Another March Anyone? by Dr Nick Edwards

RemedyUK are delighted to welcome Dr Nick Edwards to our Blogging Team

Nick is the author of the new book, In Stitches.

Read more about it here and buy it here

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Most people don’t start their rebellious phase in their late 20s early 30s. But that is what has happened to me. In March this year, I found myself at the remedy march – It got the public at last interested into the plight of junior doctors. I am now thinking about my second march – and this one is just as vital – in defence of the NHS.

The March is on November 3rd - 1pm at Trafalgar square. So why am I going on a march in defence for an organisation which has mucked my career around, ruined the lives of my friends and forced loads of colleagues to emigrate to Australia ? Why would I go on a March to support of the NHS when quite frankly despite all the extra money being pumped in, things are a bit pants. . Where money is wasted, staff are treated like crap and managers seem more obsessed with targets than patients. Then there is ridiculous political correctness, and politicians changing what we should do every two minutes. And don’t get me started on how the recent reforms have destabilised and disenfranchised a whole generation of doctors.

So when I talk to people who are pissed off with work and I go on about how marvellous the NHS is, I usually get thought of as an irritating fool and told we would be better off, if it was privatised and they they add ‘no they are not going to join me on the march comrade’. Lots of arguments get thrown at me about why the NHS is failing and I end up agreeing with them – the NHS isn’t great, and in many ways it is failing to provide quality care.

Where I disagree is that this is an argument against the NHS as a whole. What it proves to me is NOT that the concept of the NHS is crap, but that the NHS is being run crapily. The concept and ethos of the NHS is what makes it great – it just needs to be run properly. So why do I believe it is a great service model for providing care. We are one of the few countries with a truly socialised model of health care. So what is so good about it? Four main points – among many.

1) The fact that it is free at the point of need is something we should treasure. I am an A&E doctor and often see people who have no money and homeless, but they are entitled to the same standard of care as Lord Hawawawawa ‘I was born with a silver spoon in my mouth’ gets. Health is something we should all be entitled to, as a fundamental right, and the NHS provides for that.

2) Then there is the fact that we provide appropriate care without having to worry about profit margins i.e quality care is not put in front of profit margins. When we see patients we do not think - how am I going to treat the patient so that my company can make lots of money? If they are a complicated patient we don’t think – Nah I’ll leave that customer to someone else - they won’t make me money. Rightly so we still treat patients in their best interest and not a company’s/hospital trust’s best interest.

3) The fact that charging patients doesn’t come into it means that on the whole it is quite an efficient system. In America where every swab is charged for and accounted for, they spend nearly double per person than what we do on health care, and by and large 30% of their population get terrible treatment (see the new film Sicko by Michael Moore). The insured ones often get unnecessary tests and unnecessary treatment and a lot of hospitals budget is spent on advertising for new patients. Going down the American route is something I dread.

4) In a NHS where we don’t think about profits, then institutions can concentrate on teaching juniors as opposed to the private treatment centers where getting cases done asap is all they care about.

So if the concept of the NHS is great, then why are patients worried about its future and why are most workers miserable and why should we march in defence of it? How the labour government have doubled the money going into the NHS whilst still pissing everyone off and not improved things that much, all at the same time is an amazing skill. (Don’t get me wrong, it is much better than it was ten years ago and I honestly believe that without the extra resources and commitment from Labour we would have seen the NHS completely screwed by now. It is just that so much more could have been done and moral could have been so much higher if they hadn’t have been so bad at running the NHS. )

So what is so bad about the way it is being run? There are a number of issues affecting us all, but I think the main ones are that the government have forgot about running the NHS along its original ethos and have been blind to the law of unintended consequences.

Changes such as Private Finance Initiatives seem great on the surface – new money to build new hospitals with. But when you look at the rules - it is a very very expensive loan, which private companies are making a fortune from and which hospitals have to pay back each year and it is crippling them. Their budgets are de facto being cut. Why wasn’t there just up front government money for these new buildings – paid for from normal borrowing but at a fraction of the cost? Why involve the private sector.

Then there are private treatment centres being built. They take money for easy cases and leave the NHS hospitals with the rest. That means NHS money is paying for big profits for private companies and NHS hospitals loosing money.

Other factors are payment by results and patient choice. On the surface it seems to make sense that money follows the patient. But hospitals won’t be able to make plans not knowing if they will loose patients to other hospitals. We also need hospitals to have the full complements of specialities for emergency cases and not have 1 hospital being experts in knee operations but not having a hip surgeon; it is ok for elective cases but what about emergency admissions.

Then there is hospital reconfiguration. They say that centralised care is the future. But what evidence do they have to back it up. Yes for major trauma, heart attacks and stokes major centres are the way forwards but that it is only 2% of cases. The rest of patients need good local District General Hospitals which care for the other 98% of patients. These DGHs cant loose their elective services to Private treatment centres or the new Lord Dazari polyclinics models, as otherwise they wont have the personnel and resources to look after the emergency patients. And the smaller DGHs shouldn’t loose their A&E departments as all but the sickest would benefit form local emergency care.


Then there is the way the government have introduced targets without thinking about the consequences. For instance the two week cancer target, the 48hr GP target and the 4 hour A&E target – great in principle but the law of unintended consequence means that targets are becoming thought of as more important than clinical care.

And finally the way the staff is treated. I am not talking about pay – although it is disgrace how the government have tried to worm themselves out of the agreed pay deals for nurses. It is a the way as health care staff we are not respected - the fiasco of junior doctors training is the prime example.. Thoughtless planning has left doctors moved at the last minute from their family, having to change career and in many cases give up medicine altogether.

I love the NHS but hate the way it is being run and I am concerned about its future. I would like to see the NHS run by non-politicians. Make it run by a quasi independent board along its original principles and ethos. Take the politicians and targets out of health care (just let them agree on a guaranteed funding stream which is planned for a long time in advance) and let staff and patient’s care be the important thing. Remove competition and replace it with co-operation. Remove payment by results and replace it with regional planning and remove patient choice and give patients the excellent local GP and DGH that they want and that we have the money to pay for.

Can we make a difference? Can we make this utopia become real? I don’t see why not. – it is being a hot political issue at present and we just need to start expressing our views. There are various support groups out there such as the NHS Support Federation (www.nhscampaign.org) and many local groups fighting for the future of the NHS. They all need your input and your knowledge about how the NHS is being run and how it could be improved. I personally have written a light hearted book looking at my work and how the politics can pervade down to individual patients care. I doubt it will make any difference but at least it is getting some attention. But anyone can do it. Write to your local Mp and councillors. Get involved with reconfiguration meetings and write to papers so that they know what is happening. We are all at the coal face of the NHS and we know where and how it can be improved. We need to start making our voices heard.

I urge you to speak out and make a difference. Even if the government ignores you then at least we have tried and can sleep easier at night.
Regards
Nick Edwards – Author of In stitches; the highs and lows of life as an A&E doctor.
Any comments/questions/help with publicity please email drnickedwards@gmail.com