Thanks to the NHS my 14-month-old son is alive and thriving. It could have been so different. Last July my wife, then 39 weeks pregnant, and I went to our local hospital because she’d noticed the baby had been moving less.
I was extremely anxious – no longer the A&E consultant, but a panicked dad.
While the midwife carried out a specialist test to listen to our baby’s heartbeat, I saw that sudden change in facial expression I know too well: focus combined with anxiety because of a serious medical problem.
I listened as she calmly phoned the obstetrician, who arrived within minutes and told us that my wife needed a caesarean because the baby’s heart rate was falling and he wouldn’t survive without an operation.
I was just asking how long it would be before they could do the operation, when I heard the alarms that the emergency obstetric team were carrying, informing everyone from the anaesthetist to neonatologist (an expert in newborn babies) to come to theatre now for the operation.
I was a terrified wreck in the corner. But an hour later, I had a healthy baby held in one arm, the hand of my healthy and happy wife in the other.
Thanks to the NHS my 14-month-old son is alive and thriving. It could have been so different (file photo)
I’ve loved working for the NHS ever since starting at medical school at St George’s Hospital in Tooting, South London, in 1995, and I’m proud to have worked continuously for the service for all those years. But it’s only as a patient or the relative of one that you really appreciate it.
My son is only here today because of the skills and expertise of the clinical staff; the administrators ensuring that the staff needed were on duty; the managers ensuring that the staff were well trained and that the theatre had been built and equipped – and ultimately because of all of us, as taxpayers, funding the NHS.
When the NHS was created in 1948, every household received a letter explaining: ‘It will provide you with all medical, dental and nursing care. Everyone – rich or poor, man, woman or child can use any part of it… There are no insurance qualifications.
‘But it is not a charity: you are all paying for it, mainly as taxpayers, and it will relieve your money worries in time of illness.’
On July 5, 1948, the keys to Park Hospital in Trafford, Manchester, were symbolically handed over by Lancashire County Council to Aneurin Bevan, who took them on behalf of the country as a proxy for the whole health service – the first NHS hospital.
The first patient through the doors was 13-year-old Sylvia Beckingham, who had a serious liver condition. She was from a working-class background and her family couldn’t afford the intravenous fluids she needed: without the NHS she would have died.
With it, she survived and went on to live a wonderful life, working as a teacher.
The NHS grew into an amazing healthcare system.
Indeed in 2014 the Commonwealth Fund, an international health research group based in the U.S, compared the healthcare systems of the U.S., France, Germany, Sweden, Canada, the Netherlands, Australia, Switzerland, Norway and the UK – and the NHS ranked first overall on quality, access and efficiency (despite spending on healthcare in the UK being the second-lowest amount per head).
But I look at what’s happening to the NHS now and I am in despair. A&E, where I work, is like the canary in the NHS coal mine. Last month, the Royal College of Emergency Medicine (RCEM) revealed that between April 2022 and March 2023, nearly 400,000 people who went to A&E in England faced delays of 24 hours or longer.
More recent data showed that in September, 123,870 people waited over 12 hours in A&E – that’s one in 11 who went there. This is not just a number to be used on a graph or as a political football: this is your relative, lying on a trolley in a corridor waiting to get a bed. It’s not just degrading, it’s affecting your loved ones’ chances of survival.
In the seven months from the start of this year to July, figures show that 12,000 patients in our hospitals died unnecessarily because of excessive waits in A&E. That’s 300 to 500 a week – two plane loads of patients dying each week.
As readers know all too well, it’s not just emergency care: waiting lists have never been greater, and for the first time since the NHS was formed, life expectancy has begun to fall, by 1.3 years in men and one year in women in 2020 compared with 2019, a trend that began before Covid.
Nurses at Newcastle’s Royal Victoria Infirmary RVI hospital form a picket line on the first day of NHS strikes across the country last December
For those of us working in the NHS, it can often feel like a daily deckchair rearrangement on the NHS Titanic, whatever political party is running the health service and whether it’s in England, Wales, Northern Ireland or Scotland. Over the years, we’ve heard plenty of ‘new’ ideas to solve the problems – and the usual headlines about transforming our NHS from the party conferences.
But it will end up being little more than just tinkering around the edges.
As someone who loves the NHS, who lives and breathes it, I know it needs radical reform – otherwise it won’t survive. I’m not talking about givens, such as we need more staff, but real changes to save the NHS.
1. Everyone needs a named GP
A named GP who looks after you, with continuity of care, is the key to the future survival of the health service. Study after study shows that having that continuity of care provides better – also cheaper – care, with fewer investigations performed and lower levels of hospital admission (because the GP knows their patient, and is essentially better at making decisions about their care).
2. Hospitals need more beds
Long waits in A&E happen because elderly and vulnerable patients who need hospital beds can’t get them when needed, and spend long hours in corridors. This is utterly shameful and it’s because we have too few beds.
And many of those we do have are occupied by patients waiting to go home but who can’t because of a lack of care in the community. The average number of beds per 1,000 people in EU nations is five. The UK has just 2.4; Germany has 7.8.
