What do you want from the NHS? What do you need from the NHS? The current crisis in both hospital and General Practice is crystallising this question in the public's mind, and its constant presence in the press and political agenda in the run up to the General Election continues to highlight it. Despite the British Medical Association's (BMA) campaign "No More Games", asking for political point scoring and interference in the NHS to end, it is set to continue. As no politicians are brave enough to present a realistic approach to the NHS and its future, Doctors and Nurses from across all specialities are speaking out to highlight the problems.
Most of the political spin centres around meeting the perceived wants of patients. But where do "wants" and "needs" meet? Is the NHS a consumer product, or an essential public service? A new series on Channel 4 - NHS: £2 Billion A Week and Counting, is asking this question, trying to make the public think about what the NHS should and shouldn't offer; to encourage them to consider wants and needs. Should care for "self-inflicted" alcohol, drug, smoking and obesity problems be funded by the NHS? Should cosmetic surgery in any form be available free of charge? Should the most expensive new cancer drugs be funded, even though they only benefit a tiny handful of the population and cost millions? Who should make these decisions - is it fair they are a postcode lottery or should the Government be forming national policy? At the moment, the NHS isn't providing the service patients loudly complain they want, but worryingly it is also struggling to provide the service they need too.
WANTS:
We want the personal touch, to feel like an individual - and who doesn't? It can provide compassionate care; Dr Kate Granger's #hellomynameis campaign shows that even under all the stresses and strains of the current crisis, NHS staff can make patients feel valued and welcome by a simple gesture.
We want care that is quick and convenient; appointments and surgeries to fit around our work and holiday - the NHS doesn't have the luxury of making things convenient. Appointments are in short supply. If you really need to see a doctor, you need to accept it is at a time when the NHS can fit you in, or not at all. As soon as a hospital referral is made, targets kick in. A non-urgent referral means the patient must be seen within 18 weeks; if you cancel the offered appointment to reschedule it to fit around your personal holiday plans, it counts as a missed target. The hospital is fined. The fact you chose to move it outside the 18 week target doesn't matter. Money is wasted because you wanted an appointment that suited you. Missed GP appointments cost the NHS £162 million a year, missed hospital appointments cost £756 million a year.
We want care to be local and easy to access - there is an increasing move away from local cottage or district hospitals, to large specialist centres. Mental health beds are closing and being moved to larger units. GP beds, including palliative care beds are the same. Larger centres are inevitably further away from home for most of the population. Patients can expect to face travel of at least an hour for most of their hospital care. A nightmare for loved ones trying to visit, for mothers separated from children, for cancer patients having daily treatment, for kidney patients on dialysis every other day. Big state of the art centres grab headlines, but the practicalities are often lost.
We want familiarity - to know and recognise our doctors - When there are enough GPs in the system, there are enough appointments available. This means most of the time, patients can identify "their" doctor, and see them when they want. Without enough staff, you take what you can get. Most patients don't have the luxury of seeing the same doctor each time. And the "named family doctor" political headline is a paper exercise only. More targets. If you are ill and you need an appointment, there isn't a choice anymore.
We want rapid access with no delays - for what? For the heart attack you are having - of course. For the verruca you've had for 3 months - no. What different individuals think constitutes an "urgent" problem is a revelation. Inevitably those who feel symptoms of a cold or sore throat that began that morning are urgent, because they have social plans that weekend, use the appointments so the patient who has had chest pain for 48 hours and doesn't want to trouble anyone, ends up ringing back the next day.
We want follow up for our problems - if medically required. Not because it is reassuring for you to see the specialist every year for a chat. Not because it's nice to have the GP pop in once a week because you feel reassured if they do. Not because you feel you need it. The NHS does not have this luxury anymore. If it is medically required, yes. Otherwise no.
We want emergency care when it is needed - and NHS staff want to provide this. But not enough staff, not enough beds, ambulances delayed by the knock-on effect, means even this has been compromised this winter.
Apart from the emergency care, the above list of "wants" is an excellent advert for, and description of, the wide range of private hospitals and care currently available in the UK. If you want all these things without question, you should get a quote for insurance, because it is unrealistic to expect a public health service to provide this.
NEEDS:
We need access to 24 hour emergency care; to life-saving treatment - the NHS can provide it, if the contribution of experienced frontline paramedics and A&E staff is recognised and invested in. Working in emergency care has to be a speciality that aspiring doctors and nurses are encouraged to pursue, and targets that hinder the care they give removed.
We need access to appropriate treatment options - these should be decided at a national level, to end the unfair postcode lottery patients face. There should be an open debate about what the NHS will and will not provide, and the Government should acknowledge that it is not a private healthcare system. It cannot afford to be all things to all people. Treatments should be offered on a proven cost-effective population basis, because as soon as you look on an individual level, it is impossible to refuse care. Channel 4's NHS: £2 Billion A Week and Counting demonstrates this expertly; viewers will find themselves locked in a moral dilemma, but making decisions based on which patient they personally feel most sympathy for. You cannot run the National Health Service like this. There is not enough money in the world.
We need access to specialists when the need dictates - having the option for GPs to refer to specialists is essential. But the role of the GP has always been as "gatekeepers" to the NHS. We should be empowered as a profession to be able to explain to patients when seeing a consultant or having an MRI is not appropriate, and not feel bullied into it for fear of complaints, or because of the latest tabloid headlines lamenting our ability to diagnose cancer yet again. If GPs refer everything they see, or every patient that asks for a referral, the system immediately fails.
We need to be treated as an individual, in a clean, caring and appropriately staffed environment - Doctors, nurses and NHS staff are trying desperately to tell the public that individual patient care is suffering at the moment. The pressure is unsustainable, and having the time to properly care for patients, to sit with them, to listen to their fears and worries, to ensure all the essentials are done, becomes impossible when there are queues out the door, not enough staff and constant targets and restructuring. Listen to the people who know; we just want to do our job.
We need a secure, well-planned service, which can run as an organised enterprise, and train and retain its future staff - This is precisely what the BMA is asking for. Stop making unrealistic promises about thousands more doctors, about impossible targets for appointments, about yet another reorganisation for the sake of it. We need a long term plan, with independence from political interference. We need to listen to the King's Fund and their proposals to truly engage NHS staff, because at the moment not one of them is being done.
We need a realistic discussion on why doctors are leaving the NHS in droves, and not choosing the frontline specialisms of General Practice and A&E, and do whatever needs to be done to stop this. Immediately.
The NHS isn't meeting these needs in its current form. There is too much pressure, waiting times for GP appointments and to see specialists are growing, hindered by targets and demand. Staffing levels are compromised by recruitment problems. GP surgeries, A&E departments and hospital wards become unsafe because of this. There is no secure future, no long term strategy at play. The NHS can be all the things we need, but not all the things we want. The NHS does not have the money or capacity to operate on a par with private care in terms of convenience. It cannot meet all the "wants" that will make people always leave 5 star ratings on the review websites so favoured by politicians. It cannot meet the targets they dream up all the time, because illness and death is not predictable. Some patients are more complicated; some patients need more time; some patients don't fit into nice boxes of funding and budgets. Consider this next time you hear a politician waxing lyrical about the NHS. #NoMoreGames.
NHS: £2 Billion A Week and Counting begins on Channel 4, Monday 23rd February, at 9pm.