In my New Year’s message, I made it clear that the government has a duty to turn around the NHS in 2018. The urgency for this could not have been more apparent in the first week of the New Year which was sadly anything but happy for several thousands of patients suffering at the hands of an NHS unable to cope with demand.
The scale of pressures has resulted in the government resorting for the first time to the wholesale cancellation of over 50,000 operations and hospital appointments in England, and at a stroke turning a blind eye to the very targets it has set itself for the NHS. This means that patients who have suffered in pain for months, such as those waiting for a knee replacement, will now need to suffer for longer. Other patients will have to endure further uncertainty and anxiety waiting for an appointment to establish a diagnosis, as well as have their treatment delayed. While both the Prime Minister and Health Secretary have apologised for this, words will be of cold comfort to the plight of such patients and further prioritising their treatment after the winter season will simply push other patients to the back of the queue adding new future distress and delay.
We are now faced with the daily reality of corridor management of patients in A&E departments due to non-availability of beds and space.
Emergency services designed to transport patients rapidly into hospital has instead descended into pitiful scenes last week of 17,000 acutely ill patients stuck in ambulances queueing up outside emergency departments. Bed occupancy rates are up to hundred percent, exceeding the recommended safety level of 85% - flying in the face of the Health secretary’s pronounced commitment to safety in the NHS.
This distress is not just confined to patients, but also to doctors, nurses and other NHS staff who are unable to fulfil their professional duty of care to patients due to factors outside their control.
The most galling aspect of this shameful picture is that it was entirely predictable. The BMA warned in the summer that talk of a “winter crisis” was a misnomer when it was clear the NHS was already struggling to cope during what was meant to be the quiet season. We warned the NHS was ill-prepared for any surges in demand. We explained that the maths just don’t add up, when you consider the health needs of a growing older population and that we simply don’t have enough doctors, NHS staff, hospital beds, community facilities or social care capacity. We highlighted that other leading EU nations spend about £10 billion more annually than the UK on health, and that plugging this gap would increase capacity for example by 35,000 extra beds or 10,000 more GPs. And yet the funding for the NHS announced in the Chancellor’s Autumn budget fell woefully short of what was required, ignoring even the advice of NHS England’s chief executive Simon Stevens.
Throughout all of this, the BMA has actively raised public and media awareness that “pressure on the NHS continues to intensify”. On social media, we have publicised the harsh impact on frontline doctors and the state of overstretched services. We have also had extensive media presence including an exclusive comment piece from myself in the Daily Mirror, Kailash Chand on the Guardian’s Healthcare Network and Lucina Cocker in the Yorkshire Post, as well as coverage in the Guardian, Daily Telegraph, Independent, Daily Express and a number of broadcast interviews across the BBC and ITV. A full breakdown of coverage can be found on the BMA website.
What’s important now is what happens next. Unless decisive action is taken, this winter’s crisis will simply continue into spring, summer and autumn and result in an even worse next winter. The starting point must be for government to end its denial of the problem - illustrated only yesterday by the Prime Minister’s astonishing claim that the NHS was better prepared than ever for this winter - and to unequivocally accept that the NHS desperately needs greater investment and capacity. It must also immediately put an end to the punishing cuts being imposed on commissioners and providers across the UK, so that there is money now for more staff, facilities and services while we develop robust, coherent sustainable longer-term plans for the NHS. I want to assure you that the BMA will be taking these issues up directly with governments across all four nations. It is also important to remember that as doctors you should raise any concerns about what is happening around you especially if it undermines your ability to provide safe care. We have guidance on how best to raise these, and of course, we will continue to be there for any doctor who requires support at this difficult time – you can find more information here about the BMA’s counselling and doctor advisor service.
Chaand Nagpaul is chair of BMA council
There are many factors which have made to-days's NHS becoming stressed itself more than any stressed patient: The situation is as follows:
A. Politics, Economics and Law have as much to do with patient-care as Medicine; National money reserves are far less now than in the past.
B. Appraisers and Revalidators are being paid to find faults among doctors by their own colleagues. Doctors are not saints; there are prejudices.
C.Care Quality Commission is being paid to find faults in Practices by GPs and Consultants; Hospital departments and GP surgeries are shrinking.
D. Referral Services, created and paid by the NHS, are stopping GP referrals to Hospital Consultants as much as possible.
E."Patient complaints against doctors have changed from being a wind to a hurricane. After two complaints, a doctor may become a patient.
F. Pharmacists are under pressure too. Moreover, they have to charge for their services as the dentists do. They are also human and make errors.
G. Private Healthcare Companies are very expensive and have costly investigations which many dying patients or their relatives cannot afford.
H. Doctors organisations have tried to use "Patient Associations" as shelters but it has now back fired.
I. In 1998 - 2000, the third discipline of the NHS called "Clinical Public Health and Community Paediatrics plus School Healthcare" was skillfully closed.
J. Now the remaining two disciplines Hospital Service and GP Practices are being skilfully re-organised as there is no other choice.
K.British Government , the RCGP, other Royal Colleges and the BMA are really supporting the doctors under fire, and patients, as much as they can.
* Please observe that there is no one person or Party is to be blamed. We have a real situation to run the NHS within the resources available. Let us join hands together, not blame each other but calmly solve these issues as best as we can to reach the solution. Hope sustains life; we would win.
Dr Bashir Qureshi FRCGP, FRCPCH, AFOM-RCP, MICGP, Hon FFSRH-RCOG, Hon FRSPH, Hon FHPMP, Hon MAPHA-USA.
Life Member of the BMA. Author of "Transcultural Medicine" (I was informed that this book was a mandatory reading for British Army doctors in Iraq and Afghanistan wars who treated soldiers, prisoner and civilians.).
The relative silence, given the circumstances, of the BMA and the Royal Colleges is absolutely staggering.