this has not significantly decreased health care – it’s not widely enough practiced and often people don’t volunteer until pretty late in the process.
By contrast, in Canada, the MAiD program is much easier to access, and allowed for serious but not lethal illness, and for mental distress (like depression). There are a number of documented cases of people needing expensive treatment or support (eg: in house stair lift) receiving suggestions of using the MAiD program – because the program does save taxpayers significant money. That is, there are very real incentives to encourage people to use the program for the sake of others, and for vulnerable people, “voluntary” participation may be somewhat compromised.
What I’m saying is to beware of creating an official euthenasia program to be part of saving money for a failing health care system; what it looks like a decade later, following the inbuilt incentives, may not please you.
You say you want to go on your own terms with dignity; be wary of creating a system which encourages you to go on their terms instead, because say, they don’t want to fund a knee replacement, without so much dignity.
Problem is there are no private A&E centres. Just private “urgent care” which deals with non-critical conditions and doesn’t have intensive care etc. etc. So, if you have a life-threatening condition, there is no alternative to NHS.
Dr. Jones does not exaggerate. I can think of examples from my own experience which back up her narrative.
The basic problem is very simple. If you screw up in your job, does anything bad happen to you personally? For most of us (and that includes doctors and nurses), the answer is ‘yes’. For the senior managers and civil servants who run the NHS, the answer, clearly, is ‘no’.
Nothing much will change until senior management get the message that they might be rewarded with sanctions up to, and including, dismissal, if they are lazy or incompetent.
David, if only the truth was that lazy/incompetent senior managers was the root cause – life would be so much easier and the problems simpler to solve. Sadly, we are where we are despite, by and large, managers who care, try and work just as hard as you.
Is there such a thing as private A & E? I have always understood that private medical care does not cover an emergency, it may help with consultations and rehabilitation, but if the need is urgent we all have to rely on the NHS which is a scary prospect.
Here’s a vignette. I live part time in the UK and part in Sri Lanka. In March in Kent my sister-in-law suffered a fractured femur. The ambulance took well over an hour to arrive. We were told we could expect to wait up to two hours. Two years ago a guest at our Sri Lankan guest house, in the mountains south of Kandy, was taken ill and a Sri Lankan ambulance called. It arrived in a little over half an hour from Kandy Hospital. Which country is in the third world, I wonder?
Hey kids. I have this weird idea. The problem with A&E and the NHS and universal health care is gubmint.
You want a service, then pay someone to provide it.
You know what the King said in All’s Well That Ends Well. My NHS is to me religious. Else doth err.
Mind you, I get why the priests have made the NHS into a religion. That way anyone that disagrees with the 39 Articles is a heretic and you know what we do with heretics around here.
The only thing that government is good for is shafting its enemies and rewarding its friends. Period, full stop.
Having lived in Spain and France if you present at a GP with symptoms you will automatically get a blood test or x Ray, whereas here, GPs do guesswork and hope you go away until it “clears up” by itself.
Which in most cases it does.
Except when it doesn’t and it’s too late to cure……….
Unless they can bung you on metformin & statins which means they get extra money per head (if enough of their patients are deemed to need this) to have you as a patient…not a lot of people know this!
You are right people definitely do not know this. This may be because it is untrue.
I think the NHS is the country’s biggest employer and is certainly heavily exposed to all the rapid demographic changes happening today.
It seems blaming funding, or bureaucracy, or training, or having a pop at GPs, are all just biting different parts of the elephant. Until a serious overview is taken of all the systemic parts
population growth
Population aging (both as a source of more illnesses and iro underfunded care for the aging)
Rising mental health issues
Staff training at all levels
and no doubt much more,
we won’t be able to design something fit for purpose and therefore won’t have target at which to aim a transition process.
As somebody else has commented, such a review could only produce a result if undertaken as a cross party exercise. So fat chance, unfortunately.
