On the Beginning of the End of the NHS

Sad day.

There is no reason why you should know, as there has been absolutely zero media coverage on the event, but yesterday, Wednesday September 7th 2011, the NHS Health and Social Care Reform Bill was passed through the Commons on its first Reading, by 65 votes.

No party had a mandate for it, nor any manifesto mention. The parties that became the Coalition Government promised us "no top-down reorganisations" at the 2010 hustings. But they all lied. All over Whitehall pants are on fire, a bonfire of the pre-election pledges.

We have taken the first step to a US-style healthcare system. A system that is based on a price for everything and where nothing has a value. Including professionalism. It will undoubtably work efficiently for the earning, worried well but for those with co-morbidities that look unattractive to Any Willing/Qualified (Private Company) Provider, things are going to get very tough.

In a market economy, many smaller NHS hospitals will close to concentrate resources in cost-efficient centres. Community based projects (cottage hospitals, rehabilitation centres) will be nonviable, more useful as real estate. Private concerns will be able to cream off the high turnover, lower risk procedures, driving the contracts down with loss leaders, leaving the NHS to deal with the elderly and those with multiple morbidities. Accountants for GPs whose budgets run out before the end of the financial year will find a plethora of creative ways to defer organising investigations and treatments. It's already started in NHS Yorkshire " Before you consider surgery ... remember there are significant risks attached ... surgery can be painful ..." NHS 'cynical' tactics are up and running.

And training, how on earth are we going to train future surgeons when the 'routine' operations are removed to the private sector where only consultants are insured to practice...

This is only the first Reading. I realise it has to get past the Lords but the staggering lack of engagement in this last vote by the media and the general publlic has left me gobsmacked. Honestly. Nothing today on any of the national papers' front pages. No discussion of any of the BBC's flagship news programmes. Liberal Democrats crowing on twitter that they showed the Tories what they're made of (really, REALLY? You abstained in protest, oo how tough were you). Dead silence from the Labour leadership.

They all want it. They all want the NHS albatross removed from around their collective neck, it's their dirty little secret.

And now it's our future. Or is it ...

Read the Bill go on, have a go. If you like what you see, well at least you are informed. If you don't, then:

Adopt a Peer and email them your thoughts. Please engage in this process: there is no doubt that the Old Girl needs reform after 63 years but this, truly, is not the way.

On questioning the role of surgeons

Why is there so much antipathy to the Surgeon and so little value placed on the performance of Surgery?

http://www.telegraph.co.uk/health/8735934/NHS-using-cynical-tactics-to-put-people-off-surgery.html

Not for the first time the job that we do is portrayed as optional, sham, cosmetic, a luxury. Pain isn't optional. Osteoarthritis, neuralgia, tendinitis, functional incapacity, inability to be economically active through musculoskeletal insufficiency: these are not conditions to be put off to another day. A torn meniscus isn't cancer, doesn't provide the emotional photo ops of a children's ward, and yet for that patient it means pain, it means swelling, it means not driving, it means losing income, it means lack of sleep, sleep deprivation that most penetrating of all psychological abuses.

Surgeons are not charlatans. We do not exist to create a demand, a need, where there is none. We have training in a skill that maintains the human skeleton beyond its warranty: it was only designed to last for 35-40 years. After that, it loses much of its adolescent ability to repair. It starts wearing out, at the height of our economic earning potential, when our outgoings are at their lifetime peak. Mortgages, childcare, tax demands, insurance... Who will underwrite that when you take to your bed after discovering all the Nurofen in the world won't let you sleep.

Value your surgeons. If a surgeon offers an operation, it is because all reasonable non-operative options have been exhausted. It's not because we're looking for a job creation scheme. Be honest about what you are doing when you ask people to think again about surgeries to improve quality of life. You are talking about Rationing, Cost and Corner cutting. Storing up worse trouble for the future, even if it is a future government of another colour. You are talking about an NHS that can only deal with cancer, kids and crashes.

