For some reason, hard working public sector staff up and down the land, are being blamed for the state of our nation. In case you’ve been living in a cave for the past year, the NHS is “in crisis”. Aside from the political posturing (you can substitute this for “dick swinging” if you like), what does this actually mean, and what might have lead to the problems we see?
The NHS was established in post-war Britain. The past is a foreign land, and the UK of seventy years ago may as well be a different planet. Smaller populations, a greater burden of infectious disease, a younger population and a whole generation of men, either dead, or coming back to a grateful but very different nation.
In the decades since the founding of the NHS, the make up of UK society has changed. Greater migration brings different health seeking behaviour. An increasingly old, frail and chronically sick population now make up the majority of patients using the NHS. A culture of demanding instant gratification has meant “I demand to see a doctor now”, regardless of how trivial or mild the condition is, seems to be the norm. Some people I meet feel I’m some kind of resource, theirs to use, irrespective of time, place or how appropriate that visit is.
I am a GP, all things to all people. My colleagues and I across the land see 1 million people every day. We carry out 90% of the consultations in the NHS, for less than 9% of the budget. It took a decade of training to get to where I am today. I get four hours of sleep a night. I leave the house before my family are awake, and return after they’ve gone to bed. I survive because of caffeine, adrenaline, and a passion to serve the public. Yet, for some reason, I’m the bad guy. If you ask any medical student what career they’d like, very few would choose general practice, it’s not hard to guess why.
Accident and Emergency Departments are buckling under the strain. In part due to the inappropriate use of the service (the clue is in the name), partly driven by rising expectation by patients, limited family support networks, and a quick fix culture. Parts of the NHS don’t help. The much touted “111” urgent care service, when piloted, was shown to increase ambulance call outs. Is it any wonder ambulance waiting times are growing?
With an aging population brings greater complexity of illness. It takes more than ten minutes to deal with anything these days. When a frail, elderly person is sent into hospital, in some cases they are unable to return home. Urgent social care is required, but if this isn’t forthcoming, then the hospital is where they must stay. It isn’t their fault, but now that person is unwittingly a “bed blocker”.
Many Doctors don’t want to work in A&E, and much like general practice, vacancy rates are rising. Some A&E departments have up to 50% of their consultant posts vacant. So perhaps A&E isn’t the best place to go to either.
The coalition government’s Health and Social Care Act has caused mass disruption to the running of the NHS, with a confusing, byzantine reorganisation throughout England, costing billions of pounds in the process. This has paved the way for the privatisation of the NHS. Parts of the NHS will be run for the benefit of shareholders, not the public. The problem is, there is no metric for compassion. Saving a life costs money. But keeping someone’s grandmother alive will never be profitable.
I do my job because I care. At the end of my working day (somewhere around fourteen hours a day), I can feel I have made a difference. This week alone, I can probably say I’ve been involved in saving the lives of numerous people. This might involve spotting a potential cancer, or the initial treatment of a life threatening condition.
Throughout the NHS, all staff in all areas, be they clinical, administrative or management, are working flat out all year round to keep you healthy, and above all alive. We will keep on doing this. But don’t blame us for the long waits or lack of appointments. As one of my patients once said “he’s not in his room tap-dancing, he’s trying to help someone”. So when you’re in a waiting room, on a waiting list, or on a trolley, please accept our apologies. We’re busy helping someone. Your turn will come soon enough.
Header Image Rights; Jean Brocard