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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3D Organon VR Anatomy Atlas – As good as Gray’s Anatomy?

Very detailed Anatomy Atlas (gets your textbook and transplants it into an interactive virtual reality cadaver). The detail is fantastic, which is probably why it costs quite a lot, but some of the structures are a bit too small and the user-friendliness of the application probably needs to evolve over time. My feeling is that most people will still stick to their Gray’s Anatomy in 2017 to see how the leg bone’s connected to the… hip bone, but it’s good to see things like this being developed as this may change in the near future!

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The Body VR – A virtual reality version of the film “Fantastic Voyage” for schoolchildren

This Virtual Reality Human Body Educational Experience (think a virtual reality version of the film Fantastic Voyage) is geared towards schoolchildren. It is quite short, but as a free experience it is hard to criticise something which is aiming to combine education with some entertainment for kids, particularly given that there aren’t that many similar experiences. The same team is releasing an Anatomy Viewer as well, a Beta of which is included in this application.

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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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