The vaccine triumph shows us how the NHS should be run ... for the good of its patients
A rousing call to arms from a leading A&E consultant
Just imagine that you’ve woken up in the middle of the night with chest pain. Not just a twinge or a niggle but a deep, agonising pain going up to your neck, making you sweaty, lightheaded and nauseous.
Knowing something is very wrong and that you need to get to hospital immediately, what’s on your mind at this very point?
My guess is that you care about how long it will take for an ambulance to blue-light you to hospital. You care about how long it will take to see the medical team for your diagnosis (a heart attack). You care about how long it will take to get the treatment you need (for your blocked coronary artery). Because, ultimately, what you care about is surviving and enjoying a good quality of life with your family.
Or are you thinking: ‘Oh, I wonder, how did the NHs commission the cardiac theatre staff? Does the local health authority pay for the hospital to do my kind of op via a block tariff or payment by results?’
Of course you aren’t. that’s because when you’re ill, the organisation of the health service is not your priority.
As an A&E doctor, it’s not the first thing on my mind, either. I care about what I can do to increase your chances of a long and healthy life. But, actually, the organisation of the NHs is key to everything.
Who ensured that the ambulance protocol is to take you to the hospital that has a specialist centre with the capability of managing heart attacks at 3am, even if it’s not the closest one to your home?
Who set up the systems so that there are consultants in A&E 24/7 — and who ensures there are staff and equipment able to unblock your artery?
It’s these decisions that will save your life, not just the doctors and nurses. Not all heroes wear capes; some wear stethoscopes and others use Excel spreadsheets. And how these managers manage the system is as key to your chances of survival as the A&E staff in front of you.
THE system is essentially working. Yet the politicians are now talking about more reform of the NHs — yes, now of all times. But rather than throw my hands up in despair, as I and so many medical professionals did with the last (disastrous) large-scale reform of the NHs, in 2012, this time I’m hopeful that lessons have been learnt and this round of reforms leads to improvements.
this is because reform is the right thing. If Covid has taught us anything, it’s that we can never go back to the way we used to do things. the NHs needs to change.
the current system is a red tape nightmare, with multiple organisations working in silos. Instead of joining forces and working for the good of patients, hospitals and GPs are forced to tender out their services, wasting millions of pounds on accountants and management consultants.
But there is potential that the proposed new reforms could get rid of this madness.
First, the proposals remove the requirement for any NHs body to put contracts out to competitive tender for providing everything from cancer care to mental health services. this would stop the NHs wasting billions on bureaucracy.
the new plan also creates integrated care systems that bring together different strands of the NHs, local health authorities and councils to work together in a joined-up way for the good of our patients, rather than competing with each other.
Currently, if an elderly patient with dementia develops an infection, falls and needs to go to hospital, they go from the care of the GP and community trust to the hospital trusts. they may need nursing care, daily measurement of oxygen levels and intravenous antibiotics, but not the specialist care of the hospital.
However, because there are different organisations involved, the care is ‘traditional’, i.e. the patient will stay in hospital until they hopefully get better and no longer need the intravenous antibiotics or as much nursing support. On a hospital ward for many more days than they need to be, the patient’s physical state declines from a lack of exercise, while psychologically and emotionally they’re suffering outside the comfort of their own home.
And, crucially, this also puts them at risk of hospital-acquired infections, and their chance of survival is lower.
ON A local level, managers have, thankfully, been ignoring the rules of the 2012 reforms and creating integration by the back door — for instance, discharging patients, then getting a therapist to assess their ongoing needs once they’re in their own home.
Covid has accelerated this innovation and shown why the reforms are needed now more than ever.
the 2012 changes were a disaster, not just because of the billions now spent on red tape. the emphasis on competition, that’s now being removed, was based on the Government’s idea that if you open the NHs up to competition, you drive up standards of care while driving down costs.
But looking after patients is not like selling socks: competition won’t help get all of the hospitals in your area to group together to provide the best possible attention for someone who needs specialist heart attack care at 3am as an emergency, for instance. there are still worries about the new reforms. First, they should involve integrating the health service completely; worryingly, last week’s Budget made no mention of our social care system.
the reforms hand more power to governments, which could be a good thing. take how we’ve led the world with Covid vaccination as the Government, hospitals, GPs, ambulance service and the Army came together to save our nation.
By centralising power, you can make nimble decisions bringing in the help of other parts of government.
But we don’t want to just hand over powers or to outside companies (as we have seen go so wrong with the procurement of PPE): we need legally-required transparency.
Finally, the big unknown about the new reforms is the key aspect of NHs care: funding and staff.
the ultimate test of these reforms is whether they help us in our job of providing better care. As a doctor, I hope they do. And as a patient, a parent and a son, I need them to do so.
dr rob Galloway’s book, In Stitches: The highs and Lows Of Being an a&E doctor (under the pseudonym dr Nick Edwards), is published by harperCollins, £5.99.