Thursday, December 07, 2006

The NHS is dying.

I have been forced today by circumstances to do a serious post about the state of the NHS in this country. Quite recently I turned to the dark side, leaving frontline medicine for medical management.
My motivations for doing this were many but chief amongst them was the desire to make a difference to the service which I considered was being mismanaged.
I am becoming disillusioned. It has become increasingly clear to me that this government has no desire for a better, more efficient service. They want rid of the service, period. Various initiatives which I, to my shame, have been involved in implementing, are destroying the psychological contract between doctors and their employers at the Department of Health.
Today on the radio I was listening to the comments made by General Mike Jackson with regard to the army, see here. Now I am no fan of the army, or of General Jackson in particular, but some of his comments regarding the ethos of soldiering and the trust between a population and its armed forces struck home. It would be easy to replace the word army with the word medicine.
In my younger days I worked 140 hour weeks for a service I believed was doing good. For the most part health professionals were left to make decisions regarding the resources they required to do the job properly. They had the respect of the government and the public. In return they worked long hours and had a real pride in what they were doing. This is no longer the case. Resourcing decisions are in the hands of management consultants, frontline clinicians are given targets and protocols without the means to deliver them. Respect from the public is decreasing and their confidence in the service is at an all time low.
It is my belief that the government's unspoken agenda is to bring down the NHS and contract health services from competing multi-national health providers. They will do this by continuing to undermine the service by setting business-style peformance targets without consultation with those delivering those targets. Clinicians are leaving the service, medical education is a mess and getting worse. I am afraid that when I am old and vulnerable there will be no NHS to look after me. I have tried to influence this process from the inside but I have failed to make any impact. Where this leaves me personally is my concern but the rest of you should be very afraid, very afraid.


the whales said...

Good post, realdoc. At the risk of undermining bloggers:- don't leave this as a blog. Get this into newspapers and do so with the support of others.

I'm finding myself (late thirties, ex-industry and ex-UCL lecturer and now a newly qualified teacher) distressed at education. I'm unclear how to make my voice as loud as possible.

I suspect the parallel you've mentioned between the military and public health applies also to education and to law and order. Fundamental stuff for society, and it's all being very badly eroded.

Please don't leave this as a post on your blog. Get the support of others, try to find a way to make it loud and please kick up a fuss.

If only i knew how i'd say so!...

Good luck

Tattieheid said...

Your concerns are mirrored by a number of "medical" bloggers and many users of the NHS, not to mention a large number of silent but caring workers within the NHS.

I am afraid.

Trouble is I think the damage may already be irreparable. That makes me even more concerned for the generations coming up behind me.

Whales is right, you and others need to find a way to speak out, while there are still enough of us left (that remember the NHS when it was something to be proud of) to stand up and support you.

Mangonel said...

I am terrified, honestly. I can't tell you how proud I have been to be part of a country that decided its citizens' health was a priority so high. And now its all going to hell in a handbasket.

I guess its a money thing (do we blame the Tories for their infamous tax cuts?)?

How about you putting together some words, based on your post, that the UK bloggers can circulate and print and send to their MPs? With a link to the site that tells you how to find who they are? I suspect post is harder to ignore than email. How does one track such a virus?

Tim Footman said...

Our only hope is that the ghosts of Nye Bevan and Clem Attlee appear to Blair this Christmas and kick the little toerag's smarmy face in. As a warning to Brown to pull his prudent finger out.

patroclus said...

Great post realdoc. The NHS is one of the things that makes me most proud to be British, but it is clearly falling apart (even though I haven't actually been anywhere near it for about four years now - hm, maybe I should see a GP once in a while).

Tim - quite, do you think that Nye Bevan and Clem Attlee would even recognise Blair as being in the same party?

Whales - my mum and dad, both teachers, left the UK 15 years ago in despair at education going to the dogs (too much bureaucracy, not enough time in the classroom) - and that was under a Tory government.

Dave said...

As a consumer of its services, I am indeed afraid.

chatterbox said...

What is the solution though?

As someone who works in, and despairs of the further, adult and higher education system, I was seconded six months ago to the NHS, and I am brought to similar despair by what I have found there.

As someone who is trying to raise standards at the bottom of the Health service though, I equally despair of the health professionals who seem to have a policy of non-co-operation towards anything that doesn't directly benefit their own area. Clearly this is as a result of the pressures they are under, and the anger they feel towards management and government, but where can you start if there is no solidarity amongst the workers all suffering under the same regime, and there is no trust of any initiatives because of past experiences?

So, given the mess we are in, what would you do?

Anonymous said...

During last Summer I worked for the NHS (as agency) co-ordinating the training of three entire PCT's to use the new fangled Oracle finance system at a proto-type hospital. The expense of this was phenomenal, and so disorganised it was unbelievable. There was no project manager.

