The Destruction of the NHS: A Dialogue at Breaking Point

The Destruction of the NHS: A Dialogue at Breaking Point

by Nima Ghadiri

Is the NHS at breaking point?

Yes, it really is. As things stand, it will not exist in five to ten years time, and different elements of our Health Service will be apportioned as Dialysis-Plus East Coast, CrossCancer, Virgin Maternity, or whatever other word-pasticcio the “brand positioner” regorges.

With consecutive governments in seemingly total denial about the state of the NHS, the phrase “crisis point” is an understatement. We need to do something now, every month which passes brings the death sentence closer.

Ok, just…. just chill out there for a second. Are things really THAT BAD?

Chucking about numbers is often a precursor to a well-known Disraeli quote, paraphrased by Mark Twain. Nevertheless, sometimes they are needed so people can grasp what is happening.

Since 2011, there has been a 504% increase in the number of patients waiting over four hours in A&E Departments across the country, forcing Secretary of State for Health Jeremy Hunt to ditch the target.   23 hospitals were simultaneously on black alert earlier this year, which means that they “are unable to guarantee life-saving emergency care”. This included Jeremy Hunt’s own local hospital The Royal Surrey, which had 27 patients urgently needing a bed but no space.

Waiting times for surgery have been getting much longer, and 4093 urgent operations were cancelled in 2016, an increase of 27% in just two years.  Knee and hip operations are now being rationed only for those who aren’t able to sleep because of agony, using bogus “pain tests” as a differentiator.

Cancer treatment targets have been missed for four consecutive years, and services are now failing.  Mental health services are being rationed, so people who suffer are dying in their homes, unable to care for themselves.

These are frightening figures, it’s no wonder the Red Cross (who stepped in early in the year to help with a shortage of ambulances) has declared the NHS a humanitarian crisis, as people are dying needlessly in the world’s fifth-richest country…

Stop, I get the idea, things are looking gloomy all round. Surely, we have the MONEY to stop this?

Source: BMA

Astonishingly, as demand has risen hugely, funding has been cut.  Our spending on the NHS as a percentage of our GDP has plummeted below 10%.  This is a lot less than France and Germany, and amongst the lowest in the developed world.

If our national health funding matched the average amount that Europe’s 10 leading economies spend on their healthcare, perhaps we could lose this uncoveted accolade:

Source: BMA

Yes, we need more NURSES and DOCTORS!

And we are getting far less.  Medical school applications have plummeted, the proportion of med school graduates who become first year doctors has gone down from 70% to 50%, with phrases such as “in droves” and “en masse” describing the number of junior doctors leaving the United Kingdom.  Enormous rota gaps are now ubiquitous, GP vacancies have skyrocketed from 2% in 2011 to 12.2% now, and 84% of general practitioners now say that their workload is affecting patient care.

Nursing applications have fallen by 23% over the last year, and the removal of bursary funding for student nurses and midwives has sent one clear message “We don’t value you”, underlined by years of below-inflation 0% and 1% pay rises.  By 2019, NHS workers will have seen their pay capped for nine consecutive years, and nurses will have seen their pay reduced by 12%.

To add salt into these raw and gaping wounds, the Secretary of State for Health massively over-estimated nurses’ average pay this month when he was asked why so many nurses are having to use food banks.

Source: British Medical Journal

So they want things to fail, is this all about PRIVATISATION?

We don’t need to speculate about this, it’s all there in numbers, contracts, even a book with Jeremy Hunt’s name on it, calling for the de-nationalisation of the NHS.  There has been an increase in spending on “independent sector providers” of a third between 2014 and 2016, and an estimated 500% more contracts have gone private since 2012.

Source: BMA

The plan for privatising the National Health Service isn’t exclusive to one party.  The groundwork was done by the previous government, with poorly conceived “public service reforms” leading to unfettered introduction of private corporations into commissioning. It has accelerated over recent years, however.

So what are the POLITICIANS saying?

Absolutely the wrong things. For a National Health Service which is quite visibly starving, Jeremy Hunt said: “The NHS needs to go on a 10-year diet”.

Theresa May also didn’t like the Red Cross assessment of the NHS, calling them “irresponsible” and “overblown”.

The BMA has identified five key issues for the future of the NHS, and it would indeed be “irresponsible” if politicians did not address these:

Source: BMA

Are you subtly telling me which way to VOTE?

No, it’s not for me to instruct you, and people don’t like being told what to do.  Nevertheless, it’s currently very easy for the mainstream media and tabloid press to distract the general population and report on fake scandals rather than one which is very real, and affects all of us.

