So, where did the National Health Service go wrong?
I’ve written a series of entries that deal with some of the
problems, as I see it. For what it’s worth here they are;
1) I wouldn’t start from here, if I were you.
2) Money, money, money.
3) If it wasn’t for the patients…
4) Er, actually who is the real enemy?
5) How could anyone actually not like the NHS?
Of course, the NHS didn’t go wrong.
Even at its worst, when patients are left lying unwashed for
11 weeks or left to starve, as recent cases in the press have highlighted, it’s
still the best there is. Don’t believe me?
Take a look at Jamaica – I have relatives there. Effectively,
all medical treatment is private – you pay or you go home. They have the
American system and for the little things maybe that’s OK?.
Except this is a poor country, where a majority of people go
hungry many days and so most people stay at home and use “alternative
remedies”.
If you are rich – that’s fine, we take AMEX.
If you aren’t rich but you have money (preferably that’s in a
hard currency) you take out insurance like Blue Cross (it’s essentially the US
system). Except if you lose your job or miss payments it’s unlucky for you and
the family.
There are limits to what treatment you get – and major
illnesses are the gift that goes on giving, at least for private hospitals.
When the insurance runs out, so does the treatment.
Last of all, there are public hospitals, basically A and E’s
which are like a war zone.
Prescriptions are not free – the pharmacist is not running a charity
and it doesn’t matter what you’ve got, if the money runs out, its back to
alternative remedies.
Alternative remedies? That seems to involve boiling tree
bark. Hmmm.
As I said, it’s essentially the American system where the
most common cause of personal bankruptcy is falling ill.
Fall ill in the UK? The hospital is a drive away, treatment
is a few hours away and it’s provided free by some of the best Doctors and
Nurses in the world. No fear, no worry; at least about money.
And you think we went wrong with the NHS?
1) There is of course the old joke; stupid English aristocrat
asks; “Can you show me the way to Kerry?” Wise Irish peasant replies; “Oh, if I
were you I wouldn’t have started from here”.
In 1945, while the Second World War still raged, the first
election since 1935 took place. The crucial votes came from millions of
servicemen and women, many stationed far away.
Everybody assumed that the great wartime leader Churchill and
the Tory party would win. He didn’t, because no one wanted to go back to the
1930’s. There was a Labour landslide and this was because of the promise of a
welfare state, free education and a National Health “scheme”, free for all and
based on need.
The problem was that after the war, Britain was bankrupt and
on rationing. There was no money for anything and in the terrible winter of
1947, potatoes froze in the ground and even the coal ran out; sold on the world
market for desperately needed hard currency.
When the NHS was set up, the hospitals weren’t purpose built
or planned. They were inherited from the old system. So, Charing Cross and St
Bartholomew’s were ancient charity hospitals for the poor. The rest were the
old Parish Union hospitals – like West Middlesex and Upton walk-in centre in
Slough. These dark and depressing buildings were part of the workhouse system
and all that meant.
To working class people that meant the fear of entering the
workhouse and never coming out.
To Doctors and administrators whose attitudes were laid down
by a Victorian view of “the poor”, who they divided into the deserving and
undeserving, that meant contempt for patients and their problems.
If the people who built the NHS in the 1940’s had had a
choice, they would have opted for new, bright, airy buildings staffed by young
Doctors and Nurses, idealistic, caring and as forward thinking as themselves.
Instead, the system we have now, rose out of the chaos of war
and inherited the buildings and attitudes of the 1930’s that everyone had voted
to leave behind them.
2) Money, Money, Money.
When the National Health Service
was being set up, there were a lot of people who were doing very well out of
the old system and didn’t want it to change.
The consultants were almost exclusively working privately and
making good money out of it. There was no such thing as a generally available
G.P. – there were Doctors and you paid for them or you weren’t treated.
Friendly societies operated insurance schemes; you paid in
every week and while you were up to date you would get some treatment. Trades
Unions operated similar systems and some like the South Wales Miners Federation
even employed their own Doctors.
Pharmacists were making good money, dispensing “cures” to
people who couldn’t afford a Doctor.
When the NHS was being built, the British Medical Association
threatened to boycott the new service unless major concessions were made;
resulting in consultants having time and access to NHS facilities to do private
work. G.P’s and Chemists were to be self-employed.
The new health service had to guarantee the financial
interests of all those, like doctors, who had done well out of the old system.
Pharmacists were guaranteed a good living and a local
monopoly, which means that even today a Chemists shop (with a licence to
operate) sells for huge amounts of money.
The pharmaceutical industry grew up making millions out of
the NHS and in addition uses NHS patients as guinea pigs in medical trials,
without which it would have problems in developing the drugs it charges the NHS
so much for.
All of this represents huge amounts of money drained out of
the budget for treatment and doesn’t even include the “Private Finance
Initiative”, where new hospitals are built on Hire Purchase, except that at the
end of the term we don’t get to keep the hospital.
All this is paid for by annual payments over 50 years to
“venture capitalists” which add up to many times more than the cost of just
paying up front.
The Governments new proposals are to bring in private firms
to provide services and run hospitals, draining even more money out of the
system.
Think about it; if they can make a profit out of it where
does that money come from?
From the money available for staff and patients.
3) If only it wasn’t for the patients there would be such
nice orderly wards and clinics with everything running smoothly.
