Masks & ‘lockdown lite’ measures won’t fix NHS – it needs an overhaul and here’s 6 things that must urgently change
SO once again we’re being asked to stay home if we’re unwell and wear masks if we go out – this time to keep a lid on the flu epidemic AND Covid.
The UK Health Security Agency advice this week had inevitable echoes of the dreaded Stay At Home, Protect The NHS, Save Lives mantra from the pandemic.
The inevitable outcry is understandable. The NHS is meant to look after us — not the other way round.
Yet despite the huge sums of money being endlessly pumped in — £3.3billion more is going into NHS England in 2023/2024 — not a day goes by without another horror story.
Even worse situation
The NHS is on the brink — perhaps it is no wonder desperate chiefs are advising people to wear masks in crowded spaces or stay home if they get ill.
But these lockdown-lite measures are not the answer.
I’m afraid the warning signs heralding imminent NHS collapse have been there for years.
And many of us working in the health system, as I have done for four decades, didn’t keep quiet about it either.
Five years ago I wrote that “yet again our NHS is suffering a winter of discontent; operations are being cancelled, casualty units are under siege and anyone not seriously ill faces being turned away.”
At the time, two NHS bosses warned that the pressures on A&E were the worst they’d known for 30 years. Sound familiar?
In the aftermath of the Covid pandemic we are now in an even worse situation.
A&E units are overflowing, ambulances are backed up outside them, with some patients waiting hours to be seen.
A number of health service unions are now implementing strike action, adding to the problems.
Every winter there is huge pressure on the health service, and we can’t count on a few flimsy masks to save it.
And we can’t continue with the current failing system, where the Royal College of Emergency Medicine estimates there are 300 to 500 avoidable deaths a week in the UK because of failings in emergency care.
I believe the NHS itself has a need for a radical cure. We don’t drive a car or fly in an aeroplane designed in 1948, so why should we rely on a health service designed 75 years ago?
Largely, we know the problems.
People are living longer with a growing number of long-term chronic conditions including diabetes, heart disease, arthritis and dementia.
We now have the means to treat these conditions too, but that means our ageing population — with better healthcare but a lack of social care — are “bed blocking” in our hospitals.
Cottage hospitals
Up to 20 per cent of hospital beds are occupied by patients who are medically fit for discharge.
These so-called “bed-blockers” are your mum or dad, granny or grandad, uncle or aunt, none of whom have anywhere to go while recovering from their surgery or illness.
Since I qualified 40 years ago, the number of hospital beds has plummeted.
To give just one example, the Chelsea and Westminster Hospital was built to replace six hospitals.
The same has been going on around the country with the closure of local and cottage hospitals, which would be ideal for rehabilitation and recuperation of elderly patients.
So what can be done? The time for tinkering around the edges is over.
We need major changes to the system, both in the long and short term.
This would be my prescription:
1: PRIORITISE URGENT CARE OVER NON-URGENT SURGERY: It might sound obvious, or it might provoke howls of rage.
But while we have desperately ill patients waiting in corridors, we should halt elective, non-life-threatening in-patient procedures, or contract them out to local private hospitals.
This worked well with some NHS hospitals during Covid and should free up beds for urgent cases.
2: THE DOCTOR MUST SEE YOU NOW: General practices used to be the first port of call when you were feeling unwell – but now patients are finding it near impossible to see their family doctor, and are going to their local hospital’s accident and emergency department instead.
We must end the online or phone consultations which are a hangover from Covid and compel GPs to see their patients face-to-face, with booking systems which allow them to make early appointments by email as well as by phone.
Pharmacists can also help with minor ailments and should be able to prescribe antibiotics for common complaints – as is the case in Scotland.
3: STOP THE STRIKES: Nurses and paramedics are not striking simply to cause trouble, or because they are greedy.
They have very legitimate grievances, and they are taking their current course of action out of desperation. But it is making an already perilous situation even worse.
Both sides in the various pay negotiations need to come up with a sensible solution – and fast – that takes account of inflation but accepts that we have to cover the costs of closing down the country during Covid.
4: DITCH THE ROSE-TINTED SPECTACLES: We need a cross-party commission to look at how to produce an integrated health and social care system which will take us through the 21st Century.
One of the greatest problems with the NHS is how heavily politicised it is: “Our NHS”, “Envy of the world” etc.
We need to end the hysterics and have a grown-up debate about the future of healthcare.
We know the system is failing and now is the time to do something about it.
The NHS and US systems are at the opposite ends of the healthcare funding spectrum so we need to take a look at the successful French, Australian, German and similar systems, which sit somewhere in the middle – then look towards slowly converting our own.
We also need to look at how their systems are managed. Anything not directly related to patient care should be jettisoned unless a very strong case can be made for keeping it.
5: TRAIN OUR OWN DOCTORS – AND KEEP THEM: For the past few years the GMC has registered more overseas than UK graduates as doctors.
We must stop denuding developing countries of their medical and nursing staff and train our own.
But that means we need a radical rethink of how we train and pay our newly qualified doctors and nurses.
At the moment we lose vast numbers, who choose to either take up agency roles, find work overseas or leave the profession altogether because of the poor financial rewards and extremely challenging working conditions.
One thing that could be urgently reviewed is the vast student debts that newly qualified doctors now run up – we should not be saddling these desperately needed workers with such an enormous financial burden.
6: POURING MONEY IN IS NOT ENOUGH: The NHS gets a bit worse every winter – and the population is only getting older, and demands on the system are only getting heavier.
Now is the time to address this, because decisions made in haste when the system eventually goes into meltdown will be the wrong ones.
Little has changed in the past five years apart from eye-watering sums of money being poured into the black hole of funding the NHS.
This cannot continue. Which politician will have the moral courage to stand up and call for a complete review of the system?