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Wednesday 31 July 2013

A Few Thoughts On The Health Service

I'm pretty sure that many of those who choose to read the likes of the Daily Mail on a regular basis must have a pretty poor opinion of the NHS and many of those who work within it, after all the startling revelations that particular publication has chosen to highlight over the past few months, ostensibly as part of its own national campaign to uncover multiple and widespread instances of horrifying healthcare, which people might expect to receive if they are ever unfortunate enough to become seriously ill and require hospitalisation in the UK.
 
It's important to note from the outset that I don't work for the NHS, never have; and apart from a few days spent in an observation ward, following a heart attack, I actively avoid having anything to do with doctors, nurses, medical consultants, clinics, surgeries or hospitals, as they make me extremely nervous and uncomfortable, not because of what they are, or what they do, but simply because you're asked to hand over control of your body, your health and sometimes your dignity to a complete stranger, which I would rather not have to do.
 
Even though I am a comparative stranger to the NHS, on those few and rare occasions that I have had to put myself into the medical expert's hands, for the most part, my overriding memory of the experience hasn't necessarily been the exceptional standard of care provided by the nursing staff, or the encyclopaedic medical knowledge of the doctors, but rather the generally piss-poor behaviour of a minority of patients, who sometimes seem to behave as though they're paying guest's staying in a swanky hotel; and that the nursing staff are little more than paid servants who are supposed to be attendant to their every need and whim.
 
Because of campaigns lead by the likes of the Daily Mail; and a number of other supposedly outraged publications, we now seem to have handed huge areas of control of our national healthcare system to the patients themselves, or in some cases to their relatives, neither of which are in anyway qualified to know what they're doing. As a result, we now seem to have a situation where nurses, healthcares, doctors, matrons and managers are occasionally having their decisions made for them, or forced upon them by a small number of patients, or relatives, who happen to know their "rights"; and threaten to make a formal complaint, or worse still litigate, if their express wishes are not followed to the letter, by the nursing staff who are actually supposed to be in charge of the ward.
 
Knowing someone who works within the nursing profession, in an extremely busy hospital, I am often astonished, even occasionally gobsmacked at some of the incidents that occur on our hospital wards, mostly as a result of individual patients or their relatives playing the system, or just knowing their rights. There are those who demand to be given the use of bedpans or commodes at all times of day and night, even though they're fully mobile and perfectly capable of using the ward's normal toilet facilities. There are the patient's who deliberately and regularly wet or soil themselves, just because they can't be bothered to ring the bell and ask for a bedpan, commode, or to be taken to the hospital toilet. Then there are those patient's who can't get up to use the bathroom, but are still mobile enough to go outside for a cigarette; or the patients who are too weak to go to the bathroom, five yards away, but can somehow summon up the energy to walk well over two miles to go and buy themselves a burger from the local McDonald's, still dressed in their pyjamas, slippers and dressing gown.
 
And then there are the concerned relatives who loudly berate the nursing staff for allowing Aunty Flo, or whoever it is, to sit in a comfortable bedside armchair for more than half an hour at a time, noisily demanding that the poor dear be put back to bed, even though she's been lying in the bed for so long that she's begun to develop sores. Then there are the relatives who demand that their disruptive uncle, who refuses to stay in bed, must be attended by a member of staff during all of his waking hours, in order to prevent him from falling over and hurting himself. And of course there's the relative who insists that their feeble or dying, mum or dad, aunt or uncle should be practically force-fed by a member of staff, because they happened to notice that there was some food still left on their plate. And then there are those occasions where an entire ward's timetable and procedures are suspended, just because the nursing staff are forced to monitor a single troublesome patient, at the behest of a concerned relative, who has made it quite clear to the hospital's management that she knows her "rights" and is quite prepared to enforce them, should she not get her own way.
 
