On a pathway to death: the NHS

Submitted by George Callaghan…

The National Health Service is in crisis – few doubt it. Over 50 000 nurses have left nursing in the past 10 years. That excludes retirements, deaths and those who are struck off. Several thousand doctors have also stopped practicising medicine. Waiting times are going up and the NHS struggles to stay within is budget.

You may say we have been here before. In the late 1990s the NHS was in a similar downward spiral. However, this time it is worse. In the 1990s the NHS was not haemorrhaging staff. To aggravate it even further the NHS is finding it increasingly difficult to recruit from overseas. Not long ago junior doctors went on strike. To cap it all cleaners have also taken industrial action. If you think that cleaners do not matter then think again. Would you like your surgery performed in a filthy ward? Unhygienic conditions kill. Think superbugs.

What are the problems of the NHS? Staff numbers, recruitment, funding, litigiousness, the ever-increasing demand on the NHS and pointless restructuring.

People often tell themselves that the NHS is the envy of the world. It seems decidedly thrasonical. In an election the parties outvie each other to eulogise the NHS. It is right to extoll the dedication and selflessness of NHS staff. The NHS is a many splendoured thing but it is imperfect. In some respects other health systems are better. France has the best health system in the world bar none. It hardly has waiting lists at all.

The National Health Service was founded in 1948. It was established pursuant to the Beveridge Report. Sir William Beveridge recommended a mixed public-private partnership. The Labour Government ushered into office in 1945 decided to go for an entirely publicly funded system. Private healthcare exists in parallel to the NHS but few people can afford to go private.

Margaret Thatcher was a capitalist ideologue but still a convinced believer in the NHS. She assured the public that the NHS was safe in her hands. Why was she at pains to offer cast iron guarantees on this issue? It seemed to fly in the face of her Monetarist economy theory. Boris Johnson has taken pains to reassure people that he is unreservedly committed to the NHS and any trade deal with the NHS would never compromised the integrity of the NHS.

Despite being a convinced Conservative the author of this article is obliged by rationality and fairness to acknowledge that Blair made the NHS immensely better. The NHS disimproved markedly under Cameron, May and Bo Jo. One of the few things that can be said in favour of Corbyn’s Labour is that it would ameliorate the NHS. Labour would throw the kitchen sink at the issue. If it sank the economy then so be it but Labour would fund the NHS liberally.

Private healthcare does not have to be extortionate and pernicious as it is in the United States. In the Republic of Ireland we have a partly private system. It is not ruinously expensive.

Staff

Who would work in the NHS? The salary is not commensurate with the difficulty of qualifying as a doctor or nurse. The staff are overworked and under resourced. They are harassed with targets and ever-changing regulations. They have to spend most of their time completing forms. These dedicated healthcare professionals wanted to heal. They did not come into the NHS to waste their time collating information that is no use to anyone. Like in all parts of the public sector the government has created a plethora of bullshit jobs. Bureaucrats have to justify their existence and fat salaries. So they created fatuous tasks to occupy others. These futile chores prevent people do their actual jobs. When you go to the GP you might notice she is looking at the computer half the time and typing things. It is not her fault. Doctors always made notes but note taking has become the main thrust of the job.

NHS staff are often verbally abused by patients. Many are spat at and even assaulted. One would expect this from mental patients. But ordinary patients sometimes behave appallingly. They also face being officially complained about even when the NHS staff have behaved responsibly. A doctor known to me loudly reprimanded a child for sitting on a sharps bin. The child was in potentially mortal danger. The doctor had to be abrupt and direct with the child for the child’s own safety. Despite this the woman was put through a lengthy and grueling investigation process before being exonerated. The excessive formality and detail of such investigations into trivialities is galling. The whole matter should have been dismissed summarily. Doctors and nurses can be accused of racism, sexism, homophobia etc…Even if my doctor is racist against me I do not care so long as I am cured. I do not choose to be treated only by someone who has attitudinal verisimilitude to me. Many of the accusations are bogus and vexatious.

