|The NHS Needs Treatment!||Rob Smyth considers some of the burgeoning problems of our health system|
'Patriotism is not enough' - Edith Cavell
Loyalty is, or should be, a two-edged sword. Patriotism, people's loyalty to their country, should be matched by a country's loyalty to its people. This is not so in Britain, whose people have been let down on all fronts by successive governments, ever ready to submit to powerful pressure groups, foreign governments and vested interests. Disloyalty to the people shows itself in many fields, including immigration, employment, crime and transport. Failure is also evident now in one of the prime duties of government - to protect the health of its people. The National Health Service, once the pride of the nation, appears to be in the throes of disintegration.
The undignified and continual fawning and subservience by Britain's rulers to America does not stop those on the other side of 'the pond' from telling some home truths about Britain. The Daily Mail (10th March 2001) quoted at length an article in the Wall Street Journal, reporting that in England and Wales men have a 42 per cent chance only of surviving prostate cancer, 50 per cent below the US level and "far below most other EU countries." The ratio of doctors to population in Britain is about half that of the US, Germany and France. A World Health Organisation study estimated that 25,000 Britons die unnecessarily of cancer each year and would survive if British care matched the best in Europe.
More recently, The Observer (7th September 2003) gave details of a new study showing that patients who have major surgery in Britain are four times more likely to die than those in America having the same sort of surgery. This is put down to hospital waiting lists, a shortage of specialists, and lack of sufficient intensive-care beds. Of these factors, the quality of care seems to be the most important, but we have long suspected that the Government just doesn't care for us.
Lack of money is blamed for the state of the NHS, yet plenty of money has been poured into the service over the past few years with little sign of improvement and with continuing scandals. Billions of pounds are drained away annually on administration costs and compensation for patient mistreatment. Such resources as are left for patient care do not always seem to be used very wisely.
Caesarean operations are a case in point. It was revealed in 2001 that the number of caesarean births has doubled in the last ten years. Now one in five babies are born in this way. According to the Daily Telegraph (26th October 2001), there were fears that this was putting some women and their children needlessly at risk. It quoted the Director of Midwifery at the Royal College of Midwives as saying that many of the operations were "unwanted and unnecessary and a drain on the National Health Service." Caesarean births cost the NHS more than twice as much as natural births. The Royal College was concerned that caesarean operations are performed on women as a matter of course, rather than of medical necessity. Sometimes, of course, such surgery is necessary and it is entirely proper that it should be provided in such cases. However, the number of such operations in Britain is now well above the 15 per cent ratio for developed countries that is recommended by the World Health Organisation. It is another sign of waste and bad practice in the NHS.
Two reasons are given for this massive increase in such surgery. Some say that women want the surgery so that the labour "fits in with their busy life-styles." This, in so far as it is correct, could be partly a symptom of the runaway materialism that is currently plaguing society and partly the result of poisonous feminist propaganda that is undermining family life. At least, in these cases women have the surgery through their own choice. However, others say that women are being forced into caesarean sections because there are not enough midwives. This is an utter disgrace.
Euthanasia for all?
Scandals may take some time to come to light. It was a surprise, therefore, to many people that in 2001 the Government promised that the NHS and social services would guarantee elderly people equal treatment. A document entitled National Service Framework for Older People stated that age discrimination would be rooted out of the NHS. The number of operations offered to people over 65 would increase and age limits on cardiac care and the prescription of clot-busting drugs should go. This means, of course, that at that time elderly people were being routinely discriminated against and denied treatment and drugs, presumably to save money and/or free resources for people considered more worthy of help.
This change of policy did not seem to come from a change of heart, but only after The Daily Telegraph had published evidence of widespread discrimination against the elderly in hospitals, including accusations of patients being left to die, or left unfed or untreated for days. The most serious concern was aroused by reports that patients' bedside notes were being marked 'Not to be resuscitated'. Thus, the Telegraph (19th April 2001) reported another case which had come to light, this time of a 60-year-old man who had his notes marked in this way.
The question that arises now, however, is whether the introduction of equal treatment (assuming it is actually implemented) means that the same death-sentence instruction may now appear on the notes of anyone, regardless of age, whose life is not considered worth trying to save by some doctor?
Internationalisation of the NHS
Goodbye NHS; welcome the International Health Service! Lack of resources to provide proper care for our own people has not stopped the NHS providing free care for the whole world if it lands on our doorstep, no matter how ill people are or how expensive will be the treatment they need. But this is only one aspect of internationalisation. The continuing failure to improve the NHS has led the Government to the expedient of sending patients abroad to be treated (with NHS funds), to Germany in particular (where a National Health Service was established in 1935, thirteen years before the NHS in Britain). Germany still has a fine health service, with high standards, spare beds, no waiting lists and apparently specialists with some time on their hands.
