Nurses for Reform Blog

Yesterday I had an article published in the Daily Telegraph, discussing the future of the NHS and how NFR believes the process towards achieving better healthcare for the UK population should be started.

To read to complete article click here.

I also urge you to take time to read the comments.  It is amazing not only how people interpret what I have said differently but also how people have completely different expectations of what the NHS should be and do.

There has been a lot of publicity recently about the poor care given to patients by Mid-Staffordshire NHS Trust

It has been found that patients were routinely neglected, left to die and “cared” for in appalling conditions.  For me though, one of the interesting and appalling things about this is that in all of the media reports I have listened to I heard few genuine apologies.  In the main hospital managers, so-called nursing leaders such as Dr Peter Carter the General Secretary of the Royal College of Nursing and various Politicians have all been rushing to shift the blame on to each other.  I have heard no one come up with any long-term plans to improve the situation and to stop patients from dying at the hands of the NHS.

One thing that NFR believes should not happen is a rush of new target driven reforms, it is time that the Government realised that all targets do is to pull resources away from patient care and in to the administration of reports to the Department of Health.

Radical reform is needed across the NHS it is time that the Government had less involvement not more in the delivery of patient treatment and care.  As a start, Mid-Staffordshire, and indeed all other failing NHS Trusts, must be given over to new management, ideally from the private sector as has happened here.  If hospitals or trusts continue to fail their patients they must expect to be closed or taken over by new management.

It is time that we stopped tolerating this NHS that is failing in its duty time and time again.

Ladies and Gentlemen, in 1948 the British government put a leaflet through the door of every household. It said, in black and white, that: “the NHS will provide you with all medical, dental and nursing care. Everyone – rich or poor – can use it.”

Today, we live in a country where our political class is seemingly proud of the target that: “the longest you should wait after being referred by your GP until you start your treatment is 18 weeks”. More than 4 months. There is even a web site called:

www.18 weeks.nhs.uk !

Today, there are tens of thousands of people trying to get onto these waiting lists. Many are delayed so that the official 18 week clock does not start to tick.

According to Professor Julian LeGrand of the LSE, people from professional and managerial backgrounds access – on average – more than 40% more NHS resources per illness episode than those in lower social groupings. Today, 1 in 10 people in NHS hospitals pick up infections and illnesses that they did not have prior to being admitted. Over the last five years, more than 30,000 people have died from Healthcare Acquired Infections related to NHS care.

Indeed, things are now so bad in our state health service, that even basic nutrition has become an issue. According to the National Patients Safety Agency, NHS malnutrition incidents rose from 15,473 in 2005 to 29,138 in 2007. Overall, during this period, almost 70,000 NHS malnutrition and starvation “patient incidents” were reported.

Today, as students at this fine university, you are residing in a country that is a long way from the politicians’ promises of 1948. You are now in a country were where some 7 million people have private medical insurance. Where 6 million people have private health cash plans – many of them are members of trade unions. This year, 8 million will pay towards private complementary treatments. And many, many, tens of thousands of others will chose to self-fund for private surgery and treatment.

More than a quarter of all people in nursing and residential care homes now pay privately. Spectacles went private back in the 1980s. Dentistry is now going – as many of you will know – the same way.

Today, in 2010, the NHS is not doing all medical, dental and nursing care. Far from it.

Sometimes, the NHS does get things right. But, all too often, it does things badly. As my good friend Dr. Eamonn Butler put it a few years back:

““If a privatized health service had made many of its patients wait for 18 months for their operations, put them on trolleys in corridors when they arrived, given more than a quarter of them an illness which they did not have when they arrived, and confiscated the organs of their dead babies without bothering to seek their permission, or even to tell them, people would have blamed privatization. For that matter, if one of its practitioners had murdered 150 of his patients, or one of its surgeons had removed healthy kidneys instead of diseased ones, or one of its teams had conducted smear tests so incompetently that operable disease was not treated, while healthy women were unnecessarily subjected to distressing operations, all this would somehow have been put down to the reckless pursuit of profits, or to putting shareholders ahead of patients.

