Thursday, December 8, 2022

“NHS on its last legs” says Thurrock doctor

THURROCK doctor Emil Shehadeh has worked in the borough for may years.  The renowned doctor has practices in Grays and Tilbury. With so many changes taking place in the NHS, the doctor reflects on what he sees as the core problems and challenges with the NHS today. This is a hard-hitting essay that may be a bitter pill for some to swallow.

What is the Trouble with the NHS today?

The NHS is an ideal institution whose success is predicated on assumptions that the public will use it appropriately, politicians will not utilise it to further their own careers, and those who work in it will do their utmost to administer it with care. That is an awful lot of integrity to expect from a generation, 60% of which tell several lies (2.9) in the space of ten minutes of conversation. How likely are these three major guardians of the NHS to look after it? The NHS is on its last legs suffering from three plagues.

Politicians

Politicians often use the NHS as a vote winner. Therefore initiatives are announced with tremendous alacrity, which may chime with the public mood, often before they are fully assessed for cost effectiveness, feasibility or fairness. One such example is Walk in Centres, and Darzi Centres. Such centres have sent the wrong message that more appointments will improve the nation’s health. What we are seeing is the same patient with a simple sore throat visiting the walk-in centre, then OOH (paid for by the GP), then their own GP. This means management of this simple self-limiting condition has cost the NHS three times as much, without improving the outcome.

Politicians have lofty ideals and want the NHS to deliver what the nation can not afford. Rather than refrain from making promises they can not keep, they make them in order to win votes and when they fail to deliver, they blame GP’s amongst others. The longer they continue in this vein, the fewer young people will want to be doctors, let alone GP’s. We are struggling to recruit suitable candidates for general practice as it is. What planet are these politicians on?

Improving access does not necessarily improve health, unless it is appropriately used. The other name for Darzi Centres is “equitable access centres”. Apparently they were meant to improve access for the hard-to-reach. The real agenda is to strike a fatal blow to single handed practices who would lose patients and therefore find it hard to survive. However, the hard to reach are often poor people who can not afford to travel. Therefore these centres have only improved access for those in their immediate vicinity. The rest of the local population can be damned! If the government wanted to improve access equally across the board, they should have invested money in local practices, which would have benefited most patients. Therefore, in their eagerness to win votes, politicians, meaning to address inequality have actually created more inequality.

Politicians wanted to give patients choice of hospitals. This poorly thought out policy caused my then PCT an overspend of £50.00M. This is because we had a block contract with our local hospital, on top of which we paid other hospitals if our patients chose to be treated elsewhere. Which NHS managerial morons forgot to take that into account?!!! Politicians, over anxious to suck up to public demand have spent NHS money with a less than infantile sense of responsibility.

Commissioning hatched up by the last Labour government was supposed to improve efficiency in the NHS. Again, the idea was made public eight years too early by a government eager to win more votes. To-date we have no real commissioning taking place. We have recycled PCT’s to local commissioning Boards, and CCG’s. We may for now have saved money on excessive management. But watch this space and see if the past is about to repeat itself. These bodies may give rise to numerous new subsidiaries with increasing management costs. But ultimately, the aim of commissioning is to privatise the NHS. I personally have no problem with that, except politicians ought to be more honest about it. If the government gives GP commissioners the responsibility of shopping around for cheaper hospital services, money will follow services out of our inefficient NHS hospitals till they are not viable, and ripe for a takeover by private providers.
Whilst it was politicians who brought the NHS into existence, it will be they who will also see it to its grave. Civil servants are probably the engineers of all these disasters. They are self-serving nurseries of new ideas that are simply designed to keep them in their posts, hence the numerous major change sin the NHS which simply cause more confusion.

Patients:

Patient vary in attitude vastly.

However there is a significant minority who treat the NHS like a big fat cow from whom they expect milk on demand, and at whim. My 25 years as an NHS doctor have shown me the tremendous waste our public is guilty of. From failure to attend appointments, to pressure on doctors for unjustifiable treatments or investigations, through manipulative behaviour to over-medicalisation of social problems; from insisting on un-necessarily expensive prescriptions to complete brazen failure to take medication which they are happy to request for two years or even longer. The NHS has promoted dependence on others, not self-reliance. We have to chase the same people every year to make sure they take their treatment and have their usual tests. Some patients think they are doing the surgery a favour by complying. 66% of our suspected cancer patients cancel their first appointment. I find this astonishing.

