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).
4 thoughts on “Is the NHS a zombie no one is brave enough to kill?”
The frightening thing is… I believe our ‘Medicare’ in Australia is headed down that same path to poverty, and it’s everything to do with ‘not’ dealing with Life-style diseases…. Diabetes 2 / obesity which morphs into Cardiac Disease, and sets the environment for Alzheimer’s and cancers. I fear it’s too late for an effective ‘sugar tax’ to reverse the ruin, but it would go a long way towards paying for it ! I’m glad that I didn’t elect any of those politicians who have landed us with this Lead Baloon !
The trouble is that the NHS was gradually put together & increased in scope & enlarged with lots of add-ons = like trying to bodge putting up a shelf with blu-tac then as that fails put a strut under it, then that fails so you put a chair under to hold that up, the floor gives way so you put some beams under to hold that up…
If it was started now it would be far more streamlined & effective which would (as you say) save MASSIVE waste, but it wasn’t. We can’t blow it up & start again nothing to fill the gap in the meantime), hopefully lots of good people are rebuilding it from within to create a modern, sustainable and compassionate service with patients at the centre (not docs as it was set up so long ago) and with modern systems and top training & exams plus any bad apples actually weeded out in good time instead of being protected.
I’m a survivor of very serious medical errors in 2005, then the lies & cover-ups & the NHS & docs choosing to describe my experiences & symptoms as ‘purely psychiatric’ (I suffered awake paralysis with suffocation: anaesthetic errors & seriously gouged-out throat, brain & neck damage) and my GP too loyal to his colleagues at the hospital to write down all my symptoms or to examine me AT ALL (too much to say here) = they ALL knew that what they were doing was so very wrong and that I might die from untreated serious throat infection and breathing difficulties, but they didn’t care: their reputations & jobs were to be protected at all costs.
The NHS had already promised to be Open & Honest after errors before my bungled op but they chose to ignore that & carry on as they always did when the blunders were extremely serious so they falsified my fluid balance chart (& more?) to help cover up the Trust’s failings.
Healthcare free at the point of delivery is obviously the best way to fund it: through taxes = a huge sharing of risk, higher financial costs being paid by those who can afford to help poorer groups, but yes, we have put up with so many terrible experiences from the NHS saying ‘it’s free, you can’t complain, we’re lucky’ – I know I have: many examples of very poor care in my own life but I just put up with them (& got no help from GPs or hospital/consultants = they always used bad excuses including wrongly blaming me) and never complained even though I still suffer from some of their errors now.
But in 2005 they so seriously injured and neglected me and totally dumped me – then on top the even more unbearable massive psychological traumas of their lies that I intended to commit suicide – but couldn’t – to escape it.
It’s now nearly 15 years since I experienced suffocation and my ‘death’ and out of body experience then the huge wall they put up to defend themselves, I live 24/7 with brain & serious throat injuries (& have trouble swallowing & it feels a bit like I’m being constantly strangled) and in constant pain from my neck injury, my swallowing digestion was also wrecked – but they don’t care.
I wonder how many others were injured in the same ways – and by that team and in that ward that weekend and since – and in other NHS hospitals – because NO learning could take place so nobody can be protected from the same errors = that to me is criminal.
Too much to say, but I dearly hope we can keep the NHS funded as it is now but create a real top-class service so when governments crow that it is The Best it could finally actually be true and that ALL healthcare everywhere round the world can be free at the point of delivery and ALL equally The Best.
IF the doctors & nurses & NHS Direct’s computer programme operator had all listened to me (instead of them thinking they knew best) and written down what I said I wouldn’t have had the unnecessary op so my body and my life (& that of my son/family & friends) would not have been wrecked, not just one victim: it spreads out like ripples and affects the whole of society, you know.