Get a job in the NHS, you gave a job for life. Few people get sacked even if abysmal at their jobs. There are people who asoend most of every year off sick but still being paid. Why? Because they can. The way their contracts run allows for this. Change their contracts, save millions. Make the NHS run on a private sector contract model and see how much improvement happens because people will have to work or be sacked!
So this character admits the service they operate to (handsomely) pay their wages is a sham, and one that still guzzles huge amounts of money for little or no delivery? And that having paid them we should then pay again for a genuine service to do the job we paid them not to do. There are many words for this sort of behaviour in English, fraud and theft being 2 of them. Thankfully the article doesn’t match my experience of the NHS (both routine and emergency) so i’ll put it down to Dave & Dierdre Spart syndrome. Meanwhile if we put the whole show in the hands of for profit insurers like Spain or Switzerland the problem would solve itself to some extent, if we had a legal/regulatory system to control quality and the worst instincts of profit of course – which neither the UK nor US has at the moment. As for the author i’d advise them to listen carefully to track 15 of the Murderdolls debut album. There is nothing that gets me going like leveraging illness, infirmity or other weakness for pecuniary gain.
Where has all the money gone?
I’m an “A&E” (we call ourselves ER docs) here in Canada. We have no parallel private system. Our system sounds as bad or worse than yours. COVID was a great excuse for bureaucrats. They are still using it, even though out of the ~2000 patients I’ve seen so far this year between ER and family practice, exactly 5 have seen me for COVID. I admitted zero to hospital.
Here in Canada, our system is so top-heavy with management that we have 10X as many medical administrators per capita as a country like Germany that has a more functional system. We have so many managers that their express purpose seems to be to create enough rules to make our work experience miserable, and to make it as difficult as possible to actually look after patients.
I had a great talk with the cleaner at the tiny hospital I work at in Nova Scotia. She was able to correctly identify the problems in our local system and to suggest very reasonable solutions that would actually work if implemented. But given her lack of a degree in healthcare admin, and the fact that she only makes 21$/hr as opposed to 160K per year, nobody will ever listen to her or care what she thinks. And we will continue managing our system to oblivion.
To you Brits I say: hold on to your private system tightly with both hands. We don’t have one here (private care is illegal under the Canada Healthcare Act), and people are dying for lack of any options In Canada our healthcare motto seems to be “we don’t care if there is no access to care, as long as we have equal lack of access for everyone”. Very analogous to how in communism we are all equal in the rubble.
It is very hard to claim that the NHS suffers from under-investment given the ever increasing amounts of money being thrown at it.
I suspect the reverse is actually true. Lack of proper budget discipline and prioritisation leads to poor management and sloppiness.
I’ve just seen Polish A&E at first hand in Cracow. That all worked fine – 10 minutes for the paperwork (mainly language stuff), less than 5 minutes for triage, immediate referral to the relevant doctor. All very efficient and well done. How do they do it ?
One other thing – the Polish hospital had all Polish staff and Polish flags on display – i.e. a national health service.
But the NHS is “the envy of the world” and we have nothing to learn – just give us more money …
In any business run this badly, the management would be fired. Note: the management. Not the politicians.
A&E shoukd be for drastic action, everyone else sent home. Once you are stabilised….sent home. Bed blocking and sniffles shoukd not be for A&E.
The interesting thing about this article and the comments is that there is very little comment about what the NHS does. We need a public debate about this.
So for example should the NHS do:-
– tattoo removal
– sex change
– infertility treatments
– etc
I am not arguing that they shouldn’t but you couldn’t get these things done on the NHS 30 years ago. I suspect the public would be happy with reduced scope but working better.
With the increasing level of diabetes – now more than one seventh of NHS spending – more than double what it was – and the increasing scope of services it is inevitable that funding at levels of inflation or slightly above are not going to be enough.
A&E has been an issue now for a long time, clearly the NHS have decided not to prioritise fixing it. Why?
