Over the past 20 years, the NHS has systematically – and I use that word deliberately – built itself into a closed shop for every variety of care.

It has done so I believe deliberately; for by eliminating all competition it has ensured that any perceived attack on its budget will be seen as ‘uncaring’ towards each and every sick person.  Any attempt to dismantle the empire is seen as detrimental to the health of the entire nation.

If you want to have a baby, you go to the NHS.  If you don’t want to have a baby,  you go to the NHS. If you are worried about having/not having a baby, you go to the NHS. Doctors no longer come to your home, they work office hours only – if you are sick outside those hours, or taken ill away from home, even if you are just dead drunk, then an ambulance rushes you to the only possible destination – the NHS hospital.

The NHS holds all your medical records – how can anyone else treat you? Only they know what is wrong with you and what they have done/not done about it so far. It is a miniature communist state in our midst. A Berlin Wall for our bodies.

It is barely 30 years since the District Nurse on her bicycle, with her comfortable council house on the edge of the village, was a familiar sight as she sped her way towards those in need of ‘nursing care’ as opposed to ‘Doctor care’. Today we are told that her elderly and infirm patients are ‘bed blocking’, that nurses don’t have time to feed those who need help to eat, or bring a bed pan for those who cannot walk.

It is barely 30 years since the midwife was a regular visitor in every street, preparing for a natural event that has occurred for thousands of years, with her cry of ‘hot water, towels and get out of my way’! Now we are told that the end of a pregnancy is a medical emergency that only the NHS can cope with – and pay out millions of pounds every year for the result of being unable to cope successfully.

It is barely 30 years since every major town had a convalescent home for those who needed more regular nursing care than the District Nurse could provide, or perhaps had no one at home to cook and wash for them whilst they recovered.

The NHS has seen off all these competitors with its cry of ‘we can provide everything they do more cheaply in one place’. It is quite illogical – we might just as well force all supermarkets out of business, close down the grocer’s shops, ban home cooking, and announce that in future everyone will eat at the National Feeding Centre. I shouldn’t give them ideas. In no time at all we should be told of elderly people being pushed to the back of queue at the new NFCs and starvation across the land if we don’t up the pensions of all who work there.

Here in France, hospitals are for the very sick, those who need the hourly, even minute by minute, care of Doctors. There is a Doctor always present on every ward. They need to be – these are truly sick people.

Once your condition is stabilised, and you only need dressings changed, stitches removed, medicines taken regularly, injections delivered, all the paraphernalia of nursing care – you leave hospital.

If your family are unable to deliver ‘social care’ – assistance in feeding, dressing, getting to the toilet – then you go to a convalescent home. Either a really specialised convalescent home, often based in a local chateau, for those with two broken legs and a spine in traction who need constant help; or a wing of the local retirement home – not just for the elderly, but for all those who need help eating or dressing. Their speciality, when you think about it.

If you have family who can cope with your condition, you go home; back to the bookcases of