So as I sit here typing this, I'm wondering exactly which direction this blog will go. I wanted to try and get over how all the NHS news stories look from a patient point of view. The thing is I didn't want this blog post to concentrate on just one area, but in a way that is the whole point. If you listen or watch the news or read the newspapers it will be impossible to miss the stories that are constantly hitting the headlines. When an area gets such constant coverage then you truly know something isn't right.
So I wanted to try and highlight what I mean....
Doctors dispute
Stories like this one:
http://www.theguardian.com/society/2015/nov/22/patients-could-die-junior-doctors-strike-jeremy-hunt
I've come to quite dislike the term "junior" doctors, because it really does do them a disservice. Every organisation has its own way of referring to its staff, but someone who has been doing a job for 10 years is hardly "junior" - but still enough of that.
So the first thing to go into my 'evidence pot' is that the doctors and the government have fallen out big time - this is not good news for people like me, patients. As a patient what I really need is some kind of comfort that the people who will look after me in my time of need will be in a fit state to do so.
NHS - the 7 day service
This area I find particularly annoying. The government say they want a "7 day service", like there isn't one already. I've been in a hospital ward twice during a weekend and there were plently of people on duty to look after me. But I know what the government are getting at, whilst there were doctors and nurses and ancillary staff on duty to look after me, other areas were not, such as physio's, social care, etc. But this is where the story gets muddied
http://www.bbc.co.uk/news/health-34150672
The message around what the government actually wants is not clear enough and this has caused patient concern that doctors don't work at the weekend and they won't be cared for if they get ill. This is simply not the case, and the government implying that doctors don't work 7 days is an ill thought out strategy - also part of the cause of the general falling out between the two sides.
Get the message clearer in this area - what the government wants is a full 7 day service, of not just critical care, but all the ancillary services - to be able to book surgery on a Sunday, pop in for an xray or blood test on a weekend etc.
Then comes another area where the experts and government fall out. How will you staff this extra service, when recruitment and retention is already an issue. Throw billions of pounds of public money at a 7 day service by all means, but have some kind of idea how you're going to staff it and also whether that is actually the best way to spend the public money in the first place.
As a patient, has anyone ever asked ME whether I want a 7 day service, and if I did, exactly what would I want from this 7 day service. Right now, I would settle for assurances that the existing services are in safe hands, which seems far from guaranteed....
NHS - "Winter pressures"
As a patient, this is the front line, this is where it really matters. Winter pressures have been in the news every year for the last few years. Inevitably more people get ill during the winter, and this puts pressure on key parts of the NHS. The GP surgeries and in particularly the A&E departments, like this story:
http://www.bbc.co.uk/news/health-34790100
This story links to a wider issue of NHS funding....
NHS funding
This is another area where NHS experts and the government seem to disagree. The government has promised an extra £9billion to the NHS based on this weighty report, the "Five year forward view"
https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf
Although as I have already seen pointed out on social media, this 5 year view, is already one year old, and now represents only 4 years. But still, if the experts are to be believed, this £9billion is in fact not nearly enough. It isn't enough to keep the existing NHS going, let along investing in a better NHS and it certainly isn't enough to fund a full 7 day service, this was never even included in the 'forward view'.
Which leads me to this report
http://qmr.kingsfund.org.uk/2015/17/
The above doesn't paint a very rosy picture. There have been widespread reports in the news about underfunded NHS trusts and the prospects of these trusts running out of money during the next year or so. For us patients that isn't something we want to hear.
As well as being a patient, I'm also a tax payer. I want to know and deserve to know whether my money is being spent wisely. It is a huge topic.
...and more
Loads of NHS scare stories just on one page
http://www.independent.co.uk/topic/NHS
- Crisis in residential care
- Whistleblowers
- Record number of patients in hospital too long (cue the horrible term "bed blocking")
- Drugs are too expensive
- the NHS will be privatised
- War of words between 'sides'
As a patient, that little lot can't be good news, can it?
So what does this all mean for patients?
I've pulled a random selection of news stories into the above few paragraphs. You could pull in 100 more - they all tell a worrying story for a patient or potential patient.
- Will I be able to attend my appointment when doctors go on strike?
- If I get to hospital will there be anyone there to care for me?
- Will my doctor be too tired and stressed to care for me properly?
- Will there even be a hospital there when I get ill!
The list could go on....
It's a worry, that's what it is. There seem to be no end of opinions, no-one on the various 'sides' seem to agree with one another. It seems fairly certain that money is very tight and that there are a huge amount of problems to solve. Lots of people with all different views need to sit down and talk to one another, not argue about how the other side is wrong.
Of course being a patient advisor for the NHS Survival campaign means I am bound to be angling at a certain thing. A cross party commission to properly discuss the future of the NHS and set out some clear options on how we are going to keep this wonderful service afloat.
Perhaps it hasn't been clear up until now exactly why this has been important, perhaps up until now you might think there isn't much to worry about, or that things aren't really that bad. But fire up your news service of choice and most days you are going to see an NHS story, and most of them don't make very pleasant reading.