As long as you are aware of what is happening and can make up your own mind, then that’s already very important. If you can spread the word to others, even better.  Over the next few months we will see an increase in grass-roots movements in social media and the streets, in support of the National Health Service.  There will be a nurses’ summer of protest activity, a show of anger against pay-rise caps and maltreatment which has left 40,000 posts unfilled.

Battling a Murdoch and Dacre Press which has vested interests against the NHS will be challenging, and no doubt lies will be spun which confuse and subvert.  Tabloid journalism had a pivotal role in the Junior Doctor contracts dispute, and may do so against the nurses too. It is crucial to appreciate that supporting our nurses means supporting our National Health Service.

Share

Doctors With Mental Illness – Time For A Change

Mental Illness, particularly in the workplace, remains a stigma. It is time for attitudes toward mental illness to change, and we cannot ignore the doctors who suffer.

A push for mental health

 

https://www.gov.uk/government/news/prime-minister-pledges-a-revolution-in-mental-health-treatment

Earlier this year, former prime minister David Cameron pledged a mental health revolution of almost a billion pounds. Whilst this proposed outlay is welcome, it must be matched by a proactive change to the stigma attached to mental health in media, the workplace, and at home.

Mental health and doctors

 

Professor Debbie Cohen of Cardiff surveyed almost 2000 doctors this year and found that 60% had experienced mental illness in the UK (82% in England alone). In the general population, the rate is 28%. Doctors experience the same range of problems as everyone else, but the cocktail of work, exams, academia, family and relationships lowers the threshold for illness. Many have perfectionist traits which lead to doubt and self-criticism when things go wrong, leading to a self-perpetuating cycle.

Worryingly, more young doctors are being diagnosed with mental health problems. There may not be a pre-existing illness: After 25-year old junior doctor Rose Polge tragically committed suicide in February 2016, her family described a young lady with an infectious enthusiasm for life and no previous mental health problems, but long hours and work-related anxiety contributed to her decision to end her life.

Extreme stress early on

 

Doctors are as susceptible to mental problems as the general population. However, particularly early on in their careers, they face a unique combination of challenges. These include the need to develop countless skills within a short period (for which university education can never fully prepare) and service burdens in a chronically under-resourced environment, only more challenging for those with family or caring roles. Early junior doctors shifts are usually incompatible with outside interests, and losing day-to-day balance can unearth mental health struggles.

Doctors face a societal and professional weight compelling them to ignore difficulties. A cultural idiosyncracy of willing martyrdom exists, in which doctors feel it their role to attend work regardless of fitness. This is less prevalent in other countries, for example Australia and New Zealand, where attitudes towards sickness are more rational.

The stigma

 

Fewer professions stigmatise mental health disorders more prominently than medicine. In the Cardiff study, 41% of doctors with mental illness said that they would not disclose it. Doctors are not supposed to get ill, and seeking help is weakness which imperils trust in the practitioner’s ability to do his/her job. This featured in the heartbreaking suicide of GP Wendy Potts in November 2015 after a patient read her blog on living with Bipolar Disorder and complained to the surgery.

Some doctors find changing roles from helper to patient unnatural, others find treatment from a colleague embarrassing. Often the prevailing fear is of a career-threatening “black mark” on a permanent record: Doctors must labour through appraisals and assessments, and competition for jobs and training posts can be ferocious.

A culture of fear

 

A 2008 Department of Health report said:

“Doctors may fear that acknowledging the need for help will damage their career prospects or lead to scrutiny of their fitness to practise”

This happened in the case of Dr Dakhsha Emson, who killed herself and her baby during a relapse of bipolar disorder in 2000. A stirring tribute from her husband reflected a talented doctor and a successful medical career. However, worry of colleagues and patients finding out when she was applying for consultant posts led to a lack of treatment. The report highlighted a:

“Widespread stigma against mental illness in the NHS”

This stigma can arise as early as medical school, fostered by a triad of competitiveness, fear and uncertainty. Students sometimes receive conflicting information about mental health, and may fear disclosing illness. Pastoral care can be arbitrary, often with little demarcation between disciplinary roles and support roles. Some universities have introduced “fitness to practice” hearings to monitor student behaviour, fostering a culture of castigation.

