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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“Oh stop moaning about your job, It was worse in my day”

                  “120-hour weeks we worked”                  

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                                               “Fell asleep whilst clerking in a patient!

This Argumentum ad Populum type of logic in an argument about a job or job proposal is unacceptable in any line of work, from astrophysicist to zebra feeder. However, this is particularly toxic in our line of work as doctors, as there are some former doctors who are especially loud and saturate the realms of politics and media with this outlook. Thankfully, there are far more senior doctors who don’t have this attitude. This is intended towards the first group.

Dear former doctor, thank you for all you have done in service of our nation’s health. But….

• In your day, interns had free hospital accommodation

• In your day, your salary went a whole lot further, and many of you were able to pay off your mortgages.

• In your day, junior doctors lived and worked together and provided a network and coping mechanism in times of difficulty. There was a “firm” culture where health staff were a team.

• In your day, nurses had the time and authority to deal with many issues themselves instead of having to spend almost their entire shift completing paperwork.

• In your day, junior doctors did not graduate with close to £100,000 of student loans to pay.

• In your day, doctors had a ridonculous final salary pension to look forward to.

• In your day, your working life was often not left to be dictated on the whim of management or human resources. In fact, there was no management or human resources.

• In your day, junior doctors from Australia, New Zealand and North America used to flock en masse to the United Kingdom, not just for Fellowship posts for Specialist Training. Why doesn’t this happen any more?   Why is there such disparity between ourselves and our peer countries that so many junior doctors have applied to go overseas, when it was once the other way round? Does that not tell you something about how things are comparatively?

Even if junior doctors were working their feet skinless in the pits of hell in your day, why does that matter?  You are justifying the unjust, by saying the past was worse. And shame on you.

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In this junior doctors row, even real doctors can become spin doctors.

Sarah-Wollaston_2985657b

Dr Sarah Wollaston is Conservative MP for Totnes and Chair of the Commons Health Committee. She is a former GP and teacher. Her daughter, a junior doctor, left the NHS last year with 8 of her friends to go to Australia. She has consistently voted in favour of easing restrictions on private companies to deliver healthcare in the United Kingdom:

 

http://www.theyworkforyou.com/mp/24761/sarah_wollaston/totnes/divisions?policy=6677

Dr Wollaston has penned a “balanced” piece for The Guardian, looking to apportion blame for the junior doctors strikes on both the government and junior doctors:

http://www.theguardian.com/commentisfree/2016/apr/03/in-this-junior-doctors-row-both-sides-have-lost-sight-of-the-patient

This attempt is about as impartial as Bill O’Reilly’s “No-Spin Zone” programme on Fox News, with a combination of subtle spin and phony ignorance.

Here is a dissection of some key points in her article:

“Sick people seem an afterthought as the government and the BMA pursue an unnecessarily toxic debate”

No they don’t, the BMA and junior doctors’ entire motivation is to safeguard the future of care in this country.  The BMA are well-supported, but if anything much less powerful than other doctors’ unions around the world.  This has come about following years of erosion and in-fighting. If anything, junior doctors are upset that the BMA have not been going far enough:

http://doctoryak.com/blog/what-if-the-government-were-negotiating-with-the/

“Many of my daughter’s colleagues are not planning to join her on the journey home next year and there has been a marked increase in the numbers applying for certificates to work overseas.”

I wonder why?

“The dispute looks set to erupt into a dangerous full walkout by junior doctors. The British Medical Association claims that the contract will harm patients by stretching doctors too thinly across seven days while reducing their take-home pay. The government insists that patients are being put at risk by understaffing at the weekends and that the contract reduces doctors’ maximum hours and consecutive shifts while increasing basic pay by 13.5%.”

She knows better than anyone that net pay will go down for many, yet uses the same smoke and mirrors technique used by her colleague Jeremy Hunt meant to fool the public – “increasing basic pay by 13.5%”. She is being disingenuous here because anyone who has looked at the contract knows that out-of-hours pay is cut significantly so net pay is down for many fields, especially emergency ones.

And how could the government set up the world’s first and only routine national health service when it has been reducing funding for the NHS since it took power? https://youtu.be/r60Hf2CmxE0

 

“It seems to me that the contract is more about the manifesto commitment to a seven-day NHS and the perceived barrier of premium Saturday pay rates”

Well no argument here.

“Mine was the last generation of doctors to endure crushingly unsafe 120-hour working weeks and I have no romantic nostalgia for the 72-hour shifts commonplace in the late 1980s”.

But we have her on record insinuating that “doctors today shouldn’t complain, we had it worse in our day” and this is the crux of her emotion when it comes to this issue – she doesn’t think these unsafe hours are “all that bad” compared to what she went through. A former doctor who has this kind of attitude should not have this role, because they are using their own personal experiences to influence their judgment. There are many doctors much more experienced than her who had it a lot worse and know that this logic is at best irrelevant (the world is different now), at worst dangerous.

“Pressing ahead with a full walkout however, will serve only to harden attitudes and solves nothing. Most importantly, it will be disastrous for patients”.

New Zealand had a full walkout for 4 days a decade ago – patient waits were shorter, and emergency outcomes were better when staffing was only done by consultants and staff grades. It achieved the desired effect perfectly as New Zealand vastly improved its junior doctor contract, halting an exodus to Australia and attracting hordes of British doctors (when the net flow was previously the other way round).

 

“How can it be argued that patients will be safer only if all Saturdays are paid at the premium rate, however infrequently worked? Given the scale of concessions and protections on maximum hours and consecutive shifts, the BMA could have declared victory and moved on to focus on the deeper and longstanding causes of discontent.”

More spin – No one is saying this. And also this isn’t about some childish notion of “victory”. Furthermore, do you not think protections against tired doctors aren’t a worthwhile concession? Or do you want your daughter returning from her jaunt in Australia working unsafe shifts?

“Many more of their duties could be shared with others such as pharmacists, physician associates and admin staff”

Well in many hospitals we are seeing physician associate posts advertised (with salaries twice those of junior doctors) but the erosion of junior doctors’ work to become what it is today has happened over two decades now so this is going to take a long time to fix, and people like you who have taken roles in politics should have been coming out a long time ago.

“In some hospitals, such as Salford Royal in Manchester, electronic patient records are finally reducing the scandalous waste of time and resources that come with duplication and paper trails.”

In other hospitals such as Addenbrooke’s in Cambridge, electronic patient records have cost hundreds of millions and effectively bankrupted the hospital, introduced too quickly and with many, many glitches, effectively slowing down and losing continuity for patients.

 

“A constructive relationship between doctors and government will take time to rebuild; it cannot be imposed and it will not happen unless both sides put patients first and start listening. Saving lives must take priority over saving face.”

And as someone who is a former doctor and part of this government, you should practice what you preach and not keep coming out with this spin (feigned under the guise of a balanced inbetweener of two warring factions), when you know how much of a disgrace these proposals have been, you know how much the NHS has been wilfully under-funded and you personally have sanctioned the many Private Finance initiatives popping out like fungus on a damp corpse.

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