This site is intended for health professionals only


The health system isn’t failing – it has failed

The health system isn’t failing – it has failed

After an incident at a coffee morning, Dr Katie Musgrave reflects on how the health service is letting patients down, especially the elderly and those most in need of help

I had cause to reflect last weekend on the state of our health service. While attending a village coffee morning, an older lady had a funny turn. That heart-sink moment when someone asks, ‘You’re a doctor, aren’t you?’ ensued. Suddenly, I was in medical mode: do you take any regular medicines? Do you have diabetes? Chest pain? Can I feel your pulse? Thankfully, the lady came round, and I didn’t need to call an ambulance. But there were a few worrying minutes when her eyes rolled back, her pulse felt weak and she appeared decidedly clammy.

The episode got me thinking: had she been worse, where would I have told her to turn? Could I really have advised a widowed 88-year-old to go home alone and phone 111? If she had needed an ambulance, just how many hours (or days) would it have taken to arrive? The waiting time in my local emergency department right now is 11 hours – so I couldn’t, in good conscience, advise her to go there. Where can people go when they are acutely unwell? When they are an elderly person, living alone, having a worrying symptom and they don’t know what to do?

I think the sad reality is, now, they often don’t go anywhere. So many patients phone our surgery with very serious or life-threatening symptoms and are reluctant to go to hospital. They’d rather take their chances with their central crushing chest pain than face the gauntlet of an emergency department visit and a hospital admission. Who can blame them when around 4,000 patients each day are spending more than 12 hours in A&E?

Fortunately, the lady at the coffee morning is registered at a small local GP practice, which I know delivers an excellent service. I encouraged her to contact her GP to discuss these ‘funny spells’; if she does, I’m confident that she will be seen and reviewed appropriately. However, too many patients report being on hold for hours on a Monday morning, unable to get through to their surgeries. Of course, people stop trying or eventually give up.

We must reflect on where we go from here. What do we do when our most vulnerable patients do not feel that the health service is there for them? When barriers to access have become so high that those who need help most cannot get it? What will this do to mortality rates across the country? How many people are being left to quietly fade away, with reversible or treatable conditions? How has our switch to remote access influenced the age range of patients who now get GP appointments? Is our free-at-the-point-of-access system perversely making healthcare inaccessible for the most in need?  

I have a lot of questions, but few clear answers. The crux is that the status quo is clearly not acceptable. But we cannot just blame the present Government. Looking across at the devolved nations, it is not only the Conservatives who are failing in their health service management. Might it be that the founding principles of the NHS are now incompatible with 21st century behaviour?

The brutal fact is that the whole UK health system is in crisis, and there are millions of people who are understandably scared that they won’t be able to get help when they need it. We cannot deny the issues and hope they will just go away. After this winter will come another and another. Things are not going to get better without radical changes.

For every widowed lady who breaks a hip, but the ambulance doesn’t come; for every pensioner who sits at home alone having an MI; for every severely mentally unwell child who cannot get a psychiatric review; for every person whose cancer diagnosis is delayed by weeks or months; for every baby who dies avoidably due to inadequate maternity care – our health service is not failing, it has already failed.

By strange coincidence, my 98-year-old grandmother also had a funny turn this week. She lives in a care home in Holland. I sent her my best wishes via my mum, who is travelling there to see her this week. ‘Don’t worry,’ my mother said breezily. ‘I’ve rung her GP and he’s popping over on a home visit while we are there.’

The Dutch have developed a health system that provides universal, affordable and accessible care. If only it could be so simple here.

Dr Musgrave is a GP in Devon and quality improvement fellow for the South West


          

READERS' COMMENTS [9]

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

James Cuthbertson 5 December, 2022 2:06 pm

“Might it be that the founding principles of the NHS are now incompatible with 21st century behaviour?”

It certainly seems that way…..

Patrufini Duffy 5 December, 2022 3:55 pm

No one will listen to GPs. Their laser vision and immeasurable gatekeeper perspective. It is all utter crap – it is finished. No NHSE Primary Care Director, CQC “let’s shut you down” Director or hands in US-pockets DoH adviser is trying. No GMC Director gives two hoots. There’s no spark left. They’re all in on it – break it, then “procure an innovation for £20 million”. Watch our jobs and backs. And no one listens to Consultants. They need to expose this charard. The “mafia” is hiding and running for the hills, the nameless “NHS spokesperson” – leaving the blame at a physician’s door, which is an old one trick pony – people will die and this whimsical farce mirrors the sick joke of the Covid pandemic response – “let them die, we’ll be ok”:

https://www.bbc.co.uk/news/uk-england-63827648

It is over. 2023 resolution, don’t cover up for them.

Dave Haddock 5 December, 2022 6:51 pm

“Might it be that the founding principles of the NHS are now incompatible with 21st century behaviour”
The Proles no longer know their place, have stopped being grateful and insist on asking lots of impertinent questions.

Keith M Laycock 5 December, 2022 7:45 pm

Another good ‘on the nose’ commentary.

Dave Haddock 6 December, 2022 11:09 am

Effective reform would likely require cross-party co-operation; because several of the core principles need to be revised; because of the sheer size of the organisation; because of the range and scale of vested interests in status quo. With the current political atmosphere of toxic zealotry that seems unlikely.

Rogue 1 7 December, 2022 2:51 pm

Lets not kid ourselves that the NHS is a world leading health service.
We have dropped from 14 to 16th in Europe!
Most people would struggle to name 16 European countries, never mind one that ‘should’ have a better health service.
It is broken, well broken, and we are fed up flogging ourselves to prop it up.
The country needs an adult conversation about what it can afford, and what that money will buy in terms of the NHS.
But no politician is brave enough to do that, so the downward spiral continues.

Jonathan Gregson 7 December, 2022 6:39 pm

NHS is completely broken but that’s what the people want.
They keep voting in governments that kick the social care can down the road.
They voted for austerity.
They voted for Brexit.
They voted the Tories in AGAIN!
They fall for the same old NHS “must try harder” lies from populist press
They believe the anti-immigrant rhetoric and wonder where all the care staff and nurses have gone.
They think Labour is for scroungers and the Conservative are for the working man
At least they have a bank holiday for the jubilee and funeral
Bread and Circuses!
I have no sympathy for them now.
British people get the NHS they deserve.
We should stop covering up the cracks.

Simon Gilbert 10 December, 2022 8:24 am

https://iea.org.uk/publications/universal-healthcare-without-the-nhs/ Describes how we could move to a Dutch style system.
Of note in a social insurance system the outcomes aren’t so dependent on having the ‘correct’ government at a favourable time in the economic cycle as there is the
ability to draw in more resources from individual patients without an act of parliament.

Dave Haddock 11 December, 2022 4:26 pm

Anyone deluded enough to think voting Labour will fix it should review Wes Streeting’s latest witterings; they have no plan other than throwing yet even more money into the pit.
Record spending increases yet the service for patients is worse.