For some doctors, this culture is epitomised by the General Medical Council (GMC), whose role is to protect the health and safety of the public. All doctors with mental health issues are required to notify regarding their problems, which are investigated under the same procedures as misconduct and poor performance. Subsequent fitness to practise processes are required to be declared on application forms for jobs. These can sometimes be beneficial, for example recommending support. However, often they are described as harrowing experiences, and the duress of investigation affects doctors personally and professionally.

The toll can sometimes be too much, between 2005 and 2013 there were 28 reported cases of suicides following investigation. One of those was GP Belinda Brewe, describing the process:

“threatening and isolating”, eroding “self-confidence and self-belief”.

What’s needed

 
  • The NHS needs continued active campaigns to encourage openness, tackle stigma and promote healthy working practice.
  • Medical schools should be proactive in support and awareness: counselling services, pastoral care positions and peer support.
  • The insight that doctors with mental health problems have when treating their patients should be valued.

A doctor who has a mental health disorder might put his patient at risk, but a doctor hiding or in denial because of a culture of fear will put his patient at risk.

Support

  • http://www.php.nhs.uk NHS Practitioner Health Programme, free and confidential health service allowing doctors to self-refer.

Source: http://www.huffingtonpost.co.uk/nima-ghadiri/doctors-with-mental-healt_b_12760924.html

Share

Jeremy Hunt’s Seven-Day Homeopathic NHS: Just The Tincture?

Jeremy Hunt and the government appear to be on course for the world’s first routine 7-day health service. Unfortunately, this pioneering endeavour is hindered by a marked gap in resources. Currently (as according to NHS Providers) 80% of acute hospitals in England are in financial deficit, compared to 5% three years ago. Missed waiting time targets have risen from 10% to 90% during the same period. In recent years, healthcare expenditure per capita for the United Kingdom has been stagnant in comparison with other developed countries:

 

On the path to establishing this revolutionary provision, a number of steps have been taken to ensure that the foundations are as flimsy as possible. Jeremy Hunt has pushed a junior doctor contract which undervalues them and discriminates against women. He has also removed bursaries for student nurses and allied health professionals. This has nurtured an atmosphere in which applications to work abroad have skyrocketed and the portension of mass exodus hinted at in recent years may well come to fruition. Following recent events, a significant (13.5%) reduction in medical school applications over the last twelve months is unlikely to help matters.

So the question arises, how does Mr Hunt seek to introduce this 7-day NHS with negligible funding and staffing levels? And, perhaps, the answer has been there all along…

 

Back in 2007, before landing the job of health secretary, Jeremy Hunt asked the Chief Medical Officer to review three homeopathic studies. He also signed an Early Day Motion supporting the provision of homeopathic medicines (including simple saline solutions diluted to negligible concentrations) which “welcomes the positive contribution made to the health of the nation by the NHS homeopathic hospitals”, and “calls on the government to support these valuable national assets”. In 2014, he again called for herbal remedies to be made available on the NHS.

 

When one of his constituents wrote a letter to Mr Hunt disagreeing with the evidence basis for such treatments, the Secretary of State for Health responded:

“I understand that it is your view that homeopathy is not effective, and therefore that people should not be encouraged to use it as a treatment. However, I am afraid that I have to disagree with you on this issue. I realise my answer will be a disappointing one for you”

Our Minister for Magic Health’s judgement on this matter may have been influenced by another Conservative MP, David Tredinnick. Indeed, Jeremy Hunt’s request for the homeopathic studies to be reviewed was made at the behest of Mr Tredinnick, who has previously advised parliament that blood does not clot under a full moon, advocated the use of homeopathy as a treatment for HIV, tuberculosis and malaria and asked that homeopathic borax be used to control foot-and-mouth disease.

Are Mr Hunt and Mr Tredinnick on to something? The combination of drugs for treating TB vary between £5000 and £50-70000 depending on whether the variant is “normal” or “drug-resistant”. Dilution to homeopathic doses can make these expensive drugs much less costly.

Even better, nature’s finest Witch Hazel, which has been used for TB (albeit in the 19th century), comes in at a tidy £2.99 per bottle from your local chemist and can last for months if the degree of dilution is precise. It can even be grown on hospital grounds, generating further savings.

 

The workforce could also be rationalised in a homeopathic 7-day NHS. The impact of Jeremy Hunt’s contract for junior doctors (indeed, the need for doctors in the first place) can be negated by alternative healthcare practitioners, some of whom might not even require an income. A new hospital druid role potentially offsets the vast increase in applications to Australia and New Zealand and reduction in medical school applications.

