It’s been said that the extraordinary current measures – a national lockdown, school closures and travel restrictions are to prevent the NHS from becoming overwhelmed. Throughout this pandemic, however, I’ve found myself repeatedly pondering this idea. You see, the NHS I’ve worked in for the last decade appeared – by all accounts – to have been overwhelmed long ago.
Any UK medic can tell you tales of being on-call alone, covering dozens of hospital wards and hundreds of patients as a junior doctor. Of stumbling across patients who have died or come to serious harm because of understaffing, mistakes, or delays in treatment. Such scenarios are entirely commonplace, and are an institutional feature of our beloved NHS. For many years, GPs across the country have been collapsing under an unmanageable workload. In Pulse’s 2019 workload survey, 51% of GPs reported that they were working beyond safe levels.
Before Covid hit – whilst our health service battled to provide fertility treatments, gender reassignment surgery, prosthetic hands to amputees – there were little old ladies dying in hospital corridors up and down the country. Patients waited many hours to be seen in emergency departments or medical assessment units. Often, nurses were stretched so thin that patients appeared stranded and helpless – the comparison to war zone medicine isn’t far from the mark.
A survey undertaken by the Royal College of Midwives last year revealed that more than three quarters of midwives thought that the staffing levels in their trust were unsafe. If such a survey were ever to be conducted amongst junior doctors, I’m certain that the findings would match. Hospital trusts and primary care systems suffer from the same affliction – a failure to tackle staffing shortages and improve services, alongside a spiralling demand from an ageing population.
I believe that we, the UK medical profession, have found ourselves ground down into a position of learned helplessness. There’s been too much to change, and it’s felt too hard. We’ve lacked the capacity to imagine something better, and the strong hierarchies that exist in medicine have stifled change or improvement. We feel it’s our duty to persevere in keeping the system afloat, meaning that at times it can seem almost heretical to ask if the NHS is good enough.
Scandal after scandal comes out, seeing individual hospital trusts interrogated and admonished, but the truth remains unspoken – this is a national issue which affects the whole of the health service.
It may be instructive to reflect on historic scandals involving other avoidable public deaths. The response to the Hillsborough disaster wasn’t to offer ‘human factors’ or resilience training to the staff. After cover-up attempts were thwarted, it was recognised that a system overhaul was needed to avoid further tragedies at sporting events. But still, it took an enormous groundswell of public outrage to open up the scandal and demand change.
Likewise, the NHS now needs root and branch reform. The deep-seated issues – which will have been responsible for many thousands of avoidable deaths over the years (not just this past year) – cannot be solved by throwing money at the problem. A public inquiry into patient safety issues in the NHS is long overdue.
Our society has a responsibility (and now the perfect opportunity) to call for better – we must not allow ourselves to feel numb and indifferent to the failings in the health service any longer. Why have so many died in the UK? Why has our health service been incapable of adapting to a moderate increase in demand, for which it should have been prepared? How on earth will the NHS ever regain control of surgical or outpatient waiting times? Make no mistake, our health service was already on the brink of collapse. Covid was simply the final straw.
As we walk away from the burning embers of the NHS at the end of the pandemic, I cannot help but dream of building something better, and stronger, which can serve us all in our time of need. Where we regain a focus on the things that matter, and go back to providing the basics of decent medical care to the whole population, at an affordable price for all.
We must not resort to infighting, or blaming ‘Covid-deniers’, instead of placing the focus of our rage where it deserves to be placed – at the feet of those who have been managing the NHS in recent years. After all, it’s not Covid that has brought about this catastrophe – it is they.
It’s now their responsibility to fix it.
Dr Katie Musgrave is a newly-qualified GP in Devon and quality improvement fellow for the South West
Pulse is carrying out a snapshot survey on GP workload based on GPs’ day in practice on Monday 1 March. We are asking GPs to take part to help raise awareness about the strain the profession is under.