Your briefly described experience of suffering a medical injury, and the lasting effects of it, are very troubling to read, and no one can be unmoved by it. It’s the ‘adding insult to injury’ that feels like such a betrayal. It’s one thing to mess up while performing surgery, but to then pretend they didn’t, and ‘blame the patient’ is intolerable. I agree generally with your analysis of how the NHS could be improved, but with so many egos, salaries and reputations in the mix I fear that we will just have more of the same in the future. From where I stand I see the failures of fundamental medical training, as the fundamental area to focus upon. By this I mean that all trainee medics must be better educated in all the new and solid science of nutrition. This is now so extensive and reliable, building up as it has over the past 100 years, that there is no excuse for failing to teach this properly. It sounds like too little has been said when I state: ‘The body runs on nutrients’ and so this is overlooked and passed over, when in fact this statement is of the greatest importance. The whole of the first three years of a medical training should be around grasping this. It would revolutionise the world and society. It would spill out and change things for everyone, for the better. It needs just ONE school of medicine to start this process, and all others would follow, for when the basics are grasped, the issues that follow would all be found to have solutions derived from the earlier knowledge. For example, a cohort of medical students would have learned the nitty gritty of cell/organ/system nutrient requirement function and inter-relationship such that when learning about the many malfunctions/pathology of such tissues they will already have a reasonable understanding of the fundamental means by which to bring that tissue back to normal function. Because it truly is via the substances that we call ‘nutrients’, i.e. fats, proteins, vitamins and minerals, that all the zillions of structures and functions of cells and organs and systems take place. From DNA production and repair (e.g. vit B12) to peristaltic action of the colon (e.g. butyric acid) or synaptic efficiency in the brain (e.g. omega 3) or mitochondrial energy production (e.g. vit B3) every bit of it requires the appropriate deployment of multitudes of nutrients, which must not only be on board, but accessible as and when needed to achieve the symphony of function that can and should result. This is so near to being teachable (and what is still unclear to minds, is still done by bodies, whether it is known or not) that to fail to teach it at all is, to me a mixture of unforgivably stupid and tragic. Here are these edifices called universities and medical departments failing to teach the wide open young students the most valuable and logical bottom up stuff, and then all wondering why they make so many horrendous cock-ups throughout their careers, because they didn’t really know what they were working with. And the road behind them is strewn with bodies, writhing and bleeding, because those at the wheel didn’t know what they were driving, or how to handle it. Everyone is let down by this failure to grasp the subject properly. Every one of the doctors who failed you, and then stayed silent and protected themselves and each other experience guilt and shame, because, as you said, they knew that they had done you harm. They certainly didn’t intend that, but they were too ignorant (failure of eduction) and vulnerable (failure of governance) to admit to what they had done. Tragic and stupid, and unforgivable, because the knowledge is now available. Admittedly, it is not complete, and mysteries will always be there, but so much is now graspable, and teachable, and actionable, that to fail to do what can be done is a monstrous betrayal of human potential and trust.
The frightening thing is… I believe our ‘Medicare’ in Australia is headed down that same path to poverty, and it’s everything to do with ‘not’ dealing with Life-style diseases…. Diabetes 2 / obesity which morphs into Cardiac Disease, and sets the environment for Alzheimer’s and cancers.
I fear it’s too late for an effective ‘sugar tax’ to reverse the ruin, but it would go a long way towards paying for it !
I’m glad that I didn’t elect any of those politicians who have landed us with this Lead Baloon !
I am so sorry to hear that our Aussie cousins are failing to see the mistakes of others. What’s up with the Anglosphere?
The trouble is that the NHS was gradually put together & increased in scope & enlarged with lots of add-ons = like trying to bodge putting up a shelf with blu-tac then as that fails put a strut under it, then that fails so you put a chair under to hold that up, the floor gives way so you put some beams under to hold that up…
If it was started now it would be far more streamlined & effective which would (as you say) save MASSIVE waste, but it wasn’t. We can’t blow it up & start again nothing to fill the gap in the meantime), hopefully lots of good people are rebuilding it from within to create a modern, sustainable and compassionate service with patients at the centre (not docs as it was set up so long ago) and with modern systems and top training & exams plus any bad apples actually weeded out in good time instead of being protected.
I’m a survivor of very serious medical errors in 2005, then the lies & cover-ups & the NHS & docs choosing to describe my experiences & symptoms as ‘purely psychiatric’ (I suffered awake paralysis with suffocation: anaesthetic errors & seriously gouged-out throat, brain & neck damage) and my GP too loyal to his colleagues at the hospital to write down all my symptoms or to examine me AT ALL (too much to say here) = they ALL knew that what they were doing was so very wrong and that I might die from untreated serious throat infection and breathing difficulties, but they didn’t care: their reputations & jobs were to be protected at all costs.
The NHS had already promised to be Open & Honest after errors before my bungled op but they chose to ignore that & carry on as they always did when the blunders were extremely serious so they falsified my fluid balance chart (& more?) to help cover up the Trust’s failings.
