Columnist Dr Shaba Nabi relates how a family crisis brought home to her the realities of trying to access timely care in a broken NHS
We all know we’ve been stumbling around this fairground for a while. You know – the one where patients are passed from pillar to post in an effort to manage the systemic issue of insufficient capacity. We have all experienced the mix of empathy and helplessness as they bounce between general practice, community pharmacy, 111 and then back to general practice again. Patients are appalled and blame us, we know it’s rubbish but can do nothing, and the rusty carousel goes round and round.
But a recent personal experience, when I found myself walking in a patient’s shoes, showed me how truly broken things are.
It was a rainy Sunday morning when my kids persuaded me to take them indoor climbing. They are proficient climbers, so I was happy for them to get on with it while I caught up with work in the café. But when they came out, I took one look at my 12-year-old daughter and knew she had broken her elbow.
I drove her to a heaving minor injuries unit, to be told there was a five-hour wait with no guarantee of being seen before it closed. As it was approaching lunchtime I decided to drive home, give my daughter a bite to eat and pain relief, and then go to another unit nearer home. On arrival, we found that unit was closed because it could not cope with the demand. It was heartbreaking to see my resilient daughter crying in pain when told she could not be seen.
There was no option to register her name in a queue and the reasons were obvious – they were relying on a large proportion of patients to return the next day, or never return because they were better. This made me reflect on the challenges of offering everyone in general practice an appointment at first contact. The main reason we don’t do it is that we’re relying on a significant number going elsewhere for care. Even with this undesirable but natural attrition, we still can’t cope with demand.
Back to my daughter. We returned home and waited… and waited. Thankfully the minor injuries unit re-opened that evening and my daughter was treated quickly and compassionately. But what about parents who can’t or won’t wait? Where are the safeguards to ensure we are protecting the most vulnerable children when our system is failing to provide the basics of urgent care?
The system as it stands is imploding because of soaring demand and there is nothing curtailing this. Many health commentators have antibodies against any sort of co-payment, but I can’t help comparing my incredibly good-value dental review at £23.80 with the £25 I spend on a haircut.
I have previously written about the widening health inequalities for young people in the mental health space, but these inequalities are now permeating every part of the NHS. It is universally understood that a well-funded NHS that values its staff enough to retain them is the gold standard for healthcare delivery. But when that’s not forthcoming, do we rigidly adhere to our ethical values and see inequalities widen every year? Or do we allow an element of cognitive dissonance for the greater good, so that the most vulnerable in our society can gain timely access to high-quality NHS care?
My passion for reducing health inequalities is greater than my adherence to any political ideal, so I may be open to a different way of doing things. After all, the outcome is the most important, and not necessarily how we get there.
The other option is to look on helplessly and wait for the access merry-go-round to stop once again at our door.
Dr Shaba Nabi is a GP trainer in Bristol. Read more of her blogs here