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.

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[MUST READ] Coca-Cola’s secret influence on medical and science journalists

Please read this article from the British Medical Journal: http://www.bmj.com/content/357/bmj.j1638

 

This is a very important argument, and it is essential for healthcare professionals, journalists and politicians alike to make a concerted and aggressive effort to kick these sugar-peddling companies out of the sphere of academic influence.

The more overt “More Doctors smoke…” advertisements of yesteryear are thankfully a thing of the past, but the covert influence of sugar-saturated food companies is no less a threat to our health. Aaron and Siegel (1) report that from 2011 to 2015, the Coca-Cola Company and PepsiCo were found to sponsor 95 national health organizations, many medical and public health institutions amongst them. They also lobbied against 29 public health bills intended to reduce soda consumption or improve nutrition.

The British Nutrition Foundation, for example, lists amongst “Sustaining Members” Coca-Cola, PepsiCo, Kellogg, Nestle, Tate & Lyle and has “Corporate Members” British Sugar plc, Mars UK, KP Snacks, McDonalds, United Biscuits, Weetabix, Ocean Spray and many more. Although it is open to companies and corporations from a variety of backgrounds including healthcare and fitness, the actual members who have provided support read as a Who’s Who of Sugar Salesmen (2), making their promise of a “a focus on objective nutrition science interpretation and delivery” open to scrutiny. The American Society for Nutrition is no different, with an almost-identical list of names cropping up (3) for this group, which publishes the Journal of Nutrition.

Indeed, the editorial boards of top nutrition journals are littered by corporate affiliations with sweetie companies – The American Journal of Clinical Nutrition, for example, lists the likes of Mars, Coca-Cola, PepsiCo, Nestle, McDonald’s  and Ferrero amongst companies who have a relationship with members of their board (4). The ambassador’s reception may also be overflowing with hazelnut-and-wafer spherical treats at many other nutrition journals, who often  home of the Journal of Nutrition Education and Behavior, who have eight “corporate patron friends” and four “corporate sustaining friends.  (5)

It would be interesting to note how these journals consider submissions which report a detriment to health from these companies’ products, but when some of the largest nutrition journals display such a conflict of interest it must become clear to all that the Honey Pot relationship between “Big Food” and academia is poisonous and needs to be dealt with.

References:

(1) Sponsorship of National Health Organizations by Two Major Soda Companies. Aaron, Daniel G. et al. American Journal of Preventive Medicine , Volume 52 , Issue 1 , 20 – 30

(2) “Member Organisations – British Nutrition Foundation”. Nutrition.org.uk. N.p., 2017. Web. 10 Apr. 2017.

(3) “American Society For Nutrition – Our Sustaining Partners”. Nutrition.org. N.p., 2017. Web. 10 Apr. 2017.

(4) AJCN Editor Conflict of Interest Statement. (2017). Ajcn.nutrition.org. http://ajcn.nutrition.org/site/misc/EditorCOI.xhtml Web, 10 April. 2017.

(5) Nestle, Marion. Food Politics. 1st ed. Berkeley, Calif.: University of California Press, 2013. P112. Print.

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No longer taking the piss: When tabloid journalism goes from foolish to dangerous.

On 24 April 2017, the Daily Mail published an article with the title statement “Going to the loo ‘just in case’? Don’t – it could wreck your bladder”. With a daily print circulation of 1.5 million (December 2016) and 100 million unique online visitors per month, the newspaper dispenses alarming and dangerous advice which may encourage people to hold in their urine, thereby risking urinary tract infections and renal impairment.

The article itself, apart from a number of lurid stock photos, is less sensationalist in tone than the headline.  However, the focus is so scattershot (bouncing from the volume of urine that a bladder can hold, to a brief differential diagnosis of polyuria, the use of earplugs, men exercising their pelvic floor, and even David Cameron’s Brexit negotiations) that the only “take home message” risks being the first line for the newspaper’s readers. With an average reader age of 58, many of the Daily Mail’s readers will suffer from nocturia and take such advice to heart.

