The NHS stumbles on – chaotic and on the edge of financial ruin, leading the PM to announce a three year pay rise for low-end staff (The Independent, Mar 21st) quickly followed by a pledge to bring forward a ‘multi-year’ funding plan (The Guardian, Mar 27th). Yet for the vast sums of money the NHS consumes, patient outcomes are getting no better. In the UK the average doctor’s appointment lasts nine minutes and 33 seconds, the shortest time in Europe.
No surprise then that mistakes happen and patients rarely get their problems properly looked at. One symptom of the sickness at the heart of the NHS is the rapid rise in prescription painkillers. (The Independent, Mar 16th)
The breadth of the problem is alarming with news this month that more than a quarter of British adults are living with at least TWO long-term health conditions, with high blood pressure, diabetes, coronary heart disease, depression and cancer among the most common. (Daily Mail, Mar 13th). These patients are responsible for the majority of GP consultations, hospital admissions and 80% of prescriptions.
The BBC (Mar 28th) reporting that the NHS has “not got enough beds or staff”. The Times (Mar 30th) explains that doctors have been told to stop treating minor ailments such as dandruff and coughs. Yet at the other end of the medical spectrum, the NHS Cancer Plan, launched nearly two decades ago, has failed to make any difference to survival rates. (Medscape, The Times, or Daily Mail, Mar 15th). Prostate screening has come in for criticism with a study showing that one off screening does not save lives. (The Telegraph or Cancer Research UK, Mar 6th)
Along with failure to improve outcomes come damning reports of negligence, such as one in the Cambridge News (Mar 23rd) which through freedom of information requests found that serious avoidable harm to patients is taking place on a daily basis. Whilst on the opposite side of the UK the Mancunion (Mar 5th) reports that the NHS is making 200 million medication errors per year. On top of this a seperate report from the NHS ombudsman has identified a ‘devastating toll’ of ‘serious failings’ in NHS mental health services, including ‘serious harm and even death’ (TheGuardian, Mar 21st)
The medical system is also culpable for the increase in antibiotic resistance with around 5,000 people in England dying each year because antibiotics have become useless against some infections and experts predict resistance will kill more people than cancer and diabetes combined within 30 years. Not only is this being driven by inappropriate prescribing of antibiotics, but a recent study has found that statins, hay fever medicines and other common prescriptions push gut bacteria towards antibiotic resistance. (The Telegraph, Mar 19th)
Now I’ll vent my spleen…
Almost every patient I see has a horror story to tell about their NHS experience. Each patient thinks it is only they who had ‘bad luck’, and that the NHS must be serving the majority marvellously well. It’s not surprising as that has been the NHS theme-tune drummed into us since its inception in 1948. Yet, never was it true. The myth relies upon the impossibility of any one individual having a complete overview of what is actually taking place. Those patients of mine who are doctors, nurses or midwives see it with more clarity, but, with no meaningful counter-narrative they think ‘but what else is there?’
Until we recover our senses and start looking at the NHS with a healthy dose of scepticism, we will continue to excuse its blunders, incompetence and phenomenal expense. And the insanity, harm and waste of resources will continue.
Almost every time I put my head above the parapet and say that GPs are not doing a good enough job the very first words I get back in response are ‘if they had more time and resources they would do a better job’. Indeed, I’d wager you are thinking something along these lines yourself. No doubt you can name a loved one who has been saved or was well looked after at the hands of the health system. You probably assume that the doctors are fundamentally competent, but prevented from doing better by lack of time and resources; But I believe this is a delusion: Even when our GPs are given more time, or take more time, they all too often fail to grasp the patient’s actual needs, and I place the blame for this mostly upon the training they receive and their willingness to accept that training as adequate. It might be adequate for them to earn a decent living, but that is not what we, the tax payer, thinks we have signed up for. We expect them to apply their knowledge of human physiology to understand our needs, to keep up with the research – at least in their own field – and to know how to read and interpret blood tests meaningfully.
For the patients I see, the reality is totally different: diagnoses are frequently wrong, tests are inadequate, and even then ignored or misinterpreted, and symptoms are overlooked that might have been pivotal to an accurate diagnosis. Inappropriate treatments are given whether unnecessary drugs or even surgery. Patients are told ‘there is nothing that can be done’, ‘there is nothing wrong with you’ or that ‘they are imagining it’, or they are given a prescription and sent away. Patients are left confused and self-doubting as they assume their GPS and consultants are genuinely thinking about their needs, turning over in their minds the possible underlying causes and taking into account the patient’s symptoms, medical history and constitution. The reality is quite different. The doctor is mostly just checking against a very short list of prescribed conditions: simply ruling them in or out. This is why they often don’t seem to be listening, and why they don’t ask us the questions that we think are relevant from our own perspective. The reason is that they have no way of thinking outside of their tick-box mentality. That’s how the system and its employees work from the first day of medical school up. In short, they hardly have to apply any knowledge or do any real detective work. “The underlying cause? Sorry, we don’t do underlying causes”.
The system actively discourages practitioners from having an original thought about the patient in front of them. For example, did you know that your doctor is not permitted to keep notes on which procedures work with his patients and which do not (with the aim of improving outcomes) because this would be classed as a medical trial, and would require approval by the ethics committee along with reams of paperwork, months of delay and huge costs. So they don’t bother. Yet real medicine requires constant questioning, thinking, evaluation and reading the research, and if I can do it then surely they can! I have a simple barometer for NHS health: if our doctors were doing their job properly, there wouldn’t be a need for me. My patients would dry up. As it stands almost everybody that walks through my door brings a fresh new horror story of NHS incompetence, harm and idiocy. My diagnosis? The NHS is sick; sick to the core. Outwardly appearing busy and effective, there is nothing meaningful inside. The ‘god in the machine’ is dead: only the outward form shuffles on, going through the motions, a cold simulacra of what healthcare could be and should be. Keep out of its clutches if you can.
So the zombie of the NHS flails on – the half-living corpse of the guardian angel we thought we were creating 70 years ago. As a conspicuous trail of casualties accumulates in its wake our politicians stand sheepishly by. Not one of them is willing to lift the silver dagger and put the poor beast to death.It will take more than a silver bullet to fix the NHS: a stake through the heart will be necessary to finally put this monster to rest…
Note: all the news stories above were just from March 2018. If we looked at similar articles over the past 70 years, they’d fill many tomes (and all too many tombs).