Is it a NHS crisis or normal service?
The only surprise in Theresa May’s apology for the postponement of thousands of routine surgical admissions because of the NHS winter crisis was that she did not get dressed up in surgical scrubs on her visit to Frimley Park Hospital in Surrey to make it. Ever since Aneurin Bevan, the founder of the NHS, declared that “the sound of a dropped bedpan in Tredegar Hospital would reverberate around the Palace of Westminster”, there has been an element of the theatrical in politicians’ responses to the perennial crises of the system.
It is not clear why the notparticularly-severe winter weather has provoked such a crisis – or indeed whether the current crisis is much different from normal service. But the NHS has become so centralised and so politicised, and so much the focus of sensational media scrutiny, that drastic measures have to be taken, requiring abject apology from both the Health Secretary and the Prime Minister.
Panic measures from the Government have provoked predictable cries of outrage from the self-appointed custodians of the legacy of Bevan in the Labour Party, which did so much in the Blair years to promote privatisation for which it now excoriates the Conservatives. Shroud-waving medics are readily available for interview, demanding ever-higher levels of spending for a hospital system that offers patients very variable experiences.
Television reports from A&E reveal scenes of chaos: the sight of doctors and nurses rushing around in what appears to be a highly inefficient manner recalls the famous observation of Roy Griffiths, brought in from Sainsbury’s in 1983 by Margaret Thatcher to advise on improving the management of the NHS: “If Florence Nightingale were carrying her lamp through the corridors of the NHS today, she would almost certainly be searching for the people in charge.”
Rehab unease
Recent reports have exposed the scandal of referral agents, who secure substantial fees from private drug rehabilitation clinics after attracting clients through helplines advertised on websites heavily promoted through Google searches. Agents pay Google up to £250 per click, and reclaim around 30per cent of monthly clinic fees of around £30,000 when clients enter rehab.
While there are calls to make such “patient-brokering” illegal in the UK (as it is in the US), few question whether residential rehab is an effective treatment for addiction. In 2011, a medical family reported their son’s experience of such clinics, complaining of “worrying absences of an evidence base, qualified staff, ethical standards and ongoing support – and an even more worrying tendency to concentrate more on securing fees than on achieving success in overcoming these life-threatening conditions”. Last November, the Care Quality Commission reported “serious concerns” arising from its inspections of 68 private clinics: two thirds were not providing “safe care and treatment”.
Residential rehab is the extreme manifestation of the denial of agency at the heart of addiction. In the wise words of Renton in Trainspotting, Irvine Welsh’s novel of drug abuse in Scotland, “rehabilitation is s---e; sometimes ah think ah’d rather be banged up. Rehabilitation means the surrender ay the self.”
Have times changed?
Our local tribune of the British Medical Association, Dr Andrew Barton, writes to offer “an off-therecord chat” to doctors who “could be in a vulnerable position when it comes to sexual harassment from a superior”. Dr Barton offers a link to a blog by Dr Hannah Barham-brown, deputy chair of the BMA’S junior doctors’ committee, who believes, despite the lack of any evidence, that “it would be naive bordering on negligent to deny that sexual harassment exists in the medical profession in the UK”.
Last summer, BMJ editor Fiona Godlee celebrated “the ascent of woman” in medicine in a photograph including the female presidents of all eight royal medical colleges and several other prominent female medical leaders; apologies were offered for the absence of the (female) chief medical officers for England and Scotland, and the recently retired (female) CMO for Wales. The current issue of Frontline, the Royal College of General Practitioners magazine, presents, under the headline “Historic Times”, a photo of the college chairs in each of the four regions of the UK, together with chairs of committees of trainees and newly qualified GPS: all women.
Parallel universes?