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.
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.
(a don’t stop till you drop production)