Now, given the side of the debate I am on this evening, I wish I could tell you that America has got it right. It has not. I wish I could tell you that America is a genuine free market system. But it is not. Instead, away from all the propaganda and all the statements of those greedy vote-motivated politicians, America has much more of a mixed economy than most on this side of the pond realise.

Today, the US taxpayer spends a fortune on its Federal healthcare programs: Medicare, Medicaid and S-Chip. Who do you think has the larger budget? The Pentagon; or US government healthcare programs? The Answer, is US government healthcare.

I ask you: historically, which government do you think has spent a greater proportion of its GDP on its government healthcare programs: Britain or America? Well, averaging the last thirty years, the answer is America.

We hear a lot in Britain about the poor in America. We hear a lot about the 45 million uninsured. But who are they? 17m of the 45m live in households with incomes above $50,000. That is 38% of the uninsured in America. 9 million – or 20% of the uninsured – live in households bringing in more than $75,000 a year. And then there are the young-invincibles. These are the 18m Americans aged between 18 and 34 who chose to spend 4 times as much on alcohol, tobacco, entertainment and dining out, than they do on out of pocket spending on healthcare. They represent 40% of the uninsured in America.

Today, US federal law dictates that American hospitals have to treat – irrespective of ability or willingness to pay – anyone who comes within 250 yards of their Accident and Emergency department. That, my friends, is why so many Americans don’t bother with insurance. Many know that the government will already be there for them.

Now, there are probably 9 million people in America who are genuinely outside the system. But they refuse assistance and help from all sectors: be it public, private or charitable. We have those people here too: the homeless, the dispossessed, the mentally ill. For whatever reason, they want to operate on the edge of the mainstream and tonight they will probably be looked after by the Salvation Army or a myriad other good people in the independent charitable sector.

I could have talked tonight about how an American cannot buy insurance from another state. Or how the government skews the whole US insurance system so it rests with employers. I could have talked about the need for tort law reform. But, I don’t have the time to touch on these matters.

Instead, I simply want you to understand the size of US government intervention in healthcare, and to understand that like our own system, it has precious little to do with a free market.

However, I still believe that the US system is generally, better than ours in the UK. Overall it provides better rounded, more timely care for patients of all backgrounds.  This not only means that in America patients have better access to the most up to date medicines, medical and surgical procedures. It also means that if they need a hip replacement or cardiac surgery they are not left for months, or years waiting in pain or unable to leave their homes, as happens in the UK.

Indeed, I believe both systems would be better if they were more open, diverse and competitive. In short, if they were more free market.

I am not a politician. I am not an eminent medical doctor. I am a nurse. I have worked in and around the NHS for more than 25 years. And my concern his high quality patient care.

Away from Westminster, the Royal College of Surgeons and all the other vested interests, it is people like me, day and night, at ward level, who know and can talk about, the harsh realities of the NHS.

What I know, is that in this country today, most families have a horror story about the care, they or a loved one, has received in the NHS. Today, I know people find it difficult to get GP appointments. People are not able to register with NHS dentists. Increasingly, they are not always able to get the ambulances they need… When they do get one, they sometimes wait outside accident and emergency departments because the hospitals are full. If they were let in, the hospital would fall fowl of government targets on length of wait.

More than 4 months waits to get treatment? MS patients denied Beta Interferon? Patients with Kidney Cancer unable to get drugs that could prolong their lives? Women with Breast cancer not able to get Herceptin? 1 in 10 patients picking up healthcare acquired infections? 30,000 dead in 5 years? 70,000 malnourished or starved? All this, on this little Island?

You take it from me; someone who really knows;  someone who cares, on the frontline; tonight you would rather be unwell in America than here in our nationalized, vote-motivated, health system.

Thank you.