Mr Tredinnick is also a firm believer in astrology as a “useful diagnostic tool” which, alongside complementary medicine, could take “pressure off NHS doctors”. As a Capricorn, the zodiac does indeed advise that his opinion should be reliable and trustworthy for Jeremy Hunt’s Scorpio. Mr Tredinnick states “I do foresee that one day astrology will have a role to play in healthcare.” Conceivably, that day may come sooner, and we will have alternative medicine permeating into our accident and emergency departments. This delightful sketch from comedy duo Mitchell and Webb might not be too far from the truth:

When the practical and economic feasibility of a routine 7-day NHS has been roundly debunked by senior doctors, service providers and analyists, it is only natural to ask how this is going to happen. Maybe, we ought to be thinking a little more naturally ourselves, and prepare for our complementary secretary of state for health to give us a very complementary 7-day routine NHS.

This article was first posted on the Huffington Post and can be found here: http://www.huffingtonpost.co.uk/nima-ghadiri/jeremy-hunts-7day-homeopa_b_12298592.html

Share

Are Patients ‘At Risk From Thousands Of EU Medics?’

On 24th September 2016, the Daily Mail headlined with the following:

This follows on from a number of previous articles published earlier in the year by the paper concerning doctors in the NHS who come from other EU countries.

Whilst the paper has never been overly fastidious with the truth, this arrangement of falsehoods and scare-mongering is not only irresponsible but immeasurably dangerous to the National Health Service.

As a doctor who works in the NHS, I fear to imagine how we would manage if my colleagues from Ireland, Italy, Greece, Poland or Spain left their jobs as consultants, clinical fellows, registrars or house officers. It would certainly expand the existing staffing voids to breaking-point. The straightforward issue of workforce numbers aside, we would also lose the countless continental talent who contribute so much to our hospitals and research.

I wonder if Sophie Borland, the Health Correspondent for the Daily Mail, could visit hospital for a few days and witness first-hand the contribution of the 10% registered doctors and 4% registered nurses from other EU countries working in the NHS.

But what of the central premise of the Daily Mail’s campaign, that EU doctors work in the UK without safety checks and constitute a risk to the public? The Daily Mail quoted the head of the UK’s General Medical Council, Niall Dickson:

“Some European doctors – because we haven’t checked their competency – may struggle when they practise here and that could put patients at risk. We are able to assess their language skills but we cannot check their competency to practise. That’s just a reality.”

The article curiously missed out the following from the GMC: “UK patients are more protected than they used to be and the European Commission deserves credit for bringing in the fitness to practise alert mechanism, which allows regulators across Europe to share concerns about the fitness of practise of health professionals, and for giving the UK and regulators in the rest of Europe the power to require health professionals to demonstrate their ability to speak the language of their patients before granting them entry to practice.”

The GMC goes on to say “it is important to remember that employers also have a responsibility to carry out thorough pre-employment checks and make sure that the doctor is qualified and competent to carry out the duties they are being given, including having the right language skills for their particular role.”

This states the obvious: that the obligation lies with the employer for ensuring a rigorous application and interview process and then monitoring a doctor’s practice, and this should be the same whether the doctor is from the UK, Europe or the rest of the world.

However, the obvious can be ignored when a vendetta is being waged, and so the Daily Mail not only overlooks this but contraindicates itself by publishing the GMC figures:

“GMC figures for 2011 to 2015 show that just 0.55 per cent of doctors who qualified in the UK were struck off, suspended or given a warning. This compares with 1.01 per cent from the EU and 1.1 per cent from elsewhere in the world”, In summary, there was more action against non-EU doctors than EU doctors (and still a small proportion).

In a riposte to the Mail, the European Commission states in its article at blogs.ec.europa.eu: “It is out of the question that EU rules would require the UK to let linguistically or medically incompetent doctors practise. In fact, the rules – recently further reinforced in agreement with the UK – expressly require Member States to prevent such people from being employed”

This headline brings two negative consequences – firstly, patients become needlessly worried about EU doctors, which may lead to delays in seeking appropriate and timely care. Secondly, an incorrect stigma is fostered against a large group of doctors and nurses. Since Britain voted to leave the European Union, there has already been a marked reduction in applications from EU healthcare staff to work in the NHS. If those who come here from Europe and work to save lives and cure illnesses feel that they are no longer welcome and leave, then patients will really be at risk.

My article was originally posted on the Huffington Post http://www.huffingtonpost.co.uk/nima-ghadiri/are-patients-at-risk-from_b_12224216.html?

Share