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Independents' Day

When Boris needed the NHS

Dr Katie Musgrave

I wanted to take a moment to reflect on recent months. As if from nowhere, the health service has been thrust into the limelight. Neighbourhoods have been on their doorsteps clapping. The chief medical officer has fronted daily press briefings alongside the prime minister and other cabinet ministers. Never in my lifetime has there been so much attention given to the health service, and its workers.

So what, you might ask? We are in the midst of a global pandemic, it is only natural. But this is extraordinary, unheard of.

If you have read any of my previous writings, you will know that I am not a die-hard supporter of the NHS in its present guise. The national health service desperately needs transformation if it is going to provide an acceptable level of health care to the UK population over the coming decades.

Working within the service, having moved from hospital placements into general practice, it is easy to see myriad shortcomings. The staff shortages in primary and secondary care, long waiting times, an exhausted workforce, huge amounts of paperwork, excessive guidelines, and the ever-present threat of litigation.

There are many areas for improvement. Not all will require a great investment. A lighter touch in the management of GPs, greater autonomy, strategic investment in our workforce, and in systems to help reduce our workload. More investment in community care - moving the frail and elderly out of the acute trusts, into purpose-designed elderly care hospitals (remember the community hospitals?).

I can only hope his recent hospital admission was a wake-up call

And in secondary care, we need to have a long, hard look at which services the NHS can realistically provide. It is a painful conversation to have: but a system which provides fertility treatment, but leaves our elderly dying unattended in hospital corridors, is not fit for purpose. Our leading scientists and medics will always advocate for investment in their specialisms. But they will not always be right. Millions spent on reconstructive surgery, might be better invested in primary care, community hospitals, or outpatient geriatric services.

A citizen’s assembly should be commissioned to review the services provided by the NHS. Ordinary members of the public ought to be part of this decision-making. Pragmatic, but ethical, decisions would be more likely to result without political interference, and would help facilitate a cross-party consensus.

So, back to Boris. As doctors working in the health service - we see its importance. We see our patients with their unexpected cancer diagnoses, rushed into hospital, needing acute care. We see little old ladies, needing the emergency services, admitted with their strokes. But our politicians won’t always see this. Largely shielded from the NHS, a privileged group: they will, statistically speaking, have fewer emergency admissions and chronic health conditions.

When you don’t regularly need a service, it is easy to forget its importance. And it’s easy to become complacent, and underinvest in it over time. Like an insurance policy you have paid into for years, then allow to lapse; only to have your house burn down in a freak accident.

So when our Prime Minister comes face to face with his need for a health service, it matters. I can only hope his recent hospital admission was something of a wake-up call. Faced with an indiscriminate virus, such as Covid-19, right now any of us might need medical care. This is finally abundantly clear to all. And when we really need a GP, an emergency department, or an ITU bed: don’t we all want a decent service available? The demands on intensive care may be unprecedented, and impossible to maintain in normal times; but our acute hospitals, the availability of ambulances, the accessibility of GP care - our population needs these.

So, Boris, Matt Hancock et al.; don’t forget 2020. This was the year when you finally realised that we all need a health service which is fit for purpose. The NHS needs transformation, investment, and improvement. We all rely on it to be there to care for us in our hours of need.

And as you now know, any one of us might need it at any time.

Dr Katie Musgrave is a GP trainee in Plymouth and quality improvement fellow for the South West

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Readers' comments (22)

  • Chris, you need to drop out guilt by association in your arguments. Whether or not a healthcare system resembles that of socialist countries has no bearing whatsoever on whether it is good or bad, it is a complete non sequitur. `this was d' is correct, we do spend less money on our healthcare system. I don't think anyone is proposing to pour more money into the NHS to spend it unwisely, but having worked in both eh UK and Australia I know which system is more proactive. In an overcrowded world it does not make logical sense to spend money on fertility treatment, a very emotive topic, but one which needs to be dealt with. Again Dr Musgrave is raising issues that need to be dealt and seem to have been avoided by our so-called leaders. BaldrickMD, the private sector is only interested in picking the low hanging fruit, they are a profit making system. I dont think anyone would hold out the USA as an example of a good healthcare system. In terms of Jeremy Corbyn, Baldrick you may want to look at his sources, back in 2017/2018 The US-based Commonwealth Fund, a global health thinktank, last year ranked the British health system as the best of 11 well-off countries. The NHS performed better than its counterparts on fairness, ease of access and administrative efficiency, although the study acknowledged that outcomes for people with potentially fatal diseases fell short of those in western Europe and Australia' So Baldrick, Corbyn may not have been so far off the mark depending on what you are basing you judgements. And Angus is right about Trumps wording, I think you must be watching Foxtel too much....... the videos speak for themselves. https://www.youtube.com/watch?v=lFKQGGf1iiI
    If you can watch this Baldrick and think Donald Trump is still a genius..... well, everyone can make their own judgements

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  • @ Curious.
    Well put. The NHS though far from perfect as you point out, is both fair and efficient. The argument would be that if you put more fuel in the tank then the outcomes would improve toward those of our European colleagues too.
    I think the idea that if you support the concept of the NHS then you must be a communist or loony lefty is dead thinking. There are good ideas to either side of the political spectrum, but human progress also seems to be deeply limited by the idea that you have to subscribe to one ideology or another.
    Unfortunately our country’s ability to compromise is limited by a crap electoral system which gives minority governments too much of a say. Roll on PR. It might be boring but it causes people to talk.

