Saturday, June 12, 2021

WEEKENDER: Death of the NHS, by Wiggia

Does the NHS actually exist any more, or is it an urban myth ?

I am not alone in believing the NHS is being slowly dismantled. This was happening long before Covid and the virus has simply speeded up the process. My own and family problems are as good an insight as any; many friends and acquaintances tell the same sorry tale.

Underneath it all is a country that accepts so many things with a shrug of the shoulders; many others would not; it is our way. Yet we pay for the non-service.

The overall problem is just not the poor top down management, or the farcical contract the GPs have exploited after Blair gave them way above what they asked for, but the seemingly total lack of any plan with meaning to correct the deficiencies.

It could be the NHS has reached a stage, and many would concur, that it needs dismantling in its current form and rebuilding from scratch. Not easy when so many still believe it is ‘the envy of the world’ when it is clearly not.

There is also the overriding impression that many in the NHS believe they are doing you a favour by just being part of it, an example of which is the nurse who when I explained a couple of years back about not being able to get an appointment, said with a straight face, 'Well, it is free.' How a supposedly intelligent woman could actually believe the NHS was free still escapes me but she meant it and thought I should be grateful for any crumbs that fall from the table. Her attitude is not hers alone: quite a few health professionals believe the NHS is theirs to be apportioned as and when they think fit.

It starts at the entry point, the GP surgery: this has gone from a 24-hour, 365-day-a-year service for those that needed it, to five-days-a-week 8am-5pm (with lunch break), with access almost impossible in many cases.

Sometimes a bit of simple investigation reveals a lot more than appears on the surface: the interminable entry recording when you phone, about Covid measures, how not to waste the practice's time and 'do not press the wrong option or you will have to start again'; this is then followed by the inevitable 'we are currently receiving high volumes of calls, can you phone back later?' or be put in a queue. I did this this morning to be told I was number eighteen in the queue and I cancelled the call; not only could you be hanging on for over an hour as has happened several times but you could also be cut off after a similar time as has also happened, making the whole thing pointless; perhaps that is the object, to simply discourage people from actually using the service.

In my case this morning it was after going into the surgery, or as it is called a ‘Medical Centre’
and speaking to the person dealing with prescriptions because I need my pain killers increased in number or potency as my hip arthritis gets worse. It was explained to me that a doctor would have to speak to me to get the prescription altered and for that I had to phone in - which makes her job on the desk a bit pointless. I have three days of tablets left and no way of accessing them other than trying to phone in; phoning in later is not an option as all the telephone appointments have been allocated. 

In essence the surgery is not fit for purpose. The cries of 'lack of GPs' may well be true, but the position is exacerbated by the fact so many work three days or less as I have found out in my practice. My own allocated doctor, nice man though he is, only does Fridays in the surgery and half of that is phoning people; I have no knowledge of any other work or hours he puts in but he is not seeing sick people in that surgery in the numbers required.

The same cry goes up throughout the NHS, 'we are undermanned' is the mantra. Again there is something very wrong with an organisation that is so low on the list of doctors per thousand patients, hospital beds available, a shortage of nurses, when the same organisation is the biggest employer in Europe. We all know what that suggests and is undoubtedly true. The recruitment of diversity coordinators is not going to solve the problem, or interfering in the management of parks or even (despite the small numbers involved) having health workers decide to help out in foreign countries when they are needed here; who decides to spend our money that way?

Despite claimed manpower shortages you can see from the above chart there has been a 5% increase since last year and there was a 4% rise the previous year; where are they all?

NHS and social care staff burnout at an emergency level - report

Certain aspects of that report are undoubtedly true, but the GP complaining about being overwhelmed and burnt-out since the end of lock down is almost funny. They have been doing bugger-all for over a year, and how many in her practice work full-time, never mind overtime?

Using the pandemic as a way of prising more money out of us will not solve the problem. There has to be a root and branch change to all aspects of the NHS, starting with the GP area.

As far as myself is concerned this started way before the virus re GPs. My own tale goes back about five years when I became ill and had no idea what was going on. Because of the difficulties of getting in to see a GP I ignored the symptoms and they went away to return about three weeks later. I was really not well now so I phoned on several consecutive days over nearly two weeks with no joy at all, as they won't let you book in advance every day (the same saga) and was then told there were no more appointments.