Physicians can be struck off for light and transient reasons. A psychiatrist known to the author regularly self-medicated with cannabis and even cocaine. After a hard day managing someone else’s psychosis this doctor liked to unwind with a join. No harm was done to his patients. Yet had he been apprehended by an officer of the law with a single roach then this doctor would surely have been booted out of the profession. All those years of education that cost the taxpayer hundreds of thousands of pounds would have been down the drain. Should it cause us perturbation that he smoked cannabis occasionally? He would know how to manage his condition. As an expert on addiction said – a problem only becomes a problem when it becomes a problem. Drugs take a toll on mental and physical health. But they do not affect each individual to the same degree. It depends on how much he was consuming. Would I go to a doctor about a trifling issue if I knew he had smoke marijuana the night before? Yes, I would without a second’s hesitation. If a doctor was clearly addicted or used drugs at work then that would be another matter. With alcohol we recognize there is a spectrum with outright addicts on one end and outright abstainers on the other. Most people are in the middle. They have a manageable habit.

One should not rhapsodise about the NHS in days of yore. In bygone decades the medical professions was chiefly self-regulating. This gave us some Dr Bodkin Adams.

The United Kingdom is privileged to have so many splendid medical staff. People all too often take these doctors, nurses and others for granted. Whatever the public discontent with the NHS it is not the NHS staff whom the public gripe about. My experience of the NHS leads me to give most NHS staff 10/10. Having experienced healthcare in other countries leads me to appreciate the NHS personnel for their devotion to duty, professionalism, integrity and endeavour. But the UK cannot assume that it will stay like this forever. NHS staff need to receive the respect and the salary that they so richly merit.

Tax arrangements were reducing the pension pots of surgeons. Unsurprisingly surgeons chose not to do additional work. Thankfully the government has seen sense and made money available to rectify the situation. Surgeons have to be grown over decades. There is a very limited pool of people clever enough and devoted enough to qualify as surgeons in the first instance. These people are highly sought after in other countries and can easily secure lucrative word abroad. If the UK does not treat these highly mobile people with a great deal more consideration the country could easily lose surgeons each of whom it has cost millions of pounds to train.

Recruitment

Youngsters considering working in the NHS are thinking again. A brainy person can command a far higher salary, work shorter hours and be earning sooner in finance than as a doctor. It is true that a career in medicine should not be primarily motivated by lucre. The sort of talented young people who would have become doctors a generation ago are not doing so. The government is making it harder than ever to become a doctor and to stay one just at a time when fewer people want to be doctors.

India was once a huge reservoir of doctors for the UK. As India is becoming more prosperous fewer Indian doctors are minded to relocate to the United Kingdom. The same holds good in relation to other Commonwealth countries which traditionally sent many physicians to the British Isles.

Those who are doctors are subjected to constant reviews. They have to sit exams every few years. Sometimes the medical professions survived without these unduly onerous rules before. Doctors can be struck off for all sorts of reasons. It is ludicrous to strike them off for light or transient reasons. This could include deception or a criminal misdemeanor. Would I be willing to be treated by a physician who was caught possessing cannabis? I certainly would. In this case patients should be informed of what the doctor was convicted of. Patients should then be permitted to choose to be treated by this person or not.

Whatever happens in the United States crosses the Atlantic a few years later. The US became increasingly litigious in the 1960s. The United States has the highest per capita number of lawyers in the world. They need cases. So suing people became the national sport. Medical negligence cases made doctors overcautious. They also began to have to produce reams and reams of evidence for everything they did. People started to practice defensive medicine. This means doing things for a legal and not a medical rationale. Fewer Americans wanted to be physicians because of this. Doctors were sued ever more frequently. Insurance premiums against malpractice suits rose and drove up the cost of healthcare

The UK has caught this American disease. No one wants doctors to be reckless and the virtually never are. Medicine is the most regulated profession of all. Of course many regulations are sensible and proportionate. But it has reached the stage where the legal imperatives trump medical ones. A lawyer might tell you – where there’s a will: there’s a court case. So too with a hospital death where people sometimes unreasonably pursue claims for relatives who died in hospital decades after the event. This is part of the reason why the NHS has become preoccupied with documentation. Would you rather that a clinical professional is treating you or form filling?