What a complete and utter shambles some of our NHS services have become! We not only have A & E departments and Ambulance Services dealing with cases like dog mess on people's shoes; and cat scratches that could easily be treated by the individual themselves, but we also appear to have some our busiest hospital wards being run by patients and their relatives; and all because the NHS and those that run the service seem to be terrified of being sued by this new army of timewasters who purport to know their "rights".
 
On top of this, A & E Departments around the country are being massively overstretched by wave upon wave of patient's many of whom should not be there in the first place, or would not be there if other healthcare professionals were doing their jobs properly. Thanks to both the Labour Party and the current Coalition government, we have arrived at a point where the newly privatised "111" Health Help-lines are tasking Ambulance crews to increasing numbers of non-emergency calls, whilst GP patients, unable to see their family doctors because of new working practices, are voting with their feet and making the choice of visiting Accident & Emergency departments, often for the most spurious of reasons.
 
To add to the growing frustrations, we now have a situation where one of the main providers of the "111" service, NHS Direct, is seeking to withdraw from its numerous emergency helpline contracts, simply because the commercial viability of such contracts are largely unsustainable, given the increasing level of demand generated by the British public. In the meantime, GP's, who are typically being rewarded with salaries of £100,000 per annum for a rapidly diminishing medical role in British life, have seen some of their members exhibit the barefaced cheek of suggesting that patients should be charged for each appointment, with the suggested fee range being in the order of anything between £5 and £150 per consultation, despite the fact that these doctors are already being paid for their time and expertise by the NHS in the first place.
 
Although nobody doubts that problems have occurred at the likes of Stafford and Tameside hospitals, which were highly regrettable for those who lost loved ones; and should not in any way reduce an injured parties right to seek fair and equitable compensation. However, thanks in part to the likes of the Daily Mail and their often questionable revelations, aren't we seriously in danger of "throwing the baby out with the bath water", so to speak. Having created an almost endemic climate of fear within the NHS amongst those who work there, the healthcares, the nurses, the doctors, matrons, consultants and managers, haven't they essentially given the whip hand to every man and his dog who wants to take advantage of this very precious health commodity, the NHS. To have created a situation, where the lazy, the mean spirited, the malicious and the selfish minority can put their own needs and demands above those of the less demanding majority, is an unsustainable absurdity. We vehemently demand that our healthcare workers show us kindness, respect and courtesy whilst we stay in hospital; and yet no similar demands are made on the patients themselves, leaving them to freely abuse, mistreat and occasionally physically assault our care workers, generally on the basis of "they're too ill to know better". This excuse is such a "crock of shit", as for the most part, those who are committing these verbal and physical assaults are perfectly aware of their own actions, but because they're in hospital they seem to think that the normal rules don't apply; and they should! So when our politician's come to have a rethink about how we might create a better, more equitable NHS, perhaps they might consider introducing a set of enforceable rules and regulations both for the patient's, as well as the staff.
 
As for other matters, such as the recent overcrowding of our local A & E Departments, with "emergencies" such as dog mess on the shoe, or cat scratches, or severe hangovers, perhaps the government and NHS England might like to consider fining those private companies, who consider such events to be so serious that they require an ambulance in the first place. Maybe by targeting the actual bottom line, the profits, of such companies, might make them a little more careful about how they use such precious resources. At the same time, maybe the current government should consider renegotiating the extremely generous GP contracts that Mr Blair's former government apparently signed off without any regard for future consequences. A £100,000 of anyone's money is a significant sum, even today; and it doesn't seem unreasonable to expect GP's to actually earn their vast salaries by actually treating most of their patients in their surgeries, rather than forcing them to rely on the local A & E Department instead. In the event that government and GP's can't reach an accommodation on any new contract, then perhaps the most obvious solution is simply to remove any GP that doesn't wish to sign a new contract from the national NHS list; and use the money saved to employ a new group of doctors, who are generally more amenable to the fresh terms, or alternatively simply use the funds to try and bolster existing A & E services, thereby filling the gap left by the newly unemployed family doctors. 

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