I was told two stories about bed blocking, one patient unable to leave because the prescribed medicines hadn’t arrived for a couple of days, the other because the care home didn’t have the right lifting gear and NHS weren’t prepared to lend theirs. Back to the Blob thinking.
.
I have private health care. It costs me £500 per month. But I still have to go to A&E if I have an Emergency. (My wife drove me there last time) Private health care DOES NOT deal with emergencies. You have to have a referral from a GP. So Emma Jones, I’m afraid your starting point is not valid. Most of the rest is.
Jeremy Bray says “It is hard to see who has the critical will and ability to unclog the system that needs a virtual enema. If the Conservative party politicians can’t or won’t change things Labour, the party of the Blob, certainly won’t.” This is why the Tories stay in power. I don’t know what he means by “The party of the Blob”. Clement Atlee, Harold Wilson, Gordon Brown, Tony Blair, all had distinctive differences. No-one knows how Milliband, Corbyn would have performed, or how Keir Starmer will perform.
Finally if we had Proportional Representation we probably wouldn’t have these problems.
It’s not to hard to organise oneself to create chaos…
I reckon it’s similar to Irelands HSE problems:
– “free” meaning an extraordinary level of waste
– an ageing population that will only ever gather more health problems.
– more available treatments to spend more money on.
– a mostly weekday 8-4pm service trying to deal with round the clock problems
– smaller families to look after older, further-away relatives with ever more complex health problems. Needs more professional basic care staff employed.
– exporting huge numbers of trained Drs and nurses, leaving for better conditions
– while paying to import huge numbers of trained Drs and nurses from poorer countries.
– third level institutions that cater for ever growing numbers of foreign fee paying students who will never work in this healthcare system.
– strong unions resistant to change.
– a public who don’t care until they land themselves in the Emergency Dept despite having heard of the state of array in media for the last 15 yrs.
– if I go on, I’ll only ruin my Saturday.
Read: “Can Medicine be Cured” by Dr Seamus O’Mahoney
https://seamusomahony.com/books/can-medicine-be-cured/
Follow the money.
But it is employees of the NHS that are responsible for this, together with the quangos, journalists and politicians that support it. You created the problem, you own it, you solve it. The system has simply collapsed under the weight of its own bureaucracy. The bureaucrats are you. It is your system. It doesn’t work.
As usual, it’s a not a conspiracy, just a massive c**k-up
How in the world do the British put down the US system? As two older citizens in our 70s, both retired, most of our needs are covered promptly by Medicare providers. We have the choice of many fantastic private physicians as well. In addition most cities (I live in New York) have many private walk-in clinics which cover virtually anything and take virtually all insurance, private and public.
Important to hear from the front line but I have one or two quibbles. It’s nonsense to talk about austerity and NHS funding in the same breath. As the author seems to acknowledge later in the piece, there is an enormous amount of wastage.
Why the gratuitous reference to Brexit? Brexit has increased immigration from outside the EU but, frankly, we shouldn’t be depriving less developed countries of their home grown medical talent in order to compensate for our own failure to train enough doctors and nurses.
Hospitals should set up their own “halfway houses” to get bed blockers off the wards.
Finally, if something is free, there will always be a queue.
Gaslighting on the NHS! They couldn’t get away with it. NHS is not some Kafkaesque Gulag. A rip-off. Those Angels,…no wait…
There’s nothing new about dentists turning away patients. 25 years ago, they were doing everything they could to avoid ‘non-target’ patients. They actively wanted to create a community of dentally unhealthy people because they didn’t think they could make money from treating them.
Medicine is no longer a vocation, it is a business.
Businesses are driven by the profit motive, not by vocational philanthropy.
I agree, having been at the wrong end of the 999 system having suffered a stroke in July. Eventually, my son drove me at mach 3 to the hospital in Belfast, where I was unlucky enough to have a heart attack but lucky to be in the stroke ward when it happened. They gave me covid before I left, though.