However that is a minor gripe, in what seemed to be a larger issue. I now work in a University and use the Oracle system for data-basing student profiles. I was recently contacted by a bank, who said the information written in a letter I had sent them was not the same as on the Oracle system. Not to be an Orwellian conspiracy theorist and not really knowing much about it, but this computer system is an extensive network that holds all information about a person on one huge data-base

Money is being spent on the NHS. However not in a frontline Primary Care way but in more of a Hobbesian privacy/security way,as we appear to remain a nation covertly at a state of war.

These are frightening times generally that we live in. My partner's a young doctor and can arguably be a GP by the time she's 30, which is insanity, but such is the dearth of front line medical professionals, who still believe in the NHS and primary care, that this fast tracking process is necessary.

*Climbs off soap box,puts down megaphone and sheepishly apologises*

realdoc said...

My impression is that it is not just health where the problem lies but all public service from education to the armed forces. This government hates any service with professionals who view themselves as experts and will do whatever they can to undermine them. I think society is undergoing a real change and it is being done behind closed doors without consultation with the public.

Chatterbox does have a point however that some health professionals are their own worst enemies by not acting cooperatively. Part of the government's agenda is to divide and rule.

rockmother said...

Brilliant post Realdoc and interestingly enough I was having a conversation about just this yesterday with one of my relatives. I'm sure I remember reading or hearing an article some time ago - perhaps towards the end of Thatcher's office that there was a grand plan to scrap the NHS and re-create some sort of medical super system similar to the American medicare system. Nightmare. We were discussing yesterday that it was high time we all stopped taking this shit (and subsidising it) and take to the streets - properly. Other countries do it and get the government they don't want anymore to climb down - why can't we? I'm serious - more and more I feel like we are living in a dictatorship and not a democracy. We technically have no say at all - look what happened with the implementation of the poll tax/council tax?

We've got a family friend who works for the MOD and he was warning us about this sort of thing a few years ago - he also said that at some point within the next decade there will be very big problems for Britain and no-one will be allowed in or out. Of course - he wouldn't elaborate anymore. I think we all really do need to do something about this vicious government and the lack of respect it has for all British citizens today. Ok - I think I better stop I could bang on for hours about this!

Geoff said...

It all started when we became "customers".

rockmother said...

Yes - you are so right! I loathe being called that.

realdoc said...

Patients is the most appropriate term as you have to be infinately patient to put up with the bloody awfulness of the NHS these days.

First Nations said...

I am following this with interest. the last thing anyone wants to do is to adopt a medical system based on anything america has. for the love of god don't do it! the reality of the american model is one person with good medical coverage provided by his employer, and that persons circle of friends waiting to pass around his unused drugs and supplies. or one elderly person still able to drive who travels to Canada monthly to fill perscriptions for all his friends. these are working people. this is how we live. its bullshit.
*passes soapbox to the next person in line*

Tedward's Missing Ear said...

I agree that it's not just the health service but all public service that's going to the dogs. Working in the periphery of the criminal justice system my experience is the same. It's all targets and management speak while ignoring the advice of the professionals who know what they're doing. Much as I have no love of Blair I do think it's unfair to place the blame solely at his door. This was started by the Tories, with their tax cuts for the rich and 'i'm all right Jack sod the rest of them' philosophy. My experiences have brought me to the conclusion that the UK is in effect bankrupt and one of these days, probably very soon the shit is going to hit the fan.

violetforthemoment said...

Great post. I couldn't agree more. I'm a probation officer and, unsurprisingly, echo the comments of those who are worrying about the whole public sector - the prospect of working under a trust system really scares me, as does the attitude of government departments to the public services they run, the lack of respect they show to staff.

I also have regular dealings with NHS mental health services and the lack of resources and stress on the staff is obvious and shocking. The 'business' ethos spreading through the public sector is ripping it apart in my view, and I think this is clear to anyone actually working on the frontline.

Privatisation (sorry, 'contestability' - ooh, hearing the word just makes my blood boil), fragmentation, and immense pressure to hit cash-linked performance targets leads to less effective communication between agencies and departments and the consequences can be devastating, and potentially fatal. Yes, we have to be accountable for what we do, but the way this is being done at present is hindering rather than helping.

Who carries the can for cock-ups? Individuals. A colleague of mine recently went through an internal investigation after one of her cases committed a serious offence, and the lack of support from our management, who were just shitting themselves about figures and targets, was awful. She was so stressed she was almost unrecognisable the last time I saw her, and she died of a heart attack while the investigation was ongoing. I'm sure the stress was a contributory factor.

Sorry, this has got a bit personal and ranty, but this is a scary time for me as both an employee and a user of public services...

patroclus said...