Another trend is the recruitment of more and more nurses and doctors from abroad. Many of these come from third world countries, where they are probably needed even more than here. This is another case where we are actually filching away skill and dedication from countries over which our politicians are continually shedding crocodile tears. Some overseas doctors serve us very well, though language and cultural problems can arise, but it is clearly preferable for us to train our own people than to bribe talent away from other countries.
Whilst there is a chronic shortage of doctors and nurses, a vast bureaucracy has enveloped the NHS over the last two decades. The Daily Mail (21st February 2003) gave details from a report by the GMB union (using figures derived from government statistics) which showed that over the previous 13 years there had been a rise of more than 30 per cent in health service managers and a reduction of 20 per cent in beds. The proof that much of this bureaucracy is probably unnecessary is shown by the variation in the number of nurses to managers in different parts of the country, ranging from 11 nurses to one manager in London to 19 nurses per manager in the North West of England.
As the bureaucrats have flourished, so government figures reveal that the total number of nursing and midwifery staff in Great Britain fell by 25 per cent between 1990 and 1999. No wonder there is a never-ending crisis in the NHS and inappropriate treatment is being given.
Being unable, apparently, to make real improvements to the NHS, the Government has resorted of late to imposing targets on hospitals, presumably to establish some improvement in performance, in particular the reduction in waiting lists. Very commendable on the face of it, but what has happened is that seriously complex operations have been held up so that many more but simpler ones could be undertaken to improve the overall figures. Consultants have said that in 80 per cent of such cases seriously ill patients have suffered as a result. One example given is that of operations for reversed vasectomies displacing surgery for bladder cancer in priority.
The Times (26th July 2001) reported one consultant as resenting the fact that over £700 million was spent between 1998 and 2001 on reducing waiting lists. The money could have been better spent on employing more consultants and nurses. Yet, the government still persists with targets. That is the trouble with the NHS. Patients are treated as a nuisance whilst politicians and bureaucrats keep talking and' spinning' in the name of 'reform', giving false impressions of improvement whilst the service gets steadily worse. No wonder more and more desperate patients are going abroad for operations, to countries where there are no waiting lists and no infection-ridden hospitals.
The Daily Mail (12th May 2001) even reported one case of a man going to Bombay for a triple heart bypass, rather than wait a year in Britain. He found that the hospital was clean and efficient "with matrons who saw dirt as a personal insult. They made sure that everything was immaculately clean and running smoothly." It reminds one of how British hospitals were run several decades ago. Not only was the service good but also the operation cost this man £6,300 - as against £20,000 in Britain, and his fee would help fund operations for patients who could not pay.
The latest panacea of the government to improve the health service is to privatise parts of it. An example of this has just been announced in Southend, where it is reported in a local paper that "A consortium made up of UK and Canadian companies has been chosen to take over the running of some Southend hospital services, including minor operations, diabetes treatment and X-rays."
Of course, people speak well of private medical care if they are able to afford it. But the privatisation going through now is somewhat different. Private hospitals are run on patients' fees; they engage their own staff and must satisfy their patients to succeed. Under privatisation, the Government, not the patient, will be paying the operators, and NHS staff (with the same pay and conditions) will be seconded to provide the care. The only difference will be the introduction of a powerful profit motive. As, presumably, the government is not paying the private operators more than it cost the NHS to run the same services, the only way to make a profit is to run the services more efficiently or provide less for the money. It is assumed that the services will be run more efficiently but, surely, it is a bit of a gamble in the light of the experience with railway privatisation, and indeed at a time when the government is actively seeking more control over the railways in order to correct the failings of this very policy. Could someone be gambling with our health?
Is money the answer?
More resources will be needed to provide the doctors, nurses, and equipment we need for the first class health service we deserve, but money alone will not be enough. What is needed in Britain is a completely new attitude. The NHS should not be a political football; empire-building administrators should not run it. There must be complete root-and-branch reform. Health practitioners, not bureaucrats and hospital quangos, must run the health service. Government must assume overall responsibility and ensure that the highest standards prevail throughout the services. A study by Imperial College showed, for example, that the mortality rate from heart bypass operations was four times higher in the worst hospitals than in the best.
Most of all, a new spirit and ethos is needed from everyone involved: government, doctors, technicians, nurses, secretaries, porters and cleaners. They must be imbued with the ideal of public service, and of working to ensure that they (and the rest of the nation) can be truly proud of the NHS. All should realise that the welfare of patients is their welfare too because we are all part of an organic whole. It is up to the Government to provide leadership and ensure that the will to improve the health service is there. The time has come to stop making excuses and false promises.
The hospital in Bombay referred to earlier has the following motto, adapted from a saying of Mahatma Gandhi, which the NHS could well adopt:-