Dismissing tabloid medical journalism as beneath scrutiny is done at our peril, as many patients rely on newspapers to build their knowledge base and engagement can be significantly affected by what is understood to be true. When this message is dangerously incorrect, it should be confronted and disputed.

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Dying with Indignity in Iran

Published on: https://iranwire.com/en/blogs/693/4344

In this guest blog, Dr Nima Ghadiri describes the harrowing experience of the end-of-life care his grandmother received in an Iranian hospital, and the betrayal of the principles of bioethics, which were first identified many centuries ago by Iranian polymaths, including Avicenna and Razi.

Avicenna (left) and Razi (right), Persian physicians and polymaths who helped define the principles of bioethics, used by healthcare professionals to this day

My beloved grandmother and closest friend Batool Sepassi died in an Iranian Hospital ICU (Intensive Care Unit) following a short illness.

During the course of a viral illness, she became increasingly short of breath and had to be admitted to a local private hospital. She had a chest infection and was taken to the intensive care unit accompanied by close family. At this point the family had separated to go to the payment desk, and my grandmother was taken to ICU, though no medical history was taken nor treatment started until payment was organized (the privilege of private healthcare).

There were some major flaws in treatment. Having been admitted with a chest problem, it took 30 hours for a chest consultant to see my grandmother, though not without a battle — we were told “this patient is not on my list” — and a serviceable X-ray was only taken the following day.

My family was only allowed an hour a day to visit my grandmother, which was extremely hard given that she thrived on closeness to family and friends. My close relatives stayed outside all day the ICU to be able to glance at my grandmother from a distance and hear her calling out for them. This was a traumatic experience, particularly when they heard the expressions “Saaket” or “Khafeh Sho” (“Shut up”) from my grandmother when she was undergoing procedures. My grandmother loved to communicate and form bonds with people, and appreciated having her close ones hold her hand during medical procedures. During all of her stay, her arm was outstretched to hold someone’s hand, but there was no one there and her hands were eventually fastened to the bed.

The course of the disease was unpredictable, and ultimately a poor prognosis was given, i.e. the chances of my grandmother’s survival diminished. During this period, interactions with nurses and doctors were punctuated by disregard and dismissal. For example, when one relative noticed that the nebulisers were inserted in my grandmother’s eyes rather than her nostrils (where they belong), this fact was dismissed with a “oh, her oxygen was high”. There were a few good doctors and nurses, but they were conspicuously outnumbered by the poor ones. When my cousin objected against intubation (insertion of a tube into the lungs) for the last few hours of life, instead of explaining the rationale, the doctor shouted at her “Do you want to kill your grandmother?” It took a lot of pressure to prevent the ICU team from doing a completely needless invasive procedure (kidney dialysis) with just a few hours of life remaining and kidney test results that had been unchanged for years.

Nevertheless, simple measures such as giving my grandmother something to drink were considered a luxury. When my grandmother was deteriorating, no provision was made to allow her to be close to loved ones. She and her family did not want her to be in an intensive care unit, and not only was she kept there against her will during the treatment phase, but she was kept there when she was about to die.

I asked my cousin to connect her to me by video call before her death during the one-hour visiting period. Her eyes were initially closed, but as soon as she heard my voice, they opened wide. Her mouth was entirely bandaged apart from a tube coming out of it, but I could see the outline of her lips moving briskly underneath all the bandages. She wanted to say something, and had never been stopped from talking to me before. She started vigorously shaking her tied arms in an attempt to communicate with me, but then realized her efforts were fruitless and her eyes started welling up with tears. In all my years of knowing her, I don’t remember her crying. She died just over an hour later, curtains drawn and no loved ones around her.