Value the current, the existing NHS. In the words of Joni Mitchell, you don't know what you've got till it's gone...

On the importance of perspective

Holidays... A vital necessity. I thought I'd been so smart, booking leave for every single half term for 2 years straight; then realised far too late how loooonng the summer holidays are. By the time it occurred to me (May) that I really should plan something, August had already been comprehensively diced and sliced by my colleagues' ever more super-organised wives.

Depression

But sneaking a couple of days off ahead of the Bank Holiday weekend has meant I've been able to get on a plane, baste on a beach and let the mounting frustrations of the past few weeks melt away like the ice in my cosmopolitans for five glorious days... so first day back I've adopted a zen-like calm which has freaked out everyone in theatres (I've been particularly toxic of late, but today, untrained newbies, of which there seems to be an inexhaustible supply, lack of professionalism and the gay abandon with which hundreds of pounds' worth of implants seem to be dropped on the floor, just washed over me in my protective bubble of holiday euphoria)

How long can this last ... ?! Just have to hang in there till half term ...

On futile gestures

It's all going to pot. Cutbacks (cost improvement programmes, lean efficiency measures, the euphemisms are endless) mean a cut in the quality of service. But not the quantity of service, noooo, we function on the Lidl Marketing strategy: pile em high, sell em cheap. Our door never closes.
Today's bombshell: senior staff are more expensive than school leavers. Wow. Wonder why that is because experience counts for nothing in today's NHS. So, wizard wheeze, sack 20% of your senior nursing work force, employ numpties and Carry On Regardless

That strategy couldn't possibly have a down side, could it.

And of course, we now function in a Foundation State (ex-Libyan leaders welcomed) with the footsoldiers too scared to speak else they are suddenly invited to reapply for their own job.

For the first time in the history of the NHS, the hospital doctors' jobs aren't safe. Merge to grow - and rationalise. We've lost our voice

On venting spleen

My day consists entirely of listening. Listening, absorbing, assimilating, cogitating and after due consideration ... treating. I decided today, after twenty years of doing this (20 years and 23 days if we're nitpicking) I'd like to start venting.

Today, after twenty years of having every aspect of my working life overseen by here-today-gone-tomorrow, mediocre, middle-aged middle-management... I'm ready to vent. It just doesn't do to vent in the workplace. I think it scares people (management) to hear concerns spoken out loud, makes them real. Rather generates complaints in that quaint but effective catechism of attack being the best form of defence.

So I thought I would write down all the bonkers things that take place in my world, and perhaps, once I see it on the page, it will seem merely ridiculous rather than hellishly frustrating and I can laugh it all off.

Here we go...

August

Everyone knows August means entry into the Danger Zone, right? Hundreds of college students, kept infantilised by the protective cocoon of spoon-feeding medical schools, are belched forth into the Real World. This is a frightening place where People Are Really Sick: not a simulation, not a Virtual online game (sorry, 'module') but your actual real sick people. In a Hospital.

As final year students we were housemen to the Houseman, learning the nuts and bolts of patient care so come August 1st it was scary but not paralysingly terrifying. These guys have no idea they should be scared, their experience has been so far removed from real life.

And in the brave new world of Foundation training, we have these bright shiny young things for four months in which we have the opportunity to fire their imaginations, to demonstrate what a fantastic job we have, the amazing and awesome privilege of operating, fixing and mending broken and worn out People. To inspire the next generation...

Except we don't. With the EWTD, days off after nights on call, annual leave, educational half days (da di da di dah) we have them for 24 working days. 24. That's it. And they don't realise it. You can spell it out all you like but they just don't get it.

They're gone. Next job. Mad panic come the following July as they discover none of their beginning, middle and end assessments have been done, tears, pleas, threats of legal action when they realise the boat's been missed... but they always get let through by the skin of their teeth

And then it's August again...