Dr Harold Shipman reached that stage in his career when he
found the job less rewarding than it had once been. Unfortunately instead of
giving up or taking a sabbatical, he started to poison his elderly and
irritating patients. There are probably more than a few struggling A and E
practitioners who begin to feel that way on a Saturday night too.
The thing is, it’s the patients that should make it all
worthwhile. Unfortunately, Victorian attitudes have been handed down from
Doctor to Doctor and from Nurse to Nurse. Generally, if you can avoid talking
to a patient, that’s best.
One reason patients aren’t seen as rewarding is that we can
be such a pain in the neck. The problem is that when you are ill that’s all you
think about. People forget that they are human beings and that the staff around
them are human beings too.
Unacceptable behaviour should be treated as just that;
unacceptable. That doesn’t mean that people shouldn’t be treated but a system
of yellow and red cards would be easily understood and in all but the most
urgent cases there is no reason why treatment couldn’t be delayed for a patient
to be spoken to about their behaviour by someone who is trained to do that and
is not part of the medical staff. Many people actually do not realise that
their behaviour is unpleasant – it needs to be explained to them.
Some unpleasant behaviour is caused by people’s medical
condition, fear or pain.
At the same time there are medical tests that are given
painfully, cannulas that are inserted wrongly and blood samples taken by staff
less able to use a needle than a drug addict. There’s no excuse for not doing
your job properly. Maybe when Doctors and Nurses are learning at medical school
they should try out inserting cannulas on each other under supervision before
they try it out on patients.
At the end of it all, it’s about having a bit of mutual
respect.
4) Eh, who actually is the real enemy?
I’ve never come across a workplace so divided by job title
than a hospital, just at a time when unity and mutual respect between work
colleagues is so essential.
Snooty Consultants treating Nurses with contempt, placing no
value on their practical experience.
Nurses looking down on Care workers because they lack
qualifications and do all the unpleasant jobs.
Everybody envying what Consultants and Doctors earn,
unimpressed by their expertise and knowledge.
A general dislike of Junior Doctors.
Nobody having any regard for people doing scans, taking blood
samples or working in a lab.
These are Victorian attitudes, handed down from generation to
generation and they need to go.
Why?
Because patients suffer when a ward round results in a 30
second conversation and where nobody ever does anything that they feel is
someone elses job. That’s how a patient can be left unwashed for 11 weeks on a
ward.
Where no one takes responsibility unless it’s written on a
schedule and where nobody ever interferes when someone else isn’t doing their
job properly.
In a time of cutbacks and wage freezes who suffers when work
mates are divided against each other?
In fact, virtually no one in a hospital ever thinks of anyone
else as a “workmate”.
A divided workforce which doesn’t respect each other is
easily defeated; and that means cut back, privatised or outsourced.
Funnily enough, the people you work with aren’t your enemies,
any more than the patients are.
When you have worked out who your real enemy is, perhaps you
can start treating each other with respect at work.
5)How could anyone not like the NHS?
Well you would be surprised, there are lots of groups that
don’t like what we have and have been working to destroy it for the last 70
years.
Their problem is that it’s so darn popular; public opinion
polls regularly show that it’s the one thing that unites all of us in national
pride – left or right, young or old. People cannot conceive of having to pay
for medical care when they need it and nor should they have to.
It shouldn’t be any surprise that Danny Boyle made the NHS
and GOSH, Great Ormond Street Hospital for children, a centre piece in the
Olympic games opening ceremony. But not everybody thinks that way;
There are private hospitals who wish that they had a monopoly
of healthcare.
There are those who would rather treat private patients than
us.
There are drug companies who resent their reliance on the
state as a monopoly purchaser for so much of their income.
The Pharmacists would like to be able to charge whatever they
want.
There are financiers and venture capitalists who smell the
money to be made.
There are Chief Executives who dream of running the hospital
as though it was “their” business and paying themselves for doing that.
Above all, there are those who dislike the principle that
there is a right to free healthcare and want it gone.
All of these and more want change, their problem is they
don’t see how they can do it. So, for now, bit by bit, service by service, the
profitable bits are being chipped away.
Here and there, profits are being made where once only a
service was being offered.
Where there were once public servants, now super salaries are
being paid.
Public land becomes supermarkets, housing estates or car
parks. When hospitals or clinics are built, super profits are made. Pockets are
lined. Patients and staff suffer.
The “Patient Experience Manager” dealing with my complaint at
St Peter’s called me a customer. The Trauma/Orthopaedic unit is called a
“business”.
6)What’s the answer?
Well, you start with a bit of mutual respect and then you
fight back.
No one should be putting up with patients who don’t respect
the people treating them.
No patient should be jumping the queue for treatment because
they are more articulate, more middle class.
Consultants should not be encouraging queue jumping by seeing
patients privately and then pushing them to the front of the NHS queue as an
“emergency”.
1) The majority of NHS workers are women.
2) The majority of NHS workers are from ethnic minorities.
3) The majority of NHS workers are working class.
So people at work need to respect each other and the jobs
they do, whatever job they do and whatever minority/majority they belong to.
That means fighting for the NHS to be an example to everybody else for equality
at work.
People at work should be speaking out when colleagues aren’t
doing their jobs properly.
People; patients and staff, need to unite to protect
hospitals and jobs.
How we do all these things is for you and this Blog to work
out in the weeks or months to come.
Neil Harris
(a don’t stop till you drop production)
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