Not Mid Morning Matters

JD in the Morning, off air…

Tag: NHS Crisis

Experts; aren’t we all?

What makes Doctors think they are special, “so very special” that they don’t have to work 7 days a week like many of us? Actually, in reality, Doctors do already work 7 days a week on rota but they currently get more money for weekends than what’s being offered in their new, soon to be imposed contract. How you side in this Junior Doctor’s dispute, be it the emotive BMA “patient safety” or the Government “manifesto commitment to a 7 day NHS” against the constant “crisis” backdrop the NHS is always in, the whole thing is all about money.

Back to the initial question. What makes Doctors think they are special? Is it the commitment to be a doctor that starts in their early teens when they select their GCSE’s? Is it the vision, commitment and passion to select and get the right A Levels and grades to match? It could be the 4/5 years at Medical School followed by a decade or more of training, exams, more training and more exams? Maybe it is the constant changing of jobs and hospitals to gain vital experience, which could also mean travelling 100’s of miles a day, including at weekends? Perhaps it’s the failed relationships and missed family moments as being a doctor is all-consuming? Hard to know really what makes a Doctor special but in a world of Google and Social Media, where we can diagnose ourselves without having to do any of the above, what’s the point of all that effort and commitment? Doctors aren’t special. We don’t need experts.

During the now widely discredited Referendum Campaign (discredited on both sides in a report by the Electoral Reform Society published this last week) one of the most revealing moments was when Leave campaigner Michael Gove (remember him) said “I think people in this country have had enough of experts”. Experts had been telling us what might happen if we chose to Leave or Remain in the EU. It is fair to say that following the result to leave on 24th June all of the doom predicted by those experts has not happened, so far. In fact, after the initial shock, the UK economy has returned to pretty much where it was when the (then) Prime Minister David Cameron (remember him) called The In/Out Referendum in February this year. It’s been a very long 7 months.

Is Michael Gove right in his assertion that we don’t need experts? Is our existential age a time of instant information and connectivity to anything, everything and everyone making us all instant experts? We can now have hundreds of “friends”, we crave “likes” and most of us have more “followers” than Jesus could manage when he was “alive”. Does this means we don’t need real experts, doctors, elected politicians, public servants, journalists, newspapers, radio, TV because we can all get what we want when we want it, all at a click or swipe or scroll? The internet has democratized information and for those who wisely choose to go beyond one single source of information or a single “trusted” news site we can be better informed. You can check and cross reference anything.

Yet there is a problem with all this. If we don’t like what we see, read or hear we can trash it, troll it, attack it and get our “friends” and “followers” to pile in too. We don’t need experts. Your opinion is not mine. Your politics is not mine. Your race is not mine. Attack. We live in the moment were we can easily be extreme and many relish this. We are entitled to do so. We are entitled. Nobody is worth more money than me. Nobody. Social Media is allows us to be everything including judge, jury and expert.

Starting with newspapers many centuries ago, for almost the last hundred years radio followed by TV was all we had. This so-called traditional media is now changing fast to adapt to the social media world and rightly too. As this old media tries to marry with the new maybe the new needs to respect the old a little bit more than it currently does. Our rush toward Social Media is not taking account of the long path it took to get to this point. It took hundreds of years from the first printing press to create the first mass-produced published book. Facebook is just 12 and half years old. Would you just trust a 12-year-old with your life, business and future? We need to respect what was and how it came to be more than we currently doing or we risk losing the bath water, baby and the bath.

This is the case with junior Doctors too. We need to respect what happened in the past. This past and path gave us the Consultant Medics and Surgeons we rely on today and will have to rely on even more with the coming strikes. Both sides in the Junior Doctors dispute would do well to remember this and would do better to talk less and listen more. Doctors know better than most the power of listening. It saves lives. Taking a “history” is vital to diagnose and treat anyone. We need to respect our past, our experiences and do a little less existential scrolling, clicking, swiping and living. Doctors are special and we do need experts.

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Doctor, Doctor give me the news 24/7

This week the Government made it clear that it wants a 7 day a week health service because it will give us the patients access to healthcare, at its best, 7 days a week. Why? We are more likely to die at the weekend, which ‘statistics’ say will happen, because there aren’t enough doctors on the wards. Apparently the worst day to be admitted to hospital is Sunday. Imagine ending up in hospital on the ‘day of rest’ and finding a notice on the door saying closed until 8am Monday morning.

The stupidity of thinking that a doctor, any doctor, can cure you on his or her own is beyond belief so the idea of stuffing hospitals with Consultants together with ‘junior doctors’ who include Registrars and F2’s and F1’s is potty. Consultant Medics or Surgeons are not gods, although some believe they are. They are part of a team and the head of that team. The collective experience and wisdom of that team is the key to your successful treatment. If the Consultant is there along with their full team every day then this will impact on the following. Training, development and the numbers of doctors actually available every day of the week. This will impact on patient care. So the answer is we need more doctors, 10,000 of them.

It takes at least 10 years to become a Consultant in the NHS. You can’t fast track being a surgeon or a medic. If you think you can then you or your loved ones can get treated by that fast tracked doctor. I will always go for the one who has a breadth of experience.

My ex-wife is a Consultant Surgeon, a published, peer-reviewed author and award-winning in her chosen specialty. She is, frankly, amazing but achieving all this has consumed her. It is only our two children that she has time for outside of medicine. Nothing else. It has taken her 15 years to get there and she has sacrificed much to do so. So have her colleagues. She already works weekends, every 6th weekend on call, day and night. I know what this means because I look after our children when she is on call. It does involve a ward round Saturday and Sunday, then staying in the hospital or going back to the hospital at ANY time day or night to do what she has trained for and has the extensive experience to do. Her colleagues also do this for the other five weekends. Her hospital is just like every other hospital in the UK at the weekend. It is full of highly qualified doctors.