Healthcare free at the point of delivery is obviously the best way to fund it: through taxes = a huge sharing of risk, higher financial costs being paid by those who can afford to help poorer groups, but yes, we have put up with so many terrible experiences from the NHS saying ‘it’s free, you can’t complain, we’re lucky’ – I know I have: many examples of very poor care in my own life but I just put up with them (& got no help from GPs or hospital/consultants = they always used bad excuses including wrongly blaming me) and never complained even though I still suffer from some of their errors now.
But in 2005 they so seriously injured and neglected me and totally dumped me – then on top the even more unbearable massive psychological traumas of their lies that I intended to commit suicide – but couldn’t – to escape it.
It’s now nearly 15 years since I experienced suffocation and my ‘death’ and out of body experience then the huge wall they put up to defend themselves, I live 24/7 with brain & serious throat injuries (& have trouble swallowing & it feels a bit like I’m being constantly strangled) and in constant pain from my neck injury, my swallowing digestion was also wrecked – but they don’t care.
I wonder how many others were injured in the same ways – and by that team and in that ward that weekend and since – and in other NHS hospitals – because NO learning could take place so nobody can be protected from the same errors = that to me is criminal.
Too much to say, but I dearly hope we can keep the NHS funded as it is now but create a real top-class service so when governments crow that it is The Best it could finally actually be true and that ALL healthcare everywhere round the world can be free at the point of delivery and ALL equally The Best.
IF the doctors & nurses & NHS Direct’s computer programme operator had all listened to me (instead of them thinking they knew best) and written down what I said I wouldn’t have had the unnecessary op so my body and my life (& that of my son/family & friends) would not have been wrecked, not just one victim: it spreads out like ripples and affects the whole of society, you know.
Your briefly described experience of suffering a medical injury, and the lasting effects of it, are very troubling to read, and no one can be unmoved by it. It’s the ‘adding insult to injury’ that feels like such a betrayal. It’s one thing to mess up while performing surgery, but to then pretend they didn’t, and ‘blame the patient’ is intolerable.
I agree generally with your analysis of how the NHS could be improved, but with so many egos, salaries and reputations in the mix I fear that we will just have more of the same in the future.
From where I stand I see the failures of fundamental medical training, as the fundamental area to focus upon. By this I mean that all trainee medics must be better educated in all the new and solid science of nutrition. This is now so extensive and reliable, building up as it has over the past 100 years, that there is no excuse for failing to teach this properly.
It sounds like too little has been said when I state: ‘The body runs on nutrients’ and so this is overlooked and passed over, when in fact this statement is of the greatest importance. The whole of the first three years of a medical training should be around grasping this. It would revolutionise the world and society. It would spill out and change things for everyone, for the better. It needs just ONE school of medicine to start this process, and all others would follow, for when the basics are grasped, the issues that follow would all be found to have solutions derived from the earlier knowledge.
For example, a cohort of medical students would have learned the nitty gritty of cell/organ/system nutrient requirement function and inter-relationship such that when learning about the many malfunctions/pathology of such tissues they will already have a reasonable understanding of the fundamental means by which to bring that tissue back to normal function. Because it truly is via the substances that we call ‘nutrients’, i.e. fats, proteins, vitamins and minerals, that all the zillions of structures and functions of cells and organs and systems take place. From DNA production and repair (e.g. vit B12) to peristaltic action of the colon (e.g. butyric acid) or synaptic efficiency in the brain (e.g. omega 3) or mitochondrial energy production (e.g. vit B3) every bit of it requires the appropriate deployment of multitudes of nutrients, which must not only be on board, but accessible as and when needed to achieve the symphony of function that can and should result.
This is so near to being teachable (and what is still unclear to minds, is still done by bodies, whether it is known or not) that to fail to teach it at all is, to me a mixture of unforgivably stupid and tragic.
Here are these edifices called universities and medical departments failing to teach the wide open young students the most valuable and logical bottom up stuff, and then all wondering why they make so many horrendous cock-ups throughout their careers, because they didn’t really know what they were working with. And the road behind them is strewn with bodies, writhing and bleeding, because those at the wheel didn’t know what they were driving, or how to handle it. Everyone is let down by this failure to grasp the subject properly. Every one of the doctors who failed you, and then stayed silent and protected themselves and each other experience guilt and shame, because, as you said, they knew that they had done you harm. They certainly didn’t intend that, but they were too ignorant (failure of eduction) and vulnerable (failure of governance) to admit to what they had done.
Tragic and stupid, and unforgivable, because the knowledge is now available. Admittedly, it is not complete, and mysteries will always be there, but so much is now graspable, and teachable, and actionable, that to fail to do what can be done is a monstrous betrayal of human potential and trust.