Tuesday, 18 January 2011
The NHS, Grist To The Mill
After staggering through torrential rain, luckily just ahead of the shunt that closed the motorway, we arrived at the hospital. Again, we had no letter or e-mail; the new booking service has yet to inform us as promised.
Phone calls had been made, but it was apparent that critical advice that should have been in place wasn’t there. Other than all this admin’ things went as they should do; which made a change.
So we were less than happy when we put on the TV when we returned to see Dave At The RSA doing his serious concerned chap routine to convince us that it was all about “Change”, he alleged for the better. What does he think has been going on for the last sixty odd years?
In the thirty five years before the inception of the NHS, ten had been in major wars and around another ten in serious economic difficulties, counting the bad time after 1918 in with the better known Great Crash.
There was a mish mash of local, Poor Law, private, academic and various forms of community services that had tried to cope with the demands of an increasingly urbanised population.
All in all, it was not in good shape and without the resources or means to deal with the mounting health problems and the pace of development in the science and the technology of medicine.
As the creation of the NHS was a political act, at the beginning it was organisational, financial and control systems that mattered. The medicine and the underlying stresses were low on the agenda, being taken for granted.
Since then we have seen roughly two full generations of the NHS and are now into the early years of the third. The first generation lasted until 1974 when the Edward Heath inspired major changes were made in organisation, again largely politically and financially based rather than in the context of the period and what amounted to a take off in medicine, science and treatments.
I recall in the late 1970’s in our meeting before the Area Health Authority met looking gloomily down the agenda as the Senior Community Medical Officer and I contemplated the problems we were going to have with the politicians who preferred to listen to accountants and “executives”.
We agreed that it wasn’t working well and was becoming more and more disconnected with the reality of the work to be done.
So in the 1980’s Ken Clarke, looking at the problems through his haze of cigar smoke, decided to throw it all up and the air and see how it came down before addressing many of the more intricate issues.
After then in the period of Mrs. Thatcher’s decline and fall and the Major years of trying to get the Tory party to agree to anything, we had years of indecision and uncertainty.
Worse there came to be an increasing reliance on haphazard initiatives, all sorts of schemes, largely promoted by non-medical consultants and worse endless spin and obfuscation of the difficulties and needs for radical re-provisioning and rebuilding.
Then came New Labour, who arrived at what was soon the start of the third generation. By this I mean a period when medical and technical technology were being transformed and research and knowledge were advancing far more rapidly, especially in the new context of immediacy in the transmission of information and knowledge.
So what did they do? One thing was ever more spin and a deliberate policy of “turning” the NHS into a bedrock agency of Labour ideology and beliefs. Also, they let loose the money men in PFI etc., hordes of management consultants from The Big Four and others and financial advisers of all shapes and sizes.
The professionals, doctors and nurses, essentially were bought off to subject them to the new disciplines and there was never ending change and reshaping. What did happen was major distortion of medical provision according to political demand rather than real need.
The funding and organisation of computer services for basic recording and service has been an expensive disaster.
It was all to be paid for by the new boom boom bust free economy. Now there is an expensive mess that apparently we can no longer afford. Also it bears the burden of huge financial liabilities that will extend for two generations beyond that of the present one.
Treatments may or may not be available for many conditions that are not “sexy” or spin worthy. Political criteria will govern who does what where. The mood of the moment is likely to continue to be key to decision making.
It is sometimes in the detail that you see how things are lost. There are many people with dangerous conditions that may cause them to collapse with little or no warning. You may well know one or two.
There is nothing in the NHS to deal with this situation and no system of recording or recognising those who live with such risks. Those than can afford it can sign up with a private service which has a 24 hours response and advice line. But large numbers of NHS are not aware of the meaning and nature of the dog-tags and bracelets.
Nor are police or fire or other services that may be dealing with people who have gone down and in difficulty. Typically, a police officer who sees someone writhing on the floor or not entirely coherent will simply assume drink as will almost all the public. It is the reason why so many now are dying where they fall or in police hands.
Yet the cost of this compared to many things is absurdly cheap, as is the cost of creating awareness both within the services and in the general public of what are high risk conditions and what might need to be done.
And these conditions and needs have been known ever since the NHS came to exist.