On 7th November we copied an article published in the LRB (London Review of Books) by John Furse which outlined what in his view is the ongoing threat to the NHS posed by privatisation. In a subsequent edition the LRB published two letters criticising the article. The authors of these two letters were Helen Buckingham (a Director of the Nuffield Trust) and Mary Guy (a lecturer at Lancaster University). In the next edition of the LRB the following letter was published by Roy Macgregor (a front-line GP) applauding and supporting John Furse’s original proposition.
As a GP, I sighed with relief reading John Furse’s article on the NHS. No lies on the side of a bus, just home truths. The critical letters the piece received in response do not reflect the changes that have already occurred on the frontline.
Frank Dobson, as Tony Blair’s first health secretary, oversaw the introduction of the National Institute of Clinical Excellence (NICE), intended to help end the ‘postcode lottery’ in the availability of treatments. It has been a partial success but huge variations in availability of treatment remain. What has followed is an ever increasing barrage of guidelines, pathways and directions for clinicians, setting the parameters for what they can and cannot do. Young doctors and nurses, with no memory of any other way of doing things, treat these guidelines as if they were rules while general practice has been transformed into a Kwik-Fit operation that doesn’t give you the freedom to choose even the tyres your patient should have for their onward journey.
An elderly patient with a bad head injury attending casualty is seen by a triage nurse who is obliged to follow specific guidelines. He is treated for a facial cut and broken nose. But severe symptoms persist for four weeks. Only when he returns to see a doctor is a CT scan requested. The scan explains the symptoms. Had he been just a few months older at the time of the accident, he would have been old enough to qualify automatically for a CT scan.
Ankle and knee injuries used to be judged on their severity and other factors specific to the patient. Now the only pathway permitted is to direct the patient to make contact with his local ‘musculoskeletal service’, which is delivered by an outsourced private, profit-driven provider. After telephone consultations, he may, eventually, get to see a physiotherapist; only then might he be referred to an orthopaedic consultant. This may be more than six months after the initial contact. What cost the time off work, the limiting of mobility and exercise, the weight gain, the consequences for the patient’s mental health?
Another patient survives a heart attack because someone in the community performs CPR on her. After being taken to a major hospital, she is given a full cardiological and pulmonary work-up. Two weeks later a request arrives to refer the patient to cardiology for review. When the question is asked what blood tests or other cardiology tests were done when she was admitted the answer is none. New referral, further costs, more anxiety for the patient and her family.
The NHS is being dismantled, and the effects are felt daily by patients and staff alike. Everyone is struggling to practise safe care. So long as sensible thinking and commonsense selection of tests and referrals – specific to each individual – are excessively restricted by guidelines and by fears over costs, we will all suffer; and in the end, no money will have been saved.