Following this post the Daily Mirror published this rather good article:  Apart from making the mistake that NFR is in anyway allied to the Tories (that is offensive!), it helps to get some important history out in the public domain. Intellectually, the NHS and the welfare-warfare state does have some unsavory roots that no one should deny.

Indeed, there have been two recent comments posted on this blog that are so good I have decided to reproduce them here. Here is number one;

“The history behind the NHS and the eugenics movement does have common elements, to pretend otherwise is to live in a fantasy world.

Specifically, it was the beginning of national health statistics in the late 19th century that led to the moral panic of “degeneracy”,which came from the combination of Darwinian ideas applied to social sciences, and the emergence of medical data about the health of working class people.

One part of this panic was to promote the idea of deliberately removing “undesirables”, a process begun in the USA in the early part of the 20th century, but applied most horrifically in Nazi occupied countries from 1933 onwards.

But the other, whilst less violent, had the same objective: the national improvement of collective healthcare. The Fabians originally believed that the “feeble minded” should be institutionalized (given electro-shock therapy), homosexuality was considered “a mental illness” and state control of hospitals became an ideological programme.

This is why Nazi Germany was the first European country to adopt major campaigns against smoking, and why the various prohibitionist movements were strong in late 19th-early 20th century USA and UK.

What part of the NHS’ rationing of healthcare to deny treatment for old people, or smokers, or the obese, do the commentators above think Hitler would object to? I can think of none. As for the smoking ban in pubs: no fascist dictator would have dared introduced such a thing, but Hitler, would certainly approve.

As for A Davidson, I would merely point out, that it seems wise to ask if the reasons for Hitler’s support for socialized healthcare (which you admit) are bad, shouldn’t we consider them? If Hitler was right to think that socilized medicine would advance racialist policies, are we wrong to make sure this does not happen?

One last thought. Harold Shipman. Clearly, this was an extreme individual, but his attitude towards patients was entirely logical, once one accepted the notion that it is not the patient to control healthcare provision or objectives.”

Now, for those of you interested in the burgeoning literature and research into this history – much of it written by socialist writers – see comment number two:

“Even those who like the NHS have to accept that it does have some very strange intellectual underpinnings.

It is curious how the existence of an alliance of statist Toryism and Socialism has fallen out of any popular consciousness. One of the few studies can be found in Semmel, B., (1960) Imperialism and State Reform: English Social-Imperial Thought, 1895-1914, Harvard University Press, Cambridge M.A. There is a growing literature on eugenics, ‘right wing’ (that is, anti-capitalist and anti-liberal) social Darwinism and paternalism. See: Searle, G. R, (1971) The Quest for National Efficiency, Oxford Universisty Press, Oxford and (1986) Social Hygiene in Twentieth Century Britain, Croom Helm, London. Soloway, R. A., (1990) Demography and Degeneration: Eugenics and the Declining Birthrate in Twentieth Century Britain, University of North Carolina Press, Chapel Hill. Some socialist scholars are also beginning to reconsider the origins and nature of the rise of the welfare state in light of such evidence. See: Skocpol, T., (1992) Protecting Soldiers and Mothers: The Political Origins of Social Policy in the United States, Belknap Press/Harvard University Press, Cambridge M.A. Jamieson, L., and Corr, H., (eds) (1990) State, Private Life and Political Change, Macmillan, London. Dwork, D., (1987) War is Good For Babies and Other Young Children, Tavistock Publications, London.

Under analysis, the origins of the welfare state looks less like the pure juice of human kindness and altruism, a liberation of the masses, and increasingly more like authoritarian social engineering for the sake of national strength, war or racial hygiene.”

Yesterday I was told something very strange. If it is true, then it is quite a coup. But so far, I simply don’t know.

Did you happen to notice that this Christmas there were fewer government drink driving adds on the television? I don’t always watch a lot of TV and I honestly don’t know about this. But, apparently, having written this and this I am advised that the government decided to do less preaching this Christmas.

