This site is intended for health professionals only

Acute NHS care is a sick joke

Acute NHS care is a sick joke

Columnist Dr Copperfield says we need to stop peddling the myth that prevention is always better than cure and accept that people will still get sick

If you want to have a big think about the current state of the NHS – and I appreciate you don’t, you just want a holiday, but bear with me – then go to your local A&E, either as a patient or a relative. I’ve recently done both and believe me, it’ll give you plenty of food for thought. And plenty of time to think about it.

First was with my elderly dad, who’d had a fall. It’s a cliché to describe A&E as a war zone, but, honestly, it was a war zone. Ill patients on trolleys in every conceivable space, with barely any room for the clinical staff to move. I genuinely thought that there might have been some major incident. When I queried this with the sister, she just shrugged and said, ‘This is quiet – you should see it in winter.’ Er, no thanks.

Second was my own urgent attendance at a local DGH. Utterly rammed, and a six-hour wait for assessment. Big deal? Well, yes, I think so, given that it was 2am on a Wednesday in mid-summer. When I used to work in A&E, I’d normally expect a couple of hours kip on a midweek night shift. The staff here looked like they’d never slept, and had an air of grim resignation, maybe because they were thinking of resigning.

So I spent my many waiting hours – sat on the floor, as there were no seats available – mulling over the NHS. And I made a resolution that the next person I hear saying, ‘What we need is a National Health Service rather than a National Illness one’, I will punch in the face, even if that means they’re bumped above me in the casualty queue.

This mantra is trotted out during every NHS debate or reorganisation, and I’m sick of it because it’s wrong. The concept of ‘health for all’, aka ‘preventing illness in the first place’, was one of the fundamentals of the NHS’s inception, 75 years ago. And we should realise by now that, with one or two exceptions (off the top of my head: immunisations), it doesn’t work. Focusing on prevention doesn’t stop illness or death, it simply delays it. Obvious, really.

Yet we continue to peddle this myth, kidding ourselves that all the pressure on the frontline would be relieved if only we screened more/diagnosed earlier/statinised more widely etc. Well, those frontlines are A&E and general practice: I’ve painted a picture of what the former is like, and you know all about the latter. It’s not working. That frontline is so routinely overwhelmed that the ensuing chaos and dysfunction is becoming dangerously normalised.

So how about we properly fund those services by diverting some of the absurd amounts we spend on preventive initiatives of marginal benefit? How about accepting that people will still get sick and distressed and need urgent care? How about, in fact, a National Illness Service? Because, at the moment, we don’t even have that.

Dr Copperfield is a GP in Essex. Read more of his blogs here



Please note, only GPs are permitted to add comments to articles

SUBHASH BHATT 25 July, 2023 5:55 pm

Sorry to hear your trouble. In old days gp will talk to sho on call and admit patients. Why does that not happen now.. OOH service taken from gps was one of biggest mistake made. Every one direct every people to an and e.. contacting 111 is not easy.
Best wishes for your health.

Paul Loxton 25 July, 2023 6:08 pm

Spot on Dr C.
Various parties remain obsessed with ever more preventative medicine that repeatedly has been shown to make no difference to outcomes.Politicians still see this as a solution to the Nation”s ills .
Vast amounts of money are also spent on endless leaflets for patients and copying clinical correspondence which the majority are not interested in .
The current method for GPs to refer patients to hospital for an admission is only further clogging up A /E DEPTS .
Don’t forget also how many departments have closed further exacerbating the situation

Anonymous 25 July, 2023 6:17 pm

I am glad you reflected on current state of healthcare system in this country. Now you know that poor access to GP appointments results in overburdened secondary care. There is also more people living in the UK than ever before hence we need more services.

Deborah White 25 July, 2023 10:12 pm

Anonymous, I think you’ll find that it is poor access to secondary care that results in overburdened GP appointments.

David Mummery 25 July, 2023 11:27 pm

A&E is inundated as AI powered medical triage chatbots and 111 algorithms keep on telling people to go there…please can we bring back ‘common sense medicine’ as a specialty?

Some Bloke 26 July, 2023 7:03 am

Common sense is not allowed – as per protocol

Loucas Louca 26 July, 2023 9:20 am

Excellent post-

Common sense not allowed

Truth Finder 26 July, 2023 4:05 pm

Guess the AI, new ipads, more bed managers as well as the assistant to the assistant managers, more quangos and micromanagement did not help.
When you have more customers, you’ll need more cooks and waiters/waitresses. Not more useless innovations.
They need to now improve terms and conditions of staff before more leave.

Finola ONeill 29 July, 2023 1:24 pm

NHS doing disease prevention doesn’t work because disease prevention isn’t achieved through healthcare.
It is achieved through government public health measures; previously that was addressing tobacco through advertising bans and taxes.
Now the even bigger demon obesity, and its correlate type 2 diabetes and all the complications those pair produce need similar government action; their own adviser Dimblebey told them exactly what to do; in his report.
Not far different; advertising bans, fast food, processed food sugar taxes. The government won’t do it.
And elaborate plans to get primary care to clear up the mess through mass referral for gastric banding, weight loss injections and the various pointless obesity programs are expensive and are overmedicalisation of a government’s refusal to introduce the measures they have been told to implement.
Don’t under estimate how much proper prevention, ie these public health measures, would help.
Think how much disease we see is caused by obesity and/or type 2 diabetes.
heart attacks, strokes, renal disease, hip and knee replacements, chronic pain, hypertension, increasingly liver disease (yep everyone has a fatty liver theses days), retinopathy.
And that is without an understanding of what super processed food is doing to us all; that is yet to unfold.
So yes lets put NHS budget into treating illness; both through hospital and primary care funding.
Can we remove the bullshit wellness adviser/social prescribing etc pushed through additional roles and let that funding be given for more GP appts and nurses and receptionists.
Paramedics for home visiting save us a lot of time we really need clawed back.
But send the physios back to the community and hospital, the pharmacists to the empty closing community pharmacies and the paramedics back to the failing ambulance services.
You can’t divide up care in general practice and farm it out to multiple additional roles. It doesn’t save work and often creates more and they are needed in the jobs they were trained for.
We could do with the ring fenced funding assigned only for them, back in core contract to fund our own actual staff; GPs, nurses and receptionists.
Enough of the dumb experiment by the quango NHSE that is PCNs, ARRS and the like.
Let us do our job, hospital do theirs, paramedics, pharmacists and physios the jobs they were trained for and maybe the government can do their part regarding health.
Then dear government; give primary care our proper funding, in to the core contract, pay your NHS staff properly and go away.

Some Bloke 30 July, 2023 7:19 pm

Fiona, you have my vote.

Imogen Bloor 3 August, 2023 12:37 pm

Well said Dr DC, I agree with many points so eloquently made… prevention measures can’t be at the expense of necessary acute reactive care. . Whilst I still believe there is a role in in general practice for opportunistic health prevention conversations and proactive care to help manage long term conditions better, adequate resourcing & work force are both key . Finola O’Neill is correct that true preventative measures happen though national public health measures and interventions , and implementing these are political decisions .. And if such measures are not taken, pressured and under-resourced GPs (and other clinical services) will continue to struggle to manage competing demands & skewed priorities .