Friday, 23 December 2011

The NHS – with a little help from Charles Dickens

‘I am the ghost of the NHS present’ said the Spirit ‘Look at me’

And Scrooge looked at the NHS and he saw:

  • Hospitals struggling to achieve foundation status
  • Disenfranchised staff, bickering between disciplines and striking about their pensions
  • General practitioners split between those embracing the challenge of commissioning and their new powers and those who don’t want the extra hassle and responsibility as the Royal College of Practitioners consider balloting their members on another motion to scrap the reforms
  • Divisions between primary and secondary care, with community care coming a very poor third.
  • Scandals such as the elderly left literally starving on hospital wards, waiting list manipulation, crumbling facilities, unsustainable patient pathways and care staff not fit for purpose.
  • A Secretary of State rightly intent on reform  but wrongly focussing on top down restructure instead of the basics of strong clinical practice, service improvement, measurable targets (yep – the T word) and recognition that every qualified individual along the care pathway has value.
  • A population taking little responsibility for their wellbeing, with  poor diet, poor lifestyle choices and an expectation of freely available care and choice of treatment.
  • Incredible achievements in medical innovation, ground-breaking treatment capabilities and examples of exemplary care and dedication among many staff.
  • A core of committed, concerned and talented clinical and support staff and a general population who value the NHS but do little to support it.
I am the ghost of the NHS past’
‘Long past?’
‘Your past’

And Scrooge saw an interesting vision:
  • A new healthcare system available to all, created in 1948 based on the following principles:
    • That it meets the needs of everyone
    • That it be free at the point of delivery
    • That it be based on clinical need, not ability to pay
  • Two decades later in 1968 he saw Christmas Day in a ‘Nightingale ward’ in hospital (these are the wards familiar to all of us over 40 – twenty or more beds in one long room with the nurse ‘station’ in the  middle.) The patients had all been washed, with clean gowns or pyjamas, their bedding changed, the ward was spotless, truly spotless and the nurses bustle around the ward in crisp starched white aprons and black stockings.. The nurses bustled trough their busy day, responsible for every aspect of care, the cleanliness of the ward, patient, and themselves.  Antibiotics were still very effective in reasonably low doses and infection control was simpler. Matron was a force to be reckoned with. On Christmas day – the senior consultant would come in to carve the turkey on the ward and help hand out dinner to his patients– ‘Health and Safety’ didn’t get in the way of tradition.
  • But Scrooge also saw that the survival rates for major diseases were poor in those days- cancer was synonymous with ‘death sentence’ – average lifespan of the UK population significantly lower. Deceased donor transplantation of kidneys had only been possible for four years and the first heart transplant had only taken place the previous year. Leukaemia survival rates were poor – nowhere near the 80% success rate in children achieved now.
  • Diet was healthier and alcohol consumption lower than it is now
  • Then the Ghost of NHS past  fast forwarded to the 80’s and 90’s – a melee of targets of variable validity, over-management and waste balanced with incredible medical advancement and innovation
  • Then he glimpsed the noughties – huge advancements in cardiac, stroke and cancer treatment and survival rates , but slips in general quality of care and resource management.
And then Scrooge saw Ghost of the NHS Future. He exclaimed, "I fear you more than any spectre I have seen. But as I know your purpose is to do me good, and as I hope to live to be another man from what I was, I am prepared to bear you company, and do it with a thankful heart. Will you not speak to me?"

And the ghost of NHS present did speak to scrooge, through the NHS future forum. But the vision of the future was unclear – clouded with uncertainty, financial complexity, confusion, disillusionment and disappointment. So Scrooge asked the Ghost of the NHS future to create a prefect vision and it was like this:

  • NHS staff working as a team, while taking individual ownership and responsibility for the very best care of their patients
  • All staff demonstrating a strong command of the English language and appropriate communication skills.
  • The elderly and vulnerable treated with special consideration.
  • Mutual respect among professionals at every stage of the patient pathway (how many time have I pleaded for that this year?)
  • Realistic expectation among the public and understanding that although the NHS is still a ‘national treasure’ and a ‘sacred cow’ – this amazing resource is provided at great cost, more of which should be borne by those who can afford it (through taxes or personal contribution)
  • Close and constructive working relationship between the public and private sector.
  • Individuals taking personal responsibility for keeping fit and healthy – resulting in tumbling incidence of diseases related to unhealthy lifestyle
  • Government, clinical teams, administration staff and the voluntary sector working in harmony….
Oh dear – I seem to have slipped from a Christmas Carol to another classic novel. Paradise lost…

Happy Christmas everyone!


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