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The waiting game

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)

  • THERE'S NO POINT IN KEEPING ON WRITING ABOUT IT KATIE

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  • Rather than squabbling over who is more worthy of care, the discussion needs to be with the electorate, we spend a lower proportion of GDP on healthcare than most developed nations and you get what you pay for. Dr C Ho no need to reply.

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  • I think C Ho will probably be too busy injecting bleach on the advice of his Libertarian friends.

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  • One things for certain Boris will need the NHS again, its only a matter of time, unless NHS has unlocked the remedy to immortality.

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  • I certainly don't get what I pay for. Whilst many others get what I pay for them for. You wanna spend a higher proportion of GDP on healthcare as decided (or squabbled over) via the state? You'd end up with more NHSE/GMC/CQC/Personal health budgets/24/7 access at less cost effectiveness/religious circumcisions/rationing, and that's before I get started on greater debt, i.e greater taxation and interest rates for us and our descendants, and a smaller private sector/economy/tax take, which harms everyone. Yeah, you don't want me to reply, as I tend to point out the fallacies in the 'economics' of the socialists. You happy to double what you pay in tax, D? Katie?

    As for Katie,
    "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."

    I agree, but it isn't throwing more money at it. Its allowing the individual the liberty to decide for themselves what and how to prioritise their healthcare, i.e. striving to afford it, saving for a rainy day, and deciding where the money goes.

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  • Angus Podgorny | GP Partner/Principal24 Apr 2020 8:40pm
    I think C Ho will probably be too busy injecting bleach on the advice of his Libertarian friends.

    - Haha, nah I don't follow an ideology blindly. And I know from your comment that you haven't actually watched the press conference and seen what Trump actually said. More likely, you just read the headline/s of reported mainstream media, which can only be objective, I'm sure.

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  • Money spent on the NHS is not the problem it is the waste and inefficiency on the part of the bureaucrasy suppliers and the all you can eat buffet on the part of the punter-demanders

    By the way, for all the people taking cheap shots at Trump, Corbyn was calling the UK the best healthcare system in the world so 'have a giraffe' about that. And secondly, public hospitals in Boston, Mass. are giving routine courses of hydroxychl/azithro, as per what Trump said 6 weeks ago

    And as for Dr Katie's point, Boris needed qualified doctor, he didn't necessarily need the NHS. There's a big difference

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  • I just went to the FULL White House transcript. Dr Angus' "having a laugh" cheap shot is a textbook traduction of what was actually said, like how we warn schoolkids about in following bad journalism

    Here is the relevant quote. Trump was being totally reasonable throughout, since he was moderating, off the cuff, a detailed scientific report about 1. The lethal effect of UV light and 2. The lethal effect of disinfecrants on the virus, and at every step, the press corps were trying to put words and 'fake news' in his mouth

       Q: But I — just, can I ask about — the President mentioned the idea of cleaners, like bleach and isopropyl alcohol you mentioned.  There’s no scenario that that could be injected into a person, is there?  I mean —

    ACTING UNDER SECRETARY BRYAN:  No, I’m here to talk about the findings that we had in the study.  We won’t do that within that lab and our lab.  So —

    THE PRESIDENT:  It wouldn’t be through injection.  We’re talking about through almost a cleaning, sterilization of an area.  Maybe it works, maybe it doesn’t work.  But it certainly has a big effect if it’s on a stationary object.

    Q    Mr. Bryant, are we simplifying it too much by saying that it’d be better with the warmer weather and the sun coming out more and more, that people would be outside than staying inside their home, confined to the four walls of their house?



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  • Thought I'd better read the article properly, like

    "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. "

    Money for nothing and jokes for free. That paragraph gave me the best laugh of the day. Cheers

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  • The full transcript shows that the president listened to a presentation by a Mr Bryan from the Science and Technology Dept and then came out with the bizarre ideas about injections and UV light BEFORE any questioning from journalists began. It was at that point Dr Birx looked like she was going to disappear into a hole, and perhaps to her eternal shame did not speak up.
    So not quite sure what your point is. The parts you have chosen to quote above come from later on in the meeting so you have chosen selectively to leave the first bit out. Not surprised the journos were trying to pin him down on what he had been suggesting after that - after all they are only doing their job.
    The President clearly has the scientific understanding of a 5 year old and as leader of a country ought not be letting his tummy rumble in public. Wonder how many of his worshippers have ended up in the ER since then?

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