Is the NHS in need of Terminal Care?

imgres-5You get to that age when health care becomes a top priority in your life, that is if you have manged to steer clear of significant illness when younger and the NHS is where most us turn. It is one of the most revered institutions on the planet and with good reason. During our working lives we all pay in fully expecting it to step forward with help when we really need it. The dynamics of the service are mind boggling with 1.7m employees and an annual budget of around £110bn, 370,000 nurses and 40,000 GPs. It stands to reason that nothing of this size can be managed without things going wrong. We all hope that we are not on the wrong side of things that do but is inevitable that eventually we will be. 

Age makes you vulnerable and for many it means that they are less able to deal with the life issues surrounding you let alone the illness itself. If you are lucky you have a support network of family and friends that can help you through it but many have not. The state is the only safety net they have. The recent exposures of poor health care and problems in the NHS must be of real concern to everybody especially to those that are truly vulnerable. The national press has been full of the reports but it still needs to ignite the fuse of public outrage at the level of the person in the street. 

A number of issues have been discussed in the these columns and you will find them on the site. Health care has been a common feature amongst the list our interests. We don't want to repeat too much of what has already been covered so we are now going to talk about some the more recent matters that have been at the forefront of the news. The first is the fact that the incident of death in hospital increases at weekends and holidays. I still put my own father's demise partly down to the fact his had his heart attack on Good Friday when it seemed that specialist clinicians were not readily available. Gerry Robinson, in his series of programmes on the NHS, very quickly discovered that operating theatres and expensive scanners were all to often idle from Friday afternoons to Monday mornings and he found it exceedingly difficult to do anything about at the hospital where he based his programme. 

Whilst in government the labour party substantially reviewed GP's contracts giving them vastly increased pay but less flexible availability leaving many practices relying on locums to deal with their patients out of hours. This has contributed to the crisis we now face where our doctors, consultants and senior staff are just not available for a substantial proportion of the week. When this became a hot topic recently it prompted an aggressive response from the BMA at their annual conference accusing the Health Secretary of wanting a "Tesco" NHS - open all hours. They asserted that the nation could not afford it especially as doctors would have to be paid premium rates at weekends which we gather can be as much as £200 nper hour. Consequently they went on the attack and passed a vote of no confidence in Jeremy Hunt, the Health Secretary, accusing him wanting substantial change for ideological reasons. Those reports of the BMA view will have disappointed and worried most people. The fact is that there are many doctors out there that do work more than their standard hours and do their best to provide the cover that the nation and patients would want but it not widespread enough and there are too many large gaps through which people fall every day. The time has come for change but change that is not driven by increased finance alone but change that is cultural and focuses on excellence. The BMA needs to demonstrate that it understands the concerns that are endemic in communities and show its willingness to work with the government of the day to bring the NHS to the point of, once again, being the service that meets the demands of current day needs.

The reports of the breakdown in care at Mid Staffs and others have been horrifying but the abuse that the whistleblower, Julie Bailey, who exposed the Stafford Hospital failings has beggered belief. The neglect led to 1,400 lives being lost and Julie has been victimised by people whon claim that nothing happened at Stafford and there were no unnecessary dealths. Her mother's grave has been desecrated, she has had death threats and she has had to sell her cafe, which was the centre of the pressure group she had created called Cure the NHS. What is the matter with us all? The anecdotal evidence that something is fundamentally wrong is so strong that it cannot be ignored any longer and yet there are those who feel that the bullying of people who are prepared to stand up and be counted is fair game. It seems that illness amongst us does not always follow our conventional view.

Many readers of these columns will have their own experiences and we would love to hear them, both good and bad. In particular we would be interested to hear from the "silver" generation who have concerns for the future. It is only by constantly debating this issue that we will effect the change that we all need.

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