For many years the jewel in the crown of the British welfare state and of civilisation in the UK has been the national health service. Since it’s inception after the second world war it has strived to bring health and equality to the people of this country.
Labour spent the last decade pumping money into the service, setting targets to direct effort and remove the long queues largely introduced by the Tories. One would think that the service would be in the best state it has ever been in at this point.
One may think that. Certainly the medical profession is in good health, earning more, hours trimmed by the working time directive and with the advances in medical science and equipment working more and more miraculous cures. But have the ethics kept pace with the investment? I think not. The recessions in the 80’2 and 90′s started a train of thought within the medical profession, they thought about rationing care. Of course they dressed it up into more acceptable jargon, dreamed up more and more sophisticated questionnaires to allow ‘medical decisions’ to be made. But in the end the result is a form of rationing. Each patient is assessed not only for their medical situation but also for their quality of life, whether action needs to be taken now or postponed and directed through different cheaper channels. Almost a “not from my budget you don’t” mentality.
In keeping with the British aversion to centralisation, each area of the country, each hospital team devised their own strategies. The result the “post code” lottery of treatment that NICE was established to stop. NICE started their own form of rationing, punctuated by occasional successful pressure from the public ( really the drug companies ) where they changed their minds over particular drugs.
Improvements in pain relief and management now seem to allow those in chronic pain to be treated as non urgent. Someone bed ridden, unable to work and in constant pain, is sent to hospital, examined to the point of the test suggested by their GP, prior to admission. This test is only given quickly to those with sufficient priority, so the patient is put on the waiting list ( currently 6 weeks ), sent home with more pain killers to await the test which is then used to determine whether to operate at a later date. The result, probably 8-12 weeks in total of pain and frustration, loss of earnings and stress. All for want of a scan that takes 15-20 minutes and costs a few hundred pounds.
Stories like this come as a real shock to a life long Labour supporter, who approved whole heartedly of the investment in the Health Service over the last few years. The Condem government is saying that the health service budgets are ring fenced. It is difficult to ring fence something that will be as drastically re-organised as planned in the near future. If they want to really effect the outcomes in the Health Service then there is one very simple area that needs to be addressed. That of communication.
Communication is still the weakest part of the system. Consultants, GP’s and the rest of the service depend on the vast quantity of paper used to communicate. Referrals and appointments must be gained by a doctor writing, seemingly via a postal system that makes Royal Mails second class service look instantaneous, to another doctor, asking for a test, or operation. The patient is then written to, when they have an appointment available. The results are said test are then communicated in writing to the original doctor. The strangest thing is that doctors seem to be able to write but no read. If I meet with a client I read the history before I see them, not in the middle of a meeting or consultation. The rest of the world uses email to communicate and it is about time the medical profession moved out of the 18th century and did the same. It strikes me that perhaps the NHS computerisation project is not so bad after all. The issue with it is that the medical profession cannot cope with the idea of the change. This is after all the major issue with most new computer implementations.
This is, for me a long blog, some may say a diatribe. That is probably true. While you are reading it , agreeing or disagreeing as is your right, consider that the main thrust is that the service that was once a national treasure, the service that countless volunteers have given up time to support, that has done so much to improve the life chances of the people of this country, is now slowly dying because of the actions of its most important people, the medical profession. So I think that it is time to recognise that the national health service is no longer safe in their hands. Putting budgets in the hands of GPs may help focus their minds, but only if the infrastructure is in place to resolve the inevitable communication and scheduling issues