Over the last weekend I said to the wife I was going to the surgery to demand to see a doctor on Monday morning, Monday morning came; I got up, went into the bathroom, felt terrible, came out and passed out on the bed. An ambulance was called and a paramedic did various tests, phoned the hospital and I was taken in to the emergency ward.

The long and the short of it was I had blood clots on both lungs and on the feeder arteries. There was nothing wrong with the treatment I got in hospital but I did learn a few home truths about GPs loading hospitals with procedures they should be doing; but when I was discharged the anti-coagulation senior nurse told me I was very lucky, another 48 hours and I would have been dead; so my loathing of the GP service went up a notch at that moment.

No health service is faultless. All suffer the perennial problems of new procedures and new drugs, all of which add to the bill. The difference in so many other countries is that the people who pay (you and I) have a say in how the health service is run; using an insurance element takes some control away from those who want to decide how we access medical services: you have a choice of doctors, surgeons and hospitals.

I was emailing the daughter of my oldest friend in Australia who is a psychiatric nurse, as is her husband. She could not believe how the NHS has sunk, and when I mentioned having to go private for my hip operation because of a two year wait on the NHS, she could not believe that either - plus no rebate for going private?

The price incidentally has firmed up since the virus created the waiting lists, and the private sector is using market forces in deciding how much you pay. Pre virus, depending on where you went to have the op, it could be as low as 9k; now everyone is around 15k and it is either that or a wheelchair. The time I have left is too precious for spending years suffering and not being able to walk, so I dip into hard-earned savings; and I am lucky enough to have that - many don’t and they have been left behind by the caring NHS as have so many others with different diseases and complaints.   

On the procurement level the NHS is like all national bodies: it is not their money and so what? Nobody is ever accountable, unlike in the private sector. The many billions of pounds wasted on failed IT projects is a total disgrace in its own right, never mind badly-designed hospitals and equipment fiascos.

There has to be a change in the way the NHS is run. It has to be run for our benefit. If it needs more money it has to be accountable. The taxpayer needs a say in it all by having real choice; at the moment there is none, we are at the mercy of government whims, NHS self-interest and completely inadequate entry level care. When you add to that the deity which the NHS for many has become we have a huge problem.

The BBC article linked above is largely concerned with NHS staff shortages and well-being, focusing on their stress during the pandemic. It quotes 44% of staff being made unwell during the pandemic; how is that, when most of the NHS was at home or on standby? Only a relatively small number were engaged with catering to virus victims. There is so much emphasis on the NHS staff and very little for those who the NHS is supposed to care for and has failed miserably. The numbers in other areas outside of Covid who have died or been severely handicapped by their neglect is only just beginning to surface.
Either the NHS reinvents itself soon or it would be better if it went away. On so many levels now it really is not fit for purpose.


Sobers said...

Its the inevitable destination of any large organisation that operates with zero market feedback, it will become run pretty much entirely for the benefit of the staff and any customer service that occurs is a by product of the primary aim of providing for the staff's needs.

The NHS has more than enough staff to achieve its aims, the fact is that a huge proportion of them do very little. The ones that do try are hampered by the utter confusion and lack of communication that reigns over the entire edifice. Plus of course you have the malingers and downright liars who actively do as little as possible. My father is very sick (dying basically). He is cared for at home by my mother and a team of private carers (which incidentally the NHS doesn't like - there is a seam of chippiness a mile wide throughout the NHS towards anyone who dares to try to get a better level of care than they deign to provide). As it has been hard to get him to eat recently my mother called the district nursing care team to attempt to get some assistance with diabetic needs (lifelong type 1 diabetic) The nurse she spoke to said that the issue at had was the responsibility of the diabetic nursing 'team', so my mother asked if she would contact them and ask them to come and see him. 'Oh, no we don't do that, you have to do that yourself!' Cue to a few days later and a meeting when this very nurse was present with the GP, and she flatly lied to my mother's face 'Oh, we spoke about contacting the diabetic team but Mrs XXX said she would do it herself'.

The whole edifice is rotten from tip to core. There is no 'reform' capable of improving it. Any amount of money thrown at it would be consumed by the staff and no additional healthcare would come out of it. Only a complete destruction and rebuilding from the ground up on better principles would achieve anything, and that is not going to happen, so just get used to having no healthcare when you need it, all the while having the refrain 'The wonder of the world' ringing in your ears. The NHS is basically pure socialism, and as such we have reached the inevitable final destination of socialism - utter failure to provide anything, and bucket loads of lies telling you how wonderful it all is. Oh and public denunciations of anyone who points out reality.