The pressure on the NHS is burgeoning. Ironically the NHS is a victim of its own success. People are living ever longer. This greying population creates an ever-greater need for care especially gereontology. We are going to need an awful lot of hip replacements. Falling birth rates means we need proportionately less obstetric care and fewer midwives.

Some NHS care needs are self-inflicted. This applies to drug abuse in particular. To some extent this also applies to alcoholism, tobacco consumption, obesity and STDs. However, there are already hefty sin taxes on tobacco and alcohol. They fund the NHS. Drinkers and smokers are very publicly spirited. They voluntarily pay a lot of tax and die younger. They take a burden off the NHS.

To fund the NHS would should legalise drugs and allow tobacco advertising again. Smoking at 16 must be permitted on libertarian grounds. We can smoke out way out of the NHS crisis. Legalising drugs will lead to premature deaths. The people who die young from drug overdoses are generally speaking the sort of people whom one would wish to die young. After all heroin was invented by a British doctor in London.

It is highly questionable whether the prohibition of drugs reduces drugs deaths at all. Even if it does lower the number of fatalities from the recreational use of drugs then it is a philosophical issue as to whether or not drugs ought to be outlawed on the ground that so doing will reduce the death toll.

Paradoxically lowering taxation can increase revenue. A pack of cigarettes costs around £10 in the UK depending on the brand. About 80% of this is tax. If tax were lowered and more people could afford to smoke and the average smoker purchased significantly more tobacco then the revenue derived from this would increase. It would have the additional benefit of taking these people out of the pensions system and off the NHS sooner. You might think this is tongue in cheek but I am dead serious. The NHS should not be evangelical about puritanism. The moral authoritarianism that underpins this campaign is deeply distasteful. Curiously such puritanism is not applied to matters sexual.

Howard Marks made a very valid point. Mr. Nice said, ‘why die in perfect health?’ A body is there to be enjoyed. Few pleasures in life should be foregone for the sake of another couple of years in a nursing home.

People often say half the money spent on a person’s healthcare is spent in the last six weeks of that person’s life. Therefore, failing to scare people out of smoking will not say money. That six weeks could come at the age of 18 or 100 or indeed six weeks. Smokers typically die 12 years earlier than non-smokers having controlled for extraneous factors. Life expectancy is about 80 in the UK. Most people draw pensions at 67. If everyone smoked then everyone would die at 68 on average. The pensions system would be sustainable. At the moment paying for pensions is an intolerable strain on working age people. It is only going to get worse as up to 50% of youngsters do to ‘uni’ many of them in Mickey Mouse courses emerging semi-literate. As longevity is endlessly extended the pension system will face collapse. But if many people smoke it will not. Of course we shall not return to the 1950s when 80% of males smoked but the smoking rate could go up considerably from where it hovers at around 15%.

People always lament the NHS being starved of cash. There is much truth in this. Yet the NHS is sometimes profligate. It should not be squandering money on trying to persuade people to give up smoking. These smokers are doing the health service a favour.

What is the purpose of the NHS? It might seem that it should go without saying but it does not go without saying. The purpose of the NHS is to treat the ill and the injured. It is to provides healthcare more generally such as in pregnancy. You might say that promoting healthy lifestyles is part of its mission. But who does not know that smoking has a deleterious impact on one’s health? As Oscar Wilde said the consumption of alcohol produces all the symptoms of inebriation. The role of the NHS is not to evangelise for certain lifestyles. We all know that gay men are about 50 times more likely to contract HIV than straight men. Does the NHS go around counselling against homosexuality? Of course not. Can you imagine the outcry if it did? He corybantic tirades against such publicity would be deafening not matter how moderately phrased or how well grounded in medical science. It is true that the NHS encourages the use of condoms. The NHS does not preach against homosexuality because it would be politically incorrect to do so. For the avoidance of doubt: the author of this article does not oppose homosexuality at all and does not believe that the NHS should discourage people with this penchant from living the way they please. Gay relationships do not always involve anal sex and heterosexual relations sometimes do. It is rectal sex rather than homosexuality per se that carries a much higher risk of HIV transmission than vaginal sex. Heterosexual women face a much higher chance of picking up STDS than lesbians. But who has ever imagined that the NHS ought to denounce straight sex for women as injurious to their health?

