Dr Phil Banfield calls on the NHS to go back to basics and remember that the NHS is about patients
I received a phone call from my daughter’s mobile in my antenatal clinic this week. It was from a member of Conwy’s recycling team whom I cannot thank enough, as they had just found my 19 year old collapsed in Abergele. They had ‘phoned 999, the ambulance arrived within 2 minutes. I left clinic immediately with sincere apologies to my patients and gratitude for my SAS doctor who covered the clinic, and drove with dread, my head full of possible diagnoses, like any parent, fearing the worst. For the record, she is fine, but this left me with a sense of awe about how lucky we are to have a national health service, with fantastic ambulance crews and compassionate emergency department staff – from practitioner’s assistant to consultant.
We have grown accustomed to having our NHS when and where we need it. The reality is, there is not always enough of it to go round, with long waits to be seen and longer waits to be operated on. Our collective attitude to our NHS has to change for it to survive. We must recognise our NHS as a precious commodity – we must not waste or abuse it. It is expensive, precious; we must conserve it and use it with care. The truth is that, as it is, the NHS just doesn’t have the money to do what is being asked of it now, let alone to be sustainable into the future.
More of us are living longer and with more chronic medical conditions. However, this also means that more have been paying taxes for longer, too. UK spending on health as a percentage of GDP has slipped below the average for OECD countries – successive governments have chosen to chronically underfund the NHS. Things have to change – the question is, to what, and who should decide?
This is why we have called for a public debate about what the NHS should be, what it should provide – and what it should not.
BMA Cymru Wales believes that the NHS should be free to all. There is an urgent need to properly assess the health needs of the population and then to challenge the service and politicians to meet those needs. As experts, we believe that doctors play a central role in this, alongside professional frontline colleagues from many allied professions, supported by a system that facilitates the provision of care through the National Health Service. Evidence shows that private healthcare systems are expensive and inefficient by comparison; marketisation of the NHS in England is based on political ideology, not evidence.
There is a shocking shortage of doctors in Wales. Many of the tasks undertaken previously by doctors have been taken over most ably by other staff, but there is a misconception that doctors can be substituted widely by allied healthcare professionals. You would never let your plane take off without a fully trained pilot and there are times when only a doctor will do.
Wales is a diverse and dispersed country. In order to attract doctors to work in Wales we must make them welcome, provide them with appropriate facilities and provide opportunities for their families, too. Primary care is facing crippling workload pressures coupled with chronic underfunding resulting in general practice being unviable in some places. This situation is further aggravated by the complexities of secondary care making the whole system inefficient and ineffective; it all needs simplifying, putting the patient first and those who care for them next.
The NHS has much to learn from industry – Keith Evans, ex-CEO of Panasonic UK, highlighted in his observations of the over-complexity of the NHS complaints system in Wales, that the NHS has much to learn by listening to patients, and if you don’t care about your staff how can they care for customers is well said by Richard Branson.
This is why the BMA in Wales remains passionate about the NHS Wales Core Principles, launched by the Health Minister in February, which will appear with every NHS employee’s payslip next month. In a set of very simple statements, they lay out the positive culture change needed to not only respond to many of the things we know are wrong – bullying, victimisation, openness and transparency – but how we the public, employers, government and staff can work together to put things right. It is a bold and ambitious map to a new and different NHS in Wales.
It is easy to get paralysed by how complex the organisation of health care has become and therefore give up. Yet, for me, it all boils down to one observation – “what would you want for a member of your family”? Let’s start back at basics – the NHS is about patients – and those who care for them. How more complex does it need to be than that?
Well, of course it is – about patients and staff! I am happy that the esteemed author’s daughter is fine and was attended to quickly by the NHS. However, I think more is needed than an exhortation message in staff payslips, statements of the obvious and platitudes.
Commentators bang on about introducing ‘culture’ change but in truth people are just people and they are what you have to work with. You can’t change habituated attitudes, mindsets and ‘culture’ overnight or even over generations.
As stated the NHS is complex and huge so ‘going back to basics’ is not an option. An evolution is required not a simplification. This will inevitably require the wider adoption of the new (and even old) technologies and proper training of staff in how to use it or employing new staff with those skillsets.
It’s all very well exhorting the patients themselves to change (their bad habits) but that is not going to happen. My dentist was moaning about this today (I couldn’t answer back as my mouth was filled with dental instruments- I just grunted!).
Bell Whether: you have an NHS dentist? They are rarer than hen’s teeth in many areas. You don’t get opthalmic care on the NHS any more either unless you are a benefit recipient. You pay for your own fillings and specs now. Residential geriatric care is slipping or has slipped out of the free zone. As medical technology expands and gets more expensive the things a free NHS does are bound to shrink. Anything that can be branded cosmetic will be charged for and all fertility treatment too, I bet. Technology will help to some extent. GPs will be replaced by remote terminals where you speak in your symptoms, answer questions from a computer and then either get a (charged for) prescription or get referred to a hospital for anything life-threatening. Sounds horrible but the evidence is the accuracy of diagnosis will improve.
The alternative is to pay a lot more tax.
Declaration: I am an elected member of the Welsh Council of the British Medical Association (BMA). Dr Banfield is Chair of the Welsh Council.
I support the call for an open discussion about improving the National Health Service (NHS) in Wales. I would want to take the discussion further to debate the options for improving the wider environments that influence health in Wales.
The NHS should be contributing to ways that promote the best health for individuals – from before birth to dying.
Hence NHS activities should include working with others on the causes of health especially the social causes seeking to reduce health inequalities of opportunity at all stages of health care.
In my teaching when we are discussing the creation of a health service there are two strands:
(1) values, beliefs, principles and
(2) current services and desired services.
We have some core principles in Wales but I question whether we have the government to discuss the options for improvements.
Dr Iain J Robbé
Clinical Medical Educationist
@tredwyn. No, I don’t have an NHS dentist. Those particular hen’s teeth were extracted long ago in my town. In any case, having had my initial Welsh teeth and dental treatment laughed at and examined in horror by my American dentist (with a consequent enormous life threatening bill), I have always been careful to go regularly and pay the small(ish) amount to my local non-NHS dentist who is good (I suppose) but talks alot!