The only solution I can see would be to give people healthcare vouchers that they could use however they saw fit, either as 'payment' for NHS services, or as part payment for private ones. This would a) create more private provision as people would seek to leave the NHS and b) reduce the NHS's income thus providing some market feed back.

decnine said...

Monopolies tend to become fat, happy and indifferent to what their customers think of them. You are half right. The NHS needs to be dismantled. A better replacement would be the publicly funded + privately delivered arrangement common across the Channel. The only force that can keep a supplier on its toes, attentive to its customers, is ... Competition. That is the one force that the NHS is not exposed to (for all practical purposes). See also Education for another example of the producer capture that Monopoly enables.

Scrobs. said...

Excellent post, Wiggia.

Since the covids started, I've had an unpleasant feeling that the talk was always about the problems faced by the NHS, not the poor bloody patient!

That's the patient, the person who actually pays for the NHS!

Nessimmersion said...

Vouchers is one way forward.
Its notable that none of the countries operating the Bismarkian or Social Insurance Model suffer from these problems, as they have a 1st world health service.
Singapore tried an NHS, realised it was stupid and rapidly went over to a 1st world health service instead.
We just need to look round the world, decide which proven method of operating a health service we prefer and adopt that one.
Examples: Germany, Austria, Switzerland, Holland, Japan, Australia, Singapore, etc etc.
They all have better health outcomes, much much lower waiting lists, the ability to bypass the GP when you feel like it and crucially the opportunity to pay more for health if you choose to.
NHS zealots will screech about selling the NHS, but I have never understood why they feel that foreigners are entitled to better healthcare than the British in perpetuity.

Sobers said...

"We just need to look round the world, decide which proven method of operating a health service we prefer and adopt that one."

Thats great, but the question is more how on earth would we get to a new system that worked, from where we are today with the NHS? In practical terms? We have a virtual monopoly supplier of healthcare services, we can't just move to an insurance based system (for example) if there are no alternative suppliers in place to keep the NHS 'honest'. Otherwise they'll know they are the only game in town and nothing will change. And I can't see any government allowing the local NHS hospital to go bust because too many patients had taken their money elsewhere. So we'd be back at square one, with the State funding healthcare provision directly again.

I just fail to see that any reform is possible - you just can't get from where we are to where (say) Germany is. Its almost certainly politically impossible, and it could be practically impossible as well. My feeling is that NHS has to descend to such a level of failure when even the most one eyed supporter is forced admit anything else would be better. Then reform might be possible. Until then we are screwed, unless you are fortunate enough to be able to go private from your own resources.

Sackerson said...

@Sobers: vouchers ?

Sobers said...

"vouchers ?"

I think vouchers are possibly the one thing that could be done to the current system that might improve things, not so much in the NHS sector, they'd still have no market feedback and would still be guaranteed State funding regardless. But it would create demand for the private sector, which would expand to fill that demand. And thus the private sector would get bigger and eventually you might get a scenario that there was sufficient private sector capacity that you could start closing down some of the NHS capacity and make people redundant there. And you might after a suitably long period of time get to a place whereby you could remove the 'free at the point of use' and replace with social insurance based model, because the range of choices was large enough for that to work. But that would take decades, and be subject to much political interference and probably rollback to the bad old ways.

I don't even think the baby step of vouchers is politically viable anyway. They would be branded as a freebie to rich people, and as 'taking money away from our NHS' and all the usual BS. There is such a huge amount of vested interest in the status quo in healthcare, and allied to the public's natural fear of the unknown I suspect the NHS is utterly unreformable in any way. It must literally collapse in a heap and be a pile of rubble before anything better will be considered.

Jim in San Marcos said...

In the US, the politicians want to give us universal health care and I don't see it working here either

Physicians and nurses are a limited resource.

Healthcare for everyone is a blank check, to an unlimited resource.

If price isn't used to limit consumption, then all you have left is rationing.

Government management in the private sector is very unproductive. There is no reward for increased productivity.

The health care professionals pay the price in socialized medicine.

I hope you find a solution. The funny thing is that our politicians keep pointing to the success of socialize medicine in GB. Go figure.