Nothing could have prepared me for this image, which remains traumatically imprinted in my mind. It will be a memory I will never forget. I keep wondering what she wanted to say – was she saying goodbye to me, or asking me to convey a message: to look after my mother, my brother, or help someone desperately in need? Finding the answer to this is a futile quest, but it is a rumination that will, sadly, remain.

Dying alone, with family not allowed to be with her is one thing, but my family were also denied the chance to see her after death. Only after begging were they able to get a brief glimpse of her in the corridor prior to entering the mortuary after challenging the comment, “She’s gone, why don’t you just go now”.

Passing away is an inevitable part of people’s existence, but the environment for this chapter of life is so important. As a doctor who works in the United Kingdom’s National Health Service, I have been well-versed in the importance of dignity in death. But in Iran, a country whose polymaths helped define the early principles of bioethics, it is unfathomable that core bioethical values were denied for such a sweet soul as my grandmother, and potentially for others. These principles include Non-Maleficence — not performing unnecessary procedures that serve just to prolong the patient’s life and often cause distress and pain to the patient — and Autonomy – respect for the desires and values of the patient, including how they want to be treated and how they want to die.

In my grandmother’s case this was with her family around her and without fruitless procedures. Denying someone’s spirit and character so manifestly in their final days and hours is criminal. These sentiments were shared by my family, and indeed being able to spend time with a loved one before and after their death to say goodbye should be a basic right, rather than just being able to observe this sorrowful moment from a distance. It should not be such as Sisyphean effort to spend time with a loved one and find out what happened during a hospital stay, hampered at all stages by a lack of sympathy and empathy alongside a degree of ageism against someone who is perceived as just a bed number rather than a human being.

A photo of Nima Ghadiri’s grandmother holding a pomegranate on Shab-e Yalda (An ancient Persian festival commemorating the Winter Solstice), three weeks before she died

I remain always indebted to my grandmother for looking after me as a child in the United Kingdom and being someone I could talk to and share my life with for so much of my existence. Even at her age, she had the spirit of someone many decades younger, was full of life and brought joy to so many. She shared all she had with charity and those less fortunate than herself. Strangers often commented on how sweet and bright she was and I used to talk to her about films, technology and current affairs. She remained a fountain of wisdom and I could not have dreamt of a better grandmother. Her grandchildren remain traumatized by the manner in which she has gone, and the suffering and abuse that she endured. Because she was such a positive and life-loving soul, I do not want the final page of her life to be negative. I am not sure how yet, but I know that I would be happy if the discussion arises for Iran, the country of Avicenna, Razi and numerous others, to re-discover what care, particularly at the end of life, means. Perhaps in the future, I will open a palliative care institute in her name.

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So… just who will be made accountable for this Brexit lie: “£350 million/week to NHS”

I just don’t understand how people or groups cannot be made accountable for such flat out lies (350 million /week for the NHS).

If the polls show that so many people voted based on that piece of complete fiction then a valid challenge needs to be made through all the available routes.

This isn’t just post-truth but the polar opposite of truth.  Medications have already become more expensive and Article 50 hasn’t even been invoked yet. We all know doctors, nurses and research staff in key positions who have resigned to return back to their countries or move to other countries in North America or the Antipodes. Rota gaps have become even worse over the last few months and the burden on service has had a tangible effect.

Just WHO will be made accountable for this?

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Studying The Kiwis: Could Britain’s Junior Doctors Learn From New Zealand?

As the British Medical Association (BMA) prepares for another meeting to discuss further industrial action against the government’s proposed junior doctor contract, the New Zealand Resident Doctor’s Association (NZRDA) has also announced a campaign for a better contract for junior doctors, with the threat of strikes on the horizon. Can British Doctors and their union learn from New Zealand?
Following a year-long stalemate punctuated by brief periods of attrition, Britain’s junior doctors remain locked in a dispute with the government over a proposed new contract, warning of “escalated” industrial action should the Government refuse to address concerns over patient safety and fairness. This is likely to encompass a rolling programme of strikes, starting in September. The BMA Junior Doctors Committee claim that worries have been repeatedly raised and not addressed, including concerns about weekend working and pay for those working less than full time.