Was it NFR? Was it that there is an election coming up and politicians don’t want to appear to be too nanny-ish? Were there really fewer drink driving adds on the box? I simply don’t know. You tell me. Is this true?

I was reminded of this quote again the other day. It is from Dr. Madsen Pirie and Dr. Eamonn Butlers’ report ‘The New Shape of Public Services’

“If a privatized health service had made many of its patients wait for 18 months for their operations, put them on trolleys in corridors when they arrived, given more than a quarter of them an illness which they did not have when they arrived, and confiscated the organs of their dead babies without bothering to seek their permission, or even to tell them, people would have blamed privatization. For that matter, if one of its practitioners had murdered 150 of his patients, or one of its surgeons had removed healthy kidneys instead of diseased ones, or one of its teams had conducted smear tests so incompetently that operable disease was not treated, while healthy women were unnecessarily subjected to distressing operations, all this would somehow have been put down to the reckless pursuit of profits, or to putting shareholders ahead of patients”.

Even the fiercest critic of the NHS would have thought that the system could manage to teach doctors to prescribe medicines safely.  Apparently not according to new research from the British Pharmacological Society.  This study has found that not only is the training so inadequate that medical students only fill in a hand full of prescriptions, but when they qualify up to 10% of the prescriptions that write are incorrect and potentially life threatening.  You really could not make this up!

The National Institute for Health and Clinical Excellence known as NICE has yet again let down patients who desperately need medicines that will improve both quality and length of life.  This time it is women with the bone disease osteoporosis that have fallen foul of this Government agency’s dubious decision making process.

It is now becoming apparent to  British people, as it will to Americans as Comparative Effectiveness starts to withhold treatment, that NICE eventually turns NASTY – Not Available So Treat Yourself!

This story about filthy and dangerous NHS hospitals has really gained momentum over the weekend. What is really bad news for the government is that not only is this is not a one off rogue trust, but that many of our hospitals are in this state and the problem has only been accurately identified by the private sector in the form of Dr Foster.  

For me it is not surprising that the Care Quality Commission (CQC) managed to rate many of these Trusts as “good” and then for Dr Foster to obtain more accurate results.  I have recently been in discussion with a number of colleagues about the CQC and the general opinion of them is that they are disorganised, incoherent and generally do not have a clue what they are doing.  In fact when some nurses that I know asked them for an opinion they were unable to give any helpful or coherent advice.

I am sure that this story and the others like it that will follow will bring calls from interest groups for more regulation.  This is the wrong way to solve this problem.  There are two courses of action that must now be taken as a matter of urgency.

First, the NHS has shown that it is now failing to provide clean, safe care with monotonous regularity.  All healthcare provision in the UK must be returned to the independent sector as a matter of urgency.

Second, the CQC has demonstrated that it is incapable of making accurate assessments of the state of our hospitals so why not abolish it immediately and let the public rely on more respected and reliable brands such as Dr Foster and Which to inform then of the true state of healthcare provision.

The only way forward is for less regulation from government and more market forces and self regulation.

Here are two stories that should make the Government and the NHS hang their heads in shame.  Despite the billions of pounds that have been poured in to the NHS under New Labour some of the most vulnerable members of society are being failed time and time again.  Not only do half of Alzheimer’s patients leave NHS hospitals in a worse state than they entered them but care in NHS hospitals for them is so bad that a third of their carers have to complain and a greater number think that they should have.

Surely we have seen enough of these horror stories for even the most die-hard NHS supporter to realise that the system is failing.  With the cuts in public spending that are inevitably coming our way there is an historic opportunity to put things right.  It is too late for the Government, who I am sure will make some empty promises in today’s Queen’s Speech, but the Conservative party must take notice of the suffering reported in these all too frequent stories.  It is time for the NHS to stop subjecting people to this substandard care.  All NHS hospitals must be returned to the independent sector where the language of price drives quality of care.  The NHS has had sixty years to try to prove its worth.  It has failed continually, now it is time for the market to demonstrate its superior qualities.