To have a full 7 day NHS you also need theatre nurses, lab assistants, receptionists, porters, clinical support staff, administration staff, managers, district nurses, mental health services, public health departments at councils and more ALL to work 7 days a week. You will also buses, park and rides, trains, shops, schools, all to be properly 24/7 so Monday is no different from Sunday. If we all don’t recognise that Sunday is not Monday, why have it? If you really want health care to be 24/7 then we and it all has to be the same 24/7. Simply this means more doctors and more bus drivers too.

If 24/7 healthcare were as simple as just making Consultants work a full Saturday and Sunday they would already be doing it. And they already are.

I have one last question that government has yet to successfully answered. This may well be the starting point to all of this call for 24/7 healthcare. If you are prepared to sit in an Accident and Emergency department for 4 hours or more, just how bad is your accident or emergency?

The NHS is not safe in anyone’s hands.

The NHS is in crisis. It’s probably been in crisis since it was founded in July 1948. It will be in crisis no matter how much money you throw at it or who runs it. It doesn’t matter which political party comes up with yet more policy or politics on the NHS or who changes it or who blames the other for what they did. Politics has put the NHS in crisis. They are all at fault. They are all to blame. To blame each other is naive and utterly insulting to us, the voter.

The most naive part of the NHS was the founder himself. Bevan’s devastating mistake was not to have the foresight to factor in the likelihood that medical advances and an ever progressive medical profession would render a health service free at the point of need impossible to deliver. If you marry medical advances and science to an NHS promised in our low taxation economy, as pledged by our two principal political parties, the NHS as promised is, frankly, little more than a big fat lie. It just can’t be done and all political parties should come clean and tell us the hard truth. Neither Labour or the Conservatives will give the NHS the £8bn it has asked for.

Let’s deal with the basic principle of the NHS being free at the point of need. This is a worthy aspiration and it is achievable, if it’s not confused with free at the point of want. ‘Need’ really means this: if you are fat and want a gastric band because you want to be thin then you pay for it. You can be treated for any mental health issues that make you eat excessively so you stop eating so much. But it is for you get off your arse, reduce your food intake and exercise. It’s not the state’s job to make you thin, that is down to you.

An NHS free at the point of need is about the heart attack, the broken leg, a stroke or Ebola. It is not for want as in ‘I want a nicer nose as my nose is to big’. But what about the heart attack due to smoking and drinking or poor diet or lack of exercise? That is why *in a world where the NHS is free at genuine ‘need’* you must pay more tax to fund your *own* failings in you not looking after you. You either pay more tax under they current system or you don’t get anything free at the point of *immediate* need, let alone at the point of want.

What of the future of the NHS? As it is now it can’t survive? There isn’t the money or the resource to deal with an ageing population who can be kept alive thanks to costly medical science and its continued advances. It is medical science that defies nature and keeps us going long after nature should have taken us.

So here is my prescription for an NHS worthy of all.

1. All political parties need to stop blaming each other for the NHS in crisis. They have all caused it and they have failed us by not being honest in what is needed. In simple terms, you and I need to pay more tax for the NHS to work. We need to pay for a GP appointment, much like those who can pay for the dentist and optician now. The same exemptions would be applicable. If we don’t turn up to the appointment we must to be fined £10 before we can see a doctor again. Personal responsibility starts with all of us treating the NHS with respect and responsibility.

2. We need be more responsible for our own health and not expect the NHS to pay for what we knowingly do to harm our health. If you want to smoke, drink to excess, go rock climbing, skiing, caving, ride a horse, surf and so on then you need to take out some insurance to protect you if you come to some harm. Don’t expect us all to pay for your choices.

3. It is a bit late for many of us but our children need to be educated about health and wellbeing at school, as part of physical education. They need to be taught how to exercise throughout life, what to eat, first-aid and life-saving, how the body functions and how to take care of it. In a generation, through education, we may have a healthier society than we have now. *If we achieved that,* they *might even* be fortunate to pay less for an NHS free at the point of need.

4. The current NHS needs to be split into the following basic groups. Acute Care, Chronic Care, Social Care and Elder Care. You will fall into one or more of these categories and will be treated accordingly.

5. Pharmacies need to be empowered to deal with sniffles and basic ailments with the power to prescribe and, if needed, refer accordingly.

6. GP’s need to be open 7 days a week, 9am to 7pm. Outside these times you wait or if it really is an emergency you go to A and E. This is THE last port of call on the NHS not the first stop in our ‘I want it sorted now’ society of today.

7. 111 must be scrapped. Like NHS Direct before it, it is a fundamentally flawed idea, thought up by a bunch of Whitehall wonks who didn’t think it through. If you’re ill you need to speak to someone medically trained, not a call handler.

8. Most importantly, we all need to be educated to take responsibility for our own health. It’s not the government’s job to make you better, it’s your responsibility to do everything you can to keep you well in the first place. If you take risks or make choices that impact on your health then you must be responsible for the consequences, regardless of income or social standing. Being rich or being poor is no excuse for poor health.

Being fit and well is all of our individual responsibility. Paying tax for those who are genuinely unable to be fit and well in our society, so they can be cared for properly, is the mark of a civilised society. Tax is the price of civilisation. We all have a responsibility to do all we should to look after ourselves in the first place so the NHS is only used when we really need it.

Finally, as this is an election year, perhaps our politicians can be honest about the NHS, its cost, its failures and its future rather than blaming each other for their collective failings since its inception back in 1948. That would be start to saving the NHS for all of us.

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