The time is now to start those conversations, or else patient harm is going to happen. None of the sides want that, or course they don't. But some backing down needs to happen, some acceptance that all sides have a general aim and that the only way to align these into a sensible way forward is to get an agreement on what the way forward is.
Please, let's do that soon
Dear everyone
I was inspired to write this blog entry by this letter written by Zoe Norris, read it if you haven't already!
http://www.huffingtonpost.co.uk/dr-zoe-norris/nhs-junior-doctors_b_8208728.html
I read it twice and it almost made me cry and yes I'm a 54 year old bloke.....to clarify:
a) cry actual tears
b) cry out in anger/frustration/fear/anxiety
I have blogged before about how I believe the only thing that will save the NHS, is the NHS. The management, the consultants, the doctors, the nurses, the healthcare workers....everyone. I don't believe a political party can solve the issue, although clearly we are talking about public money, so politics has to be involved somewhere.
I think it is fair to say that politics certainly isn't helping the current situation.
One of the things the NHS has to do is inspire the next generation of medical staff to come and work for the NHS. Seeing what an incredible vocation healthcare workers sign up for is what will make new people come along and want to do the same. But right now, there are doctors on the street protesting, 'signing up' to go abroad and feeling downright fed up. That means morale is very low and the last thing medical staff are wanting to do is say "yeah, this is such a brilliant job, you should do it too". The letter from Zoe above, just proves that point.
Whilst a lot of members of the public may not care much about that, I don't know, they really would care about patient safety. I don't know what it used to be like to work in a GP surgery or hospital (y'know, back in the good old days) but I do know that if in the present the staff morale really is as low as people are saying it is, and staff really are under as much pressure as they say they are, then patients will suffer. Not intentionally of course, just because you can only stretch goodwill and resource so far.
There has to be some good NHS news coming soon, doesn't there? Is there any chance of new ways of working that will benefit patients, is there investment that will benefit patients, is there a way people can start to work together to solve the crisis in the NHS little bit by little bit....and benefit patients? All the arguments in the media and on social media right now are no doubt justified, but they detract from what everyone should really be doing. Fixing the NHS before it becomes unfixable.
So why can't all sides just negotiate, move on, and solve the bigger issue - I don't really buy the "because they want to privatise the NHS" argument because then the government moves from 'just' falling out with consultants/doctors/nurses to falling out with the whole country! But then as you may have guessed, I'm not very good with politics.
So, in summary, I'm a worried patient - I really don't like what I'm seeing. So what am I getting at.....well if you've followed my blogs or me on social media then you can guess what's coming next.
A Royal Commission is what's needed. With so many sides lining up against one another, an impartial wide-ranging view is necessary, urgently necessary. Please, please make it happen soon.
Yours sincerely
Carl, the worried patient
I heard that old phrase dragged up again on Twitter, "bed blocking", a phrase that always annoys me. It always comes across as something someone would do on purpose when in fact hospital is the last place any patient would choose to be if they could avoid it. This train of thought also dovetailed in with some thinking I'd been doing about the proposed 7 day NHS service that the government says it is going to make happen - at the same time many experts in the industry and many clinicians are saying that a full day service (over and above what already happens 7 days now) would mean massive extra investment or even having to stop certain things that are being done now to make that full 7 day service happen.
So as a patient what's my view on this, what has my experience been? Actually it is as a family member of a patient I've realised my main experience lies, when my dad was in hospital earlier this year. He had already been in hospital a couple of times in recent years, he has Parkinsonism & Dementia but was living at home on his own with a care package in place which was working well. That is until Boxing Day 2014 when he had a double-stroke. He then spent 3 months in hospital recovering and he did indeed reach the stage where he was well enough to leave hospital but arrangements were not in place so that he could. The media would of course call this bed blocking, and I'd begin to turn the air blue!
This leads on to the other thing that I've heard a lot of recently, about certain things not being available at the weekends. One thing my dad desperately needed was physiotherapy, he did get some whilst on the stroke rehabilitation ward at the QA Hospital in Portsmouth. But he only got sessions on weekdays, if he had any at the weekend they were very few and far between. He could have also done with community physio service once discharged, but the team told me this would be very unlikely because they were so stretched and only went out to the highest need patients. We did see the same doctor frequently to catch up on exactly how my dad was progressing and we did see that doctor at the weekend sometimes (there was always a doctor around at the weekend). Seeing the same nursing staff frequently didn't seem to be an issue, they seemed to always be there!