3. And more mental health beds
Mental health care needs to be prioritised as much as medical care. Both are under-resourced but I suspect many people don’t know that the lack of beds and community care for mental health patients creates huge pressure on the ambulance services and A&E.
Patients can be in an A&E cubicle for up to three weeks waiting for a mental health bed. This is difficult for staff and other patients; it’s also horrific for the patient having a mental health crisis, who is receiving inadequate care for their condition in the completely wrong environment.
4. A wrist monitor for every patient
Everyone talks about the promise of artificial intelligence to solve the health crisis. But if you ask most NHS staff what they want from technology, they would just want their computer to load up in less than 20 minutes; to be able to get hold of a colleague without using an outdated 1980s paging system – and to not have to print off an X-ray form to then scan it onto a different system.
In addition, there are so many great innovative ideas that could transform our health service but which aren’t being rolled out. An example of one piece of high-tech that could really make a difference now is a portable wrist monitor – giving patients one of these on admission (whether that’s to A&E or on a ward) will provide real-time readings of their blood pressure, blood oxygen levels and heart rate.
Subtle changes in these are the first sign of a patient deteriorating with conditions such as sepsis. The technology can improve care by highlighting the problems earlier while also freeing up nurses from having to do these checks. This technology is being used in Nijmegen in the Netherlands, for example, but rarely in the NHS. Blame inertia and red tape.
5. Cut back on testing
To patients, this may seem wrong, but the fact is, that even in a stretched NHS we end up giving people too many tests, and overtreating them, often with drugs they don’t need – but which can have side-effects. Partly it’s because doctors fear being complained about and being sued, a culture inherited from the U.S..
But it’s also because we’re losing significant numbers of highly experienced senior decision-makers such as GPs. They’re burnt out, taking early retirement, going part time, moving abroad to work, or quitting health care altogether. We need to fix the senior workforce so we can fix our patients.
Ambulance teams work in the Accident and Emergency zone of St Thomas’ Hospital on December 19, 2022 in London
Yet currently, everything is about ‘recruitment’ and not retention: experienced doctors are being replaced by more junior staff who have enormous promise but clearly don’t have the training and expertise to be good at making the more complex and in some ways risky decisions of when not to investigate and treat.
Recently I saw a patient in her 90s, a nursing home resident who was dehydrated because she’d stopped drinking. Essentially, she was dying, and with her family we decided against tests or medical treatments but to give her palliative care. However, on the ward, a junior doctor felt uncomfortable and ordered a battery of blood tests.
As you’d expect the results were off the wall and the doctor treated these numbers, but not her: so he prolonged her life and her agony – and that of her family. This is not about life-and-death decisions, this is about everyday decisions that require skills and experience.
6. Turn into a 24/7 service
Medical services are often designed around a 9-5, Monday to Friday working week. This must change so that the same quality of care is provided 24/7, using equipment and theatre space seven days and evenings a week. This will clear the backlog much quicker and cheaper than any private provider.
7. NHS staff need more than clapping
In trauma cases, to save a patient’s life, we need to stop the bleeding rather than just give blood. That’s true for the NHS, too. Staff retention is what will save it, that means keeping experienced staff of all types – not just GPs but everyone from nurses to radiographers, physiotherapists and hospital consultants.
Retention requires a real cultural change, from sorting out the pay issues, to how we support our staff. For example, at night, often the only available food is unhealthy snacks from a vending machine. It’s a small example but it adds to the sense that staff don’t feel looked after.
We must also encourage and retain trainees. Politicians of all hues are offering more medical school places: yes, that matters, but if we’re training doctors just to work in Australia or to quit after a year or two, it’s a waste of money.
8. Bring in more flexible working
We need more flexible working – that’s how modern workforces function these days – without it we’re not going to have a 24/7 service we need (see point 6). This includes getting a grip when talking about female doctors.
The biological fact is women have babies, and often want jobs that work around this, i.e. flexibly. Some shamefully argue that such women cause problems as they take up medical school places and then ‘go part time’. This is the talk of dinosaurs. We need to plan for female staff (men want a better work-life balance, too).
9. Teach doctors diet and exercise
Most patients become ill due to preventable problems arising from poor diet, lack of exercise, smoking, etc. There needs to be a real effort to prevent the problems, not react to them.
This is essential to save the NHS. Helping people see what diet and exercise can do – in terms of prevention and treatment – is a societal issue, but in terms of the NHS, one key step is better training at medical school.
10. Put an end to the culture of fear
Too often hospital staff feel afraid to challenge and speak out – and this can lead to patients being harmed. Airlines had the same problem in the 1960s and 1970s when air crashes were more common: they changed their culture and transformed travel. The NHS needs the same transformation.
P.S. make politicians use the NHS
Ok, this could never be enforced, but imagine if politicians weren’t allowed to go private: it might just focus their minds on ensuring there’s a service good enough for everyone.
My biggest worry is that politicians won’t want to face up to these difficult problems and will kid themselves – and us – that a bit more tinkering will solve the issue. It won’t.