JDC chair Ellen McCourt has said:

“Forcing a contract on junior doctors in which they don’t have confidence, that they don’t feel is good for their patients or themselves, is not something they can accept”.

Echoing events in Britain, New Zealand’s Resident Doctors Association (NZRDA) called for changes to junior doctor working patterns, including the number of potential consecutive 10-hour night shifts to be reduced from seven to four, and the number of consecutive day shifts to be reduced from 12 to 10.

The campaign is focusing entirely on patient safety and has centred on a strong social media presence with clear statements and images:

http://www.nzrda.org.nz/

Highly publicized figures from NZRDA’s survey of its 3600 members reported that 300 doctors had fallen asleep behind the wheel on the way back from work, and more than 1000 doctors had made a mistake which affected patient care due to exhaustion. The NZRDA has warned that if there are no changes to rosters, there will be industrial action for the third time after previous strikes in 1992 and 2006.

http://www.newshub.co.nz

The NZRDA was originally founded in 1985. In contrast to Britain’s BMA it represents only Junior Doctors, not all doctors. British doctors moving to New Zealand are often surprised about the power and proactive nature of the organisation. The face of the NZRDA for the last few decades has been the organisation’s National Secretary Dr Deborah Powell. She is perceived by doctors, media and public alike as a fiery and uncompromising battleaxe who persistently wields clout in negotiations.

http://www.nzrda.org.nz/

These negotiations have yielded a number of benefits over time for junior doctors in New Zealand, which have included: consistent increases in pay, final year medical students being given a salary, free canteen food during working hours, training and membership costs being covered, presence of cross-cover and relief doctors to cover short-term absences, ease in going out-of-training for family or travel. There is even a motivation for hospitals and clinics to ensure that their junior doctors claim all of their annual and study leave, as the amount not used becomes “cashed out” as a payment.

In the few instances when conditions have deteriorated, the NZRDA has been aggressive. In April 2008, they gave notice of a nationwide 48-hour strike over pay, conditions and ongoing issues of retention, as 40% of Kiwi doctors were moving to Australia. At the time, a first year house-surgeon in NZ earned 88,000 NZD (£40,000) on average. Junior doctors sought a 10% pay rise over three consecutive years (twice that of other health service workers) rather than two rises of 4% over two years.

The strikes were widely seen as a success which brought the desired outcome for the doctors, caused no harm to patients (indeed, emergency department waiting times were markedly reduced), has improved retention of doctors and made New Zealand a very attractive destination for British and other doctors. They have also underlined the power of the NZRDA to fight annually for better conditions.

http://www.saferhours.co.nz/
The success of these victories is reflected by a reversal in the exodus of Kiwi doctors to the United Kingdom, such that British doctors are now flocking to New Zealand at record levels. We can only speculate whether a single-minded force such as Deborah Powell may have challenged the various events which have taken place over the last decade and reduced morale of British junior doctors to such an extent: Loss of House Officer Accommodation, shortages of training posts, the ill-received Medical Training Application System (MTAS), pay increases below inflation, consistently increasing GMC and examination fees.

How would the NZRDA manage if metaphorically transplanted onto the negotiating table closer to home? Their use of punchy statements and images, peppered with some humour, has helped the public clearly identify the junior doctors’ argument. Based on their track record, would they have hesitated to legally challenge the UK government: particularly on Jeremy Hunt’s early assertion that we do not already have a seven-day emergency NHS, a proclamation which has already led to well-documented patient harm?

http://www.saferhours.co.nz/

Watching the British and New Zealand negotiations developing in parallel will be an interesting comparison of the relative power of government and employers’ union in both countries.

Also published here: http://www.huffingtonpost.co.uk/nima-ghadiri/new-zealand-junior-doctors-uk_b_11675406.html

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