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  • @Curious

    Aren't you doing the opposite? Denial of guilt by trying to dissociate the similarities? The fundamental and basic idea that it should be done by the state is flawed. The reasons are also basic, and well-studied, i.e power corrupts, it is always easier to spend someone else's money.

    Let's use your example of fertility treatments. You think we live in an 'overcrowded world', hence you don't want to see taxpayer funds poured into fertility treatments. A couple finding it hard to conceive might disagree. Where is the balance? It is not struck by the state (potentially irresponsibly ) compelling that the couple is right and that you're wrong... It is struck by not forcing you to fund them, and leaving the responsibility to them to fund it, if they think the cost is worth it. You are then free to be generous to them if you so choose to.

    The NHS is anything BUT fair. It is unfair to taxpayers who fund it for non-taxpayers. It is unfair to victims of rationing, deemed unsuitable for treatment for whatever reasons e.g. elderly with covid. It is unfair to those who abuse it, as it harms them by taking responsibility away from them for their own health. It is unfair to those who think some non-medical treatments e.g. religious circumcisions, should not be funded yet are forced to fund it. You're confusing fair and equal, they are NOT the same thing. Efficient? That's one way of looking at it. The other might be under appreciating and under remunerating its front line workers compared globally.

    The attack on the US system is uncalled for. I never put it on any pedestal. It is more free market than us, but not completely, yet is still at the forefront of some areas of medicine, e.g. cancer drugs, laser eye treatment. It has the worst of both worlds, a heavily subsidised public sector, and a heavily regulated private sector, so by no means is an example of a 'good' system. The 'concept' of the NHS is not just simply healthcare for all, but as dictated by the elected representatives of the community i.e the state, i.e, socialist/communist. You think the NHS is NOT a redistributory mechanism, or a left-leaning policy???

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  • When I went to university to study medicine the biological science departments were all state funded, including the research.
    They had an interesting variety of research on the go which included UK specific illnesses like heart disease and cancer.
    They also had studies into the mechansims of disease of malaria, leishmaniasis and trypanosomiasis with a view to developing better treatments and cures.
    A waste of money?
    Or all for the greater good?
    The free market only provides when there is a buck to be made. a balance is the way forward.

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  • "A waste of money?"

    - In some sense. There might be a stated noble purpose for studying tropical diseases in a temperate country... The cynic might think it is simply a way of trying to secure additional state funding...

    "The free market ONLY provides when there is a buck to be made"

    - The ONLY is absolute BS. So there is no room for private philanthropy? That entrepreneurs are unable to be humanitarian? That it has to be compelled by the state? What about the Bill and Melinda Gates Foundation? Or Bezoz's Family foundation? The biggest advances in reducing world poverty, even targeting climate change, come from the capitalist West. I am simply more optimistic about human nature than you are Angus.

    On a side note, I actually agree with you about balance, but it has swung way too far towards the state/the left, certainly when we are in debt.

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  • "So when our Prime Minister comes face to face with his need for a health service, it matters. I can only hope his recent hospital admission was something of a wake-up call."

    Not true, dear Katie. He would have had a REAL wake-up call if he had to wait for hours for his GP's receptionist to respond, hours for the ambulance to arrive and then taken to a North West district hospital. What he experienced was an IVP treatment, beginning to end, in one of the best hospitals in the country.

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  • sceptic

    think you meant VIP !

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  • @Chris Ho
    Glad to see you can argue your corner on reasoning and not emotionally and personally :-)
    Lets start with power corrupts.... Donald Trump, Xi Ping Putin...different systems....all corrupt leaders. Right wing, left wing....it doesnt matter which way you swing... just different routes to help yourself. But thats an opinion, its have a fact next....
    PFIs and hospitals- the British taxpayer is more than £300bn for infrastructure projects, with a value of £54.7bn...mmh thats the efficiency of the private sector when its gets involved.... its a self serving edifice for the private sector..... tell me how this is better than the flawed public sector? Rather than stating well studied....lets put some facts out there to study.... back up your position! Lets play :-)

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  • @Curious

    Oh come on, you're making this too easy for me. Just because it is called Private Finance Initiative, doesn't make it subject to free market principles at all. Just like North Korea is called the Democratic People's Republic of Korea. "PFI" is still the state bureaucracy deciding how to spend other people's money, i.e less responsibly/less quality control/no competition. Hence you get things like Crapita. TRUE free market principles would be if the various private firms have to compete for the custom of the customer DIRECTLY. You blame the private sector for taking advantage of the tax payer? Why are you not blaming the state for being irresponsible with taxpayer funds?

    Your blanket statement about L and R wing corruption and trying to draw a correlation between all those national leaders is disingenuous to say the least. So Xi is persecuting Uighur Muslims, effectively committing a genocide and other human rights offences, e.g. their own journalists disappear for criticising the state. Putin is fairly authoritarian too. But if you had to choose to live under Trump, Xi or Putin, you would be unable to choose? Of course it matters which way you swing... There's one side that seems more keen to remove OUR civil liberties...

    I appreciate that you think I can argue my corner on reason. Did you not have any thoughts on my comments about fertility treatment and compulsion? Here's some broader questions for you and the L wingers out there:

    - Would you rather not have the freedom to choose who to help and how to help them? Or do you trust the state implicitly? Would you also not respect MY freedom to choose, or do you think I should be forced to do what YOU think is 'right'?

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  • OK Chris
    I doff my hat to you sir,
    "PFI" is still the state bureaucracy deciding how to spend other people's money,"
    Our government is incredibly incompetent.... I will give you that :-) There is a lot of bad management in many state areas, but also many good examples.... but more so in Scandinavia!
    But I graciously accept your point!

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