The single thing I never see in pieces like this, though, are solutions. Nobody seems to have any, or if politicians, know and understand the problems but are possibly afraid of taking action; if hospital administrators/doctors/nurses, I suspect the same, unfortunately. I’m resolutely Private now.
This is my experience of the NHS too. But what is to be done? How do we mobilise to generate political action to change this situation? Or, in personal terms, what can I do?
Good article. There seems to be a lot of ideological dogma around NHS, and all options should be considered.
This is still better than healthcare in the US.
So What? Your comment suggests that the US system is the only alternative. It isn’t.
Yes, that nails it. We are a lot closer to continental Europe; why not compare the NHS to Sweden, Germany, France etc? You never read about theses healthcare systems in the popular media. British people’s America obsession is destroying their brains.
The Swedish NHS outsources a lot of primary and secondary care to private healthcare companies based on contracts with yearly allowances/quotas. The standard of healthcare is generally pretty good. These companies were also utilised during the pandemic handling when the NHS was strained.
If the UK system received the same level of funding as most European models I’d wager we’d see similar outcomes. Unfortunately it often tries to take on much more work with much less money
This simply is not true these days. The NHS has had huge real terms increases in funding over the past 25 years (since Tony Blair decided to increase it one morning during a breakfast TV sofa interview). Shortage of money is not the problem. I suspect the reverse is true.
Israel has an insurance based system. If you can’t afford insurance the government pays for it. This is for ALL citizens not according to religion before any suggests that the Arab citizens do not get the same healthcare. They do AND it still manages to offer care to those who are not citizens such as the palestinians who have refused to take up citizenship.
An excellent point . Israels system should be examined along with (no irony intended) the German Bismarck system
It’s the usual left wing response to any criticism of the NHS.
How is the situation described, “better”? It’s cheaper out-of-pocket. That’s it. ER’s and trauma centers in the US are way too busy, but not the way described, and ambulance service is certainly not unavailable due to crews being allocated to babysit in any significant portion of cases.
Facilities go on “divert”, but the myth of the system being described being better…myth. the problems are just different.
But is it really ? The best healthcare in the US is far better than the NHS. What are you comparing ? Worst US vs average UK ? The complaint about US healthcare is not that the average level is poor, but rather that the service is poor for the less well off and that it is (overall) far too expensive.
What is “A&E”? Spelling out an acronym at least once is generally a good idea if your audience extends beyond your solipsystic sphere.
Mr. Cunningham, if you’re from the USA, it’s the equivalent of our “Emergency Department” a.k.a. “Emergency Room”. The Brits call them “Accident and Emergency” departments or wards.
As to whether the UK system is better or worse than that of the USA, that’s debatable. Some of the allegedly best and most innovative healthcare minds in America (e.g., the Institute for Healthcare Improvement (IHI)) used to praise the UK system as one the US should model. Maybe not a great idea.
The US system costs more and yet our Emergency departments are overcrowded and sometimes dangerous places to work and be. No one seems to have gotten it right. One thing’s for sure … innovation and healthcare operations seem to be antithetical.
A&E is one of the most common and understandable phrases in the country. There’s no need for insults to the author when you’re clearly reading from a totally different country. If you’re reading a British article aimed primarily at fellow Brits, it’s your responsibility to quickly google A&E if you’re confused.
Funny that Unherd didn’t require me to pass a test in UK abbreviations before it accepted payment through my non-UK credit card.
I regularly correspond with a dear US friend who frequently uses phrases and acronyms I’m unfamiliar with and always check online rather than embarrass him with such silly questions (as, I’m sure he does on my account) .
Desist sir and think on…..
What we used to call “Casualty”
How shocking that an American would accuse someone else of being ‘solipsystic(sic)’. But they don’t do irony, do they?
Love that !
This was a bit rich. Most contributors to Quora use US acronyms all the time and never spell them out for the benefit of readers from other countries.
It’s kinda like the opposite of NRA
Nice one