The provision of pre-exposure prophylaxis (PREP) is contentious. On the one hand it reduces the chances of contracting HIV a hundredfold. Conversely, it discouraged the use of sheaths and therefore augments the risk of picking up other infections which can also be fatal. PREP is sometimes provided gratis.

The Government ought to pass laws to prevent frivolous and malicious lawsuits. The requirement for an excessive capturing of data in the NHS ought to be abolished. This would free staff to care for their patients. At the moment it is all about covering your backside by producing a paper trail. You must amass documentary evidence of following the procedure.

People value a relationship with a GP. She knows me and does not even need to look up the notes. But by closing local GPs’ clinic and consolidating them into a health centre this is lost. There may be efficiency savings but something else is thrown away.

The NHS wastes money on things it should not spend on. These include abortions, gender reassignment, cosmetic surgery and IVF.

It is odd isn’t it? In a hospital one department is creating babies that would not otherwise exist without officious intervention through IVF. Down the corridor the NHS is killing babies. If a couple are unable to have a baby through the natural method that is a pity for them. But if they wanted IVF or artificial insemination they ought to pay for it themselves. This is a lifestyle choice and an indulgence. It is not a disease to be cured. We cannot cope with the people we already have. We ought not be going out of our way to create more people.

Elective abortion is a highly contentious procedure at best. It can be accomplished with two pills sometimes. But as it is unnecessary and controversial perhaps people should have to pay for it if it is not prohibited. Some abortions are medically necessary such as in the case of an ectopic pregnancy or uterine cancer.

When it comes to elective termination of pregnancy it is as though there is no ethical aspect to it. How odd being values neutral does not apply to smoking for example. Smoking is a case of an adult choosing to do something unhealthy. That ought to be far less controversial than willfully and needlessly ending the life of another person.

Gender reassignment is also a tendentious procedure. The NHS says it is more cost effective than therapy. Why should the public pay for this? How is it that people with a transgender identity coped for millions of years? All of a sudden they could not get by without surgery.

Plastic surgery is sometimes available on the NHS. Unless someone has been horrifically scarred or suffered a birth defect this should not be publicly funded.

Cancer patients do not always get life sustaining drugs.  If money were not wasted on profligate schemes there would be enough money to pay for such drugs.

The government is scrapping parking fees at hospitals. If we want to save the planet then we ought to charge people and use the money for public transport and or the NHS.

The NHS can defray costs in other ways such as by charging people cost price for food, water and electricity. The patients would have to pay this at home. Low incomes patients, pensioners and those on certain benefits could be excluded from these charges.

The NHS could be more pro-active about pursuing costs from people who are not entitled to NHS care. By all means treat them and worry about the costs later. But those who do not have the right to care free of charge ought to be pressured and legally pursued until they cough up. There is sometimes health tourism. People know that the NHS is lax about collecting payment. Incidentally, legal immigrants should get care free of charge as they currently do. Proposals to the contrary are unfair and illogical.

Re-structuring

Every few years the NHS undergoes upheaval just for the sake of it. Some bright spark of a politician will want to rebrand things. It is maddening and a distraction from the NHS’s mission.

You might find that when you speak to your GP she is looking at the computer half the time. It is not the physician’s fault. Jobsworths are on at her to produces reams of paperwork which are of no use to anyone. The self-justificatory rationale is that this bureaucracy is vital for the smooth running of the NHS. Being the third largest employer on the planet the NHS needs administering. No one doubts that. There has to be some form filling – always was and ever shall be. But the tail wags the dog as in most aspects of the public sector.

The NHS can be returned to it erstwhile glory. It faces numerous problems. Yet none of them are insuperably difficulty. There is a way. But is there a will?