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‘On the brink’. ‘Close to collapse. ‘Straining at the seams.’ All these phrases are only too familiar in public discourse about the NHS. All of them paint a picture of a service teetering at the edge of an abyss, maintaining its balance against the odds.
I don’t think that’s a helpful image, and here’s why. If – when? – the NHS collapses, it won’t be anything like a sudden fall into an abyss. We probably aren’t going to wake up one morning and find that all hospitals have been sold to McDonald’s, primary care has been outlawed, and only people with a household income over £27,000 are allowed to be vaccinated. All those figures of speech which suggest dramatic disaster may actually hinder our recognition of failure when its onset is insidious.
When I first qualified, I tended to feel faintly indignant if someone talked about ‘going private’. The NHS offered – I thought – everything you really needed. If your care was urgent, you’d receive it urgently. You might wait a while for elective procedures, or be turned down for cosmetic surgery, but basically all the important stuff would be done, and done well.
I’m not sure that’s the case anymore. Now, I often find myself delicately probing to see if patients would be able to afford private care, in situations where the NHS’s offer is clearly inadequate.
When I can see that someone needs counselling, or speech therapy, or physio, and isn’t otherwise going to get it any time soon, what else can I do? Tellingly, more and more of my colleagues have private health insurance themselves. Even the GMC provides it as a routine employee benefit.
‘Failure’ isn’t going to be a single recognisable event. In some respects, we’re there already. Missing the A&E four-hour-wait target so consistently that we’re considering giving up on it altogether is failure. One in five cancer patients waiting over two months for treatment is failure. Medical wards so poorly staffed that continent elderly people are told to ‘go in the bed’ rather than being helped to a commode are failure. Rising infant mortality – read that again, rising infant mortality – is definitely failure.
We shouldn’t be falsely reassured by images of the health service just managing, barely coping – but still succeeding by the skin of its teeth. If we are, we risk letting it deteriorate to the point where only the desperate will use it, and will find it grossly inadequate when they do.
If the NHS does fail – and I hope to God it doesn’t – it won’t be a crash into the abyss. It’ll be more like heart-failure or renal failure: a gradual, imperceptible but ultimately disastrous loss of function of one of society’s vital organs.
By the Secret Doctor. Read the blog and follow @TheSecretDr on Twitter and on Facebook
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Yep - its a progressive, accelerating downhill slide which can only be halted by an increase in funding. Sadly most of the promised funds will probably be soaked up by increased (mis)management. Cynical? Don't think so.
The main threats to the NHS come from many sources:
1. From within the organisation due to dysfunctional management and a heavily unionised workforce.
2. From the general public who are encouraged to abdicate all sense of personal responsibility with regard to diet, nutrition, exercise, personal health with the expectation that the ‘NHS’ or the ‘State’ shoulder the blame and cost.
3. The marginalisation of the primary care service triggered by the Blair Labour Gov allowing the service to withdraw from 24-7 responsibility to their patients. This is the main cause of the ED attendance crisis.
Funding is well down the order!
I speak as a consultant who has practiced in frontline medicine in two specialties.
I cannot claim the certainty that some claim on this subject all that I can do is state my beliefs in the light of 53 years experience in the service and having observed its plight closely for 19 years retirement.
I do not believe that the present plight of the N.H.S. is the responsibility of the workforce, the public or Mr Blair
I believe that the determining factor is the anti state neo-liberal market ideology which has progressively come to dominate the old one nation conservative party since it was introduced by Mrs Thatcher at the behest of Sir Keith Joseph
Like other correspondents I have practiced front line medicine in more than one specialty
Can we stop the rush the efficiency, we used to be effective. Rough about the edges sometimes, but had plenty left when things got tough. Now everything is designed to be efficient for the mythical average patient, who never appears! So yes delay is inevitable, in the 1990's being full for 24 hours, if my memory serves me right, took 3 months to get back to smooth running.
Now most places run on full all the time, so delays get worse.
Also queuing theory suggests reducing the number of servers ( locations to recieve service), increases delays and queues so why are we still doing it? Leads to staff burn out, and poor patient care.
Can we please refocus on individual care rather than efficiency? Good individual care is both least expensive overall, and satisfying to all who provide it, but it requires spare capacity in the system.
"3. The marginalisation of the primary care service triggered by the Blair Labour Gov allowing the service to withdraw from 24-7 responsibility to their patients. This is the main cause of the ED attendance crisis."
You have zero evidence for this. I imagine from your comment that you are no longer practicing. Enjoy your retirement.
I agree entirely with the comment about withdrawal of primary care from 24/7 responsibility for their patients being the top reason for the ED attendance crisis. I am still practicing as a consultant in front line services. Have been for 20 years with another 20 or so still to go. You may not agree but there is no need to be rude.