RoMo and others hit the nail on the head - this government (well perhaps not all, but particularly Blair) has absolutely no respect for the British people. When was the last time you heard Blair say he was proud of us as a nation? Not a chance. He talks as though we're all wayward, dissolute degenerates and he's the only thing keeping the country together. Twat.

Anonymous said...

Realdoc - pickled politics would be a good platform for this post. You can find them at

From the rockmother - it won't let me log into blogger for some annoying reason!

Occasional Poster of Comments said...

Excellent post.

About a year and a half in the Civil Service was enough for me. Not least because it was after that year and a half that, in line with Blair's promise to cut the number of Civil Servants, the job became non-Civil Service. I was working for what is now Consumer Council for Water, one of the watchdogs for the water industry, and continued to work there for a further year and a half - still at the public's expense, mind (CCW is "sponsored" by DEFRA, and about 50p a year from everyone's water bill funds the organisation), I just wasn't called a Civil Servant anymore. The excuse was that the organisation would now be an independent voice for customers. One with no real powers, but still. A number of similarly dubious re-classifications went on elsewhere in the Civil Service too.

Actually, all my jobs seem to have been related to the privatised industries - rail, energy, water. Oh, and a few months in the NHS (I know, not privatised, yet). God, what a mess it all is. Privatisation has been a disaster as far as I can see. Just take the Royal Mail - they've improved performance considerably over the last couple of years, they like to tell us, but only by reducing service and setting targets that were much easier to meet. And I'm not even going to start on public transport - that gets me almost as annoyed as having a room full of Daddy Long Legs's.

chatterbox said...

Ooh this is very interesting.

Can I just voice one small concern here, that we don’t fall into the trap of imagining some golden age before Thatcher’s reforms got going. Undoubtedly things are in a terrible state, but my mother’s stories about my birth and that of my sister in the 1960s and early 70s match anything that appears in newspapers today about dirty wards, uncaring and absent staff, arrogant doctors etc. Similarly, my own education in the state system on the outskirts of London was entirely reliant on the whims and professionalism of individual teachers. In junior school, for two years we did country dancing every afternoon because that was what the teacher liked. In my comprehensive school, mixed in with the inspirational and dedicated staff were violent, lecherous and drunken examples that the school was unable to get rid of. I work every day with people who were let down by state schooling from the 50’s onwards.

I agree with everything that has been said above, but with the proviso that maybe we are now demanding what we should always have had, and that governments are just continuing in their failure to deliver.

BiScUiTs said...

Ah yes, I'm very concerned about this too. All these targets and paperwork and statistics seem to be there to try and cover up the fact that everything is going horribly wrong. It seems like all these private companies are making money at the NHS's expense. I think you're right about the government wanting the NHS (and the Royal Mail and so on) to fail so that they can give the jobs to private companies to make money out of.

Tattieheid said...

I think this pretty much sums up the current crisis in the NHS.

I have been seeing a Community Psychiatric Nurse for Cognitive Behaviour Therapy. For various valid reasons this therapy has been put “on hold” over the last few months. I saw my CPN yesterday, we get on well but he had to break the sad news he was leaving.

He was given this new position rather than specifically applying for it. If it wasn’t for the fact I’m going through a bit of a bleak period I would have pissed myself laughing. As it is I feel sorry for him and his clients, myself included.

Apparently those incompetents further up the NHS tree in this area have to justify their existence by bringing in reorganisations approximately every 5 years. It is important to note that they have been working on this for 2 years leading up to implementation and he is in post.

Here are the main points he conveyed.

1. He is in his new post but it does not have a title yet.
2. He has no identified support staff or administrative structure.
3. He has no identified line manager or any kind of management infrastructure.
4. He has no base to work from.
5. He has no idea what his role is but in reality it is probably the same as his previous, just a change in title.
6. He was quite happy with his present location and the work he was doing.
7. He is probably going to end up in a physical location (city) he doesn’t really like.
8. He is likely to end up in a physical location (building) that is not best suited to the work he is doing.
9. He has less than 10 years to go until he can take early retirement and at best has only one more of these pointless exercises to survive. So he will hang in there.

He was seeing me out of professional courtesy but also because he had serious concerns about my situation and was unhappy at not being able to provide future support. He was one of those healthcare professionals that actually cared and would go that bit further. Remember those?

The NHS is in a coma; they just haven’t switched the life support systems off yet.

lisaaashmore said...

There are people out there trying to make a difference, take a look...

Dr Grumble said...

Dr Grumble takes the same view. It's the beginning of the end of the NHS.

dinahmow said...

Like First Nations, I'm also looking closely at this.In this 'Outpost of Empire', we do seem, more and more, to follow the lead of USA.And certainly, the Public Health System here has major troubles, too.(Don't get me going on Education!)
Blogs are great for giggles, but posts like this really do need to reach a wider readership.Try The Times!
Soapbox now vacated.