Nursing the NHS

Reading back through my musings last week, I had a train of thought about the NHS that I didn’t entirely follow through.

I spent a relatively short period in the organisation, a mere 7 years, but during that time, I was struck by two things.  Firstly, the tremendous loyalty and dedication shown by hard working staff, many of whom had spent their whole career as NHS employees.  Secondly, that the concept had grown too big and therefore does not work anymore.

Free at the point of delivery

In 1948, when the NHS was introduced, the country was very different, and the population had much lower expectations.  A health care service, free for everyone at the point of delivery, was something to be cherished and looked after.

As with everything though, our attitudes and our health has changed dramatically.  Improved healthcare and living conditions, coupled with a more safety conscious society, has led to longer life spans, so more people live well into their 90’s and we have over 14,000 centenarians!  That brings more complex health conditions and more expensive and labour-intensive care.

In addition, increasing obesity and ill health at a younger age mean that health care intervention is required earlier and for longer.  The healthcare burden is not what the founders of the NHS envisioned, and it is quite frankly, not sustainable.

That said, I am not advocating that we withhold healthcare, or ration it.  I still believe that urgent health care should, essentially, be free at the point of delivery, but perhaps with a few caveats to make it more efficient and effective given the finances available.

Focus on preventing ill health

Firstly, we need to focus energies on preventing ill health.  Divert some of the finances spent in the acute sector into helping keep people well – Stop Smoking Clinics, weight loss programmes, stress and anxiety support, proper mental health awareness and care.  Research regularly shows that small sums of money spent in prevention leads to large savings, as people don’t need to visit their GP’s so frequently or be admitted to hospital.

Money spent on improving insulation or providing handrails can prevent admittance to hospital for respiratory diseases or falls related injuries.  Small sums can lead to savings in treatment and free up hospital beds.

Primary Care Hubs are looking at Social Prescribing, helping people stay healthy without medical intervention.  Prescriptions might include joining a walking or gardening group to improve fitness and reduce isolation, or it might mean some gentle fitness classes to improve flexibility and reduce muscle and joint pain.

This new approach, relying on prevention and non-medical care, could save the health care system huge sums and improve our health over the long term, not just provide short term fixes.

Take responsibility for our own health

Secondly, everyone must take responsibility for their own health.  There are more stories of Doctors refusing to perform operations unless people lose weight or stop smoking. 

I hate wasting money, so the thought that someone might have an operation to replace a knee or hip when they are so overweight that the new joint won’t be able to cope is ridiculous.  I do believe however, that there must be some carrot and some stick – help the patient lose weight and reward them with the operation when a target has been reached.

Also, Doctors need to be firmer with patients who demand a prescription.  If it is for a simple painkiller, such as paracetamol – take those off prescription and get them to buy it themselves – these are a cheap and freely available medication and don’t need to be prescribed. 

If the problem is a virus, antibiotics aren’t going to help and hard as it is, the patient shouldn’t be given anything other than advice to stay at home in bed till they are better.  These drugs cost the NHS huge sums of money, and would seem a sensible place to start savings.

Get healthcare bodies to work together

Finally, and most dramatically, the NHS needs to be one organisation, not a network of businesses all fighting against each other for a share of the ever-decreasing pot of money.

Currently, the Government allocates a sum of money to the Department of Health who in turn divide it up amongst the Clinical Commissioning Groups.  This pot is then subject to a bidding war between the various healthcare Trusts in that locality, so you have GP’s, mental healthcare Trusts, community hospitals, acute hospitals and all sorts of other bodies fighting over it.

This doesn’t foster a joined-up approach to healthcare or act in the best interests of the patients.  In fact, the only winners are the armies of bean counters in each organisation whose job is to make sure every last item, procedure, medication is accounted for and claimed.

I would like to think that if we were designing a healthcare system now, we would try to keep it as simple and straightforward as we can with the patient at the centre.  We wouldn’t see the Post Code lottery fiasco as there would be clear guidelines for everyone about what is and isn’t included in an NHS free at the point of delivery.

Suggestions for inclusion would be emergency care, maternity and end of life care, infectious and life-threatening diseases.  Perhaps however, we should make some sort of contribution for health problems that have been caused by our lifestyle or as a natural product of growing old.

There would of course have to be more GP’s, but by opening other care options up, perhaps more Doctors who currently choose hospital practice could be enticed into general practice and we could return to a GP who knows us and our health history.

The current system is so complex it requires massive amounts of administration and management.  By slimming down reporting and accounting functions through simpler processes, you will relieve healthcare of a huge wage bill and even be able to make better use of the built estate.

Something has to be done soon

Controversial thoughts perhaps, but the NHS is faltering and cannot continue in its current state.  For the sake of the incredibly dedicated and hardworking staff, and for the safety and health of the patients, urgent and difficult decisions must be taken.

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