Politicians have colluded with the voting public against the NHS which everyone apparently loves. I have never heard a politician criticise the public for the years of abuse the NHS has suffered from the public. I am yet to meet a politician who has the courage to hold the public responsible or accountable for the way the NHS is ravaged. When we speak of high infection rates in hospitals, we only criticise hospitals, nursing staff and cleaners. It is the public who makes the hospitals filthy in the first place. I have been a hospital patient and have seen the filth created by some patients, worse than animals. Yes, hospitals are negligent too, but this does not absolve the great British public from the responsibility of decent personal hygiene, which includes the state of a bathroom after use.

Complaints in the NHS have increased year on year. I have analysed my practice complaints over the years. They mainly stem from an unrealistic sense of entitlement, lack of respect for the medical profession and practice of medicine, and ignorance, by people who exercise little personal responsibility, keep low personal standards and expect the NHS to do their work for them. There are always those few compensation seekers.

Professionals:

From managers who simply want to tick boxes, to nurses who are too proud to do menial tasks and who have lost the ability to care, to doctors who practice defensive medicine and exercise no responsibility in utilising NHS resources; they all have abdicated their moral responsibility to give their best.

Why do we have long waiting lists for hospital treatments? Amongst other reasons, because we spend too much money on management, some doctors over- refer and over investigate thus clogging up the system. In the last few years, some GPs have saved the NHS billions in reduced prescribing costs and reduced un necessary referrals. However, in some specialities up to 80% of referrals are not generated by GP’s. In my region, after many years of trying to deal with the problem, we still have 1/5 of all referrals to consultants generated by other consultants, most of which referrals are entirely un-necessary.

Whatever the intentions of the founders of the NHS, it has become a vote-winning tool in the hands of politicians, a fat cow in the eyes of an entitled dependent irresponsible public, and a dreadful place of work for many health care professionals who have abdicated their responsibilities. The solution to this problem is improved personal standards: personal integrity is a good place to start the repair process. Only then can the three plagues of the NHS be managed effectively.

2 COMMENTS

  1. Some interesting points. I was reading this week that the assumption that was made at the inception of the nhs and when gp’s were given 24 hours care was that patients on average would consult out of hours twice in their life. Once for a serious illness and the next would be to confirm death.

    Obviously the situation has changed where society has moved on. I feel due to improved transportation networks, rising house prices and the movement away from a local manufacturing economy to a sevices delivery base, many people now do not work in the areas that they live. Also the changes that healthcare can now deliver have increased over the last few decades.

    We need to change how we deliver care in response to the changing social situation for the betterment of the whole of society. I carry out my banking online. I order my shopping through a website. I could carry on through traditional methods of queuing at the till but I just don’t really have the time to go to a branch and queue at lunchtime if I have an alternative.

    We have various technologies that we can apply to help us manage our current demand on services that will allow us to deliver care for our registered patients. Patient online access, the emergence of teleheath technologies, patient access to sites such as http://www.mapofmedicine.com are nettles that we should be grasping. We will hopefully be installing a new electronic prescribing service which will mean patients will no longer need to attend the surgery for prescriptions and combined with communications technologies potentially could allow gp’s to work remotely.

    Unfortunately the conservatives and liberals do seem to be gunning for us at the moment, but they are gunning for everyone at the moment. We do need to account our local MP’s for the statements of the government and also they will be accounted at he next general election.

  2. Some interesting points. I was reading this week that the assumption that was made at the inception of the nhs and when gp’s were given 24 hours care was that patients on average would consult out of hours twice in their life. Once for a serious illness and the next would be to confirm death.

    Obviously the situation has changed where society has moved on. I feel due to improved transportation networks, rising house prices and the movement away from a local manufacturing economy to a sevices delivery base, and also the shift in working patterns towards shift work and contracting, people now do not work in the areas that they live. Also the treatments and investigations that healthcare can now deliver have increased over the last few decades.

    We need to change how we deliver care in response to the changing social situation for the betterment of the whole of society. I carry out my banking online. I order my shopping through a website. I could carry on through traditional methods of queuing at the till but I just don’t really have the time to go to a branch and queue at lunchtime if I have an alternative.

    We have various technologies that we can apply to help us manage our current demand on services that will allow us to deliver care for our registered patients. Patient online access, the emergence of teleheath technologies, patient access to sites such as http://www.mapofmedicine.com are nettles that we should be grasping. In the future there will be a new electronic prescribing service which will mean patients will no longer need to attend the surgery for prescriptions and combined with communications technologies potentially could allow gp’s to work remotely, thereby increasing access to care from the surgery.

    Unfortunately the conservatives and liberals do seem to be gunning for us at the moment, but I don’t think we are alone in this. We do need to account our local MP’s for the statements of the government and also they will be ultimately accounted at the next general election.

    The improvements outlined above will require community partnerships with our patients in order that we can explain them, encourage their use and modify the processes to make things easier for the patients to get the care that they need.

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