When it came to discharge planning, it became clear that my dad could not go back home and would have to be discharged to a care home. The family meeting we went to (very well organised with nursing staff, physio's and social services) said in no uncertain terms that dad could not be discharged back home. So social services gave us a big pack of information on homes available in our area and which ones had vacancies. But the process of us going out to visit these homes, places being available and then those homes coming into hospital to assess dad to check they could provide the care he needed took time and planning. Unfortunately the advice given by the discharge team that dad needed a "care home" proved incorrect, because dads mobility was so variable on his good days he was a "care home" but on his bad days he was a "nursing home". So having gone through the process of finding a care home, we had to start again and find a nursing home. This all took time and although the team we dealt with on the ward did make it clear he was well enough to go home, they never once used the term "bed blocking", in fact quite the opposite - they said they would not expect dad to leave hospital until arrangements were in place that we were all happy with. The pressure they were under was evident, they didn't have to say the words, but I knew they wanted dads bed....it was a kind of unspoken understanding.
The other service that was not 7 days was the social services element, a couple of times we visited a home at a weekend, and we could have done with speaking to social services, but had to wait until Monday. Of all the services we dealt with during my dads time in hospital, this surely should be a 7 day service, I know the person we dealt with visited her patients regularly, spoke to care homes, reviewed cases etc. The whole process would surely benefit from more cover.
What this means of course is that for me as a family member, with no experience of how everything worked, the system is very difficult to navigate and very time consuming. The thing to bear in mind is that the NHS is an inherently compassionate system. If it wasn't then when they needed the bed they would have discharged dad to my care whether I could cope or not....but I don't believe they would ever do that. So with that compassion in the forefront of how the NHS works, it means if they wait until everything is in place before they discharge then there will be periods when that patient is in hospital longer than medically necessary. But what system would you rather have? Of course it would help to have more physio's (both at the weekends and for post hospital care), to have social services available 7 days a week to have more care homes available with more spaces. But where does all this extra money come from (well, not the care home bit because a lot of them are privately run), I'm only looking at a tiny fraction of the spectrum of a wider 7 day service the government are talking about.
The NHS annual budget is what, £115billion? So even if you said a 7 day service would cost another 15% on top, that is £17billion every year. I've no idea, that figure is completely made up, but even small percentages of such a massive figure is soon going to add up. So now it makes more sense why experts get worried by how much these plans could cost. That is even assuming you can find all these additional speciality people you'd need to recruit and train (this element frequently questioned by those in the NHS).
- So, would my dad have benefited from certain things being a full 7 days, yes.
- Under the circumstances, despite him being in hospital longer than he needed to be, was he treated with compassion, yes.
- If everything was in place for a full 7 days, would dad have spent less time in hospital, probably.
- To literally just extend the things it does now over 5 days to a full 7 days, can the NHS afford that, no I don't see how. (not without increasing National Insurance contributions)
Of course efficiencies could be made, things could be stopped to help pay for it.....but how you work out what that is going to be? We need a Royal Commission to work that out, we really do.
Well this is a bit of a turn up for the books - it turns out I've joined a campaign called "NHS Survival" (www.nhssurvival.org). I must be getting old, and although that is of course a fact, I think it is also part of a process we all go through. Some people have opinions and are brave enough to say them out loud, fight for what they believe in and make their voice heard and some of those do it from a really young age....but in my case things took a little longer!
I've never stood up publicly and fought for anything, but the NHS is different, I think the NHS is able to bring out passion in just about anyone, because it is so close to our hearts. Whether those people are employees or patients of the NHS, everyone has a view and everyone I know of speaks of it with a mixture of pride and increasingly concern.
There will always be a campaign about something, that is what makes the human race what it is. We don't always agree on everything and even what we do agree on, we don't necessarily agree on what the answer to any given conundrum might be. Of course these differing opinions are brilliant, the right answer is nearly always in there somewhere. So it is with the fight that is happening involving the NHS right now, the right answer....an answer or series of answers that will help the NHS move forward is there, but it is hidden in a fog of passion, arguments and confusion about the sheer size of the problem in hand.
My theory of the day is that actually the NHS is in a good place. If you had a small company turning over (say) £300,000 a year with a CEO and 6 staff, and the CEO decided they needed to save 10% of their budget because money was tight, their scope to change anything would be limited. There's not many staff, the small size of their company means anything they do will be tricky to accomplish, the 'easy' thing to do to save money quickly might be to make someone redundant. Harsh but clean and simple. With an organisation the size of the NHS, the task is of course made massively more complicated by the size and fragmented nature of the NHS, but the scope of where you can potentially make savings, improve efficiency and improve the service is vast, the opportunity is vast.
Today is now Sunday 6th September, I had begun writing this blog a few days ago. Today the news is full of yet more media stories about '7 day service' and 'mortality is worse for people admitted on a weekend' and I see passionate feelings expressed by the medical profession who don't agree with these stories in one way or the other and I've no doubt those feelings are justified. But I'm not seeing much agreement or much chance of the sides gaining common ground. As a patient this concerns me. This is what the public see day in day out (just a screenshot of a Google search for "NHS news"):
I think the public desperately needs to see some good news soon, I know I do.
On the upside, I wrote to and emailed my MP about the NHS Survival campaign and I have had an email back acknowledging me and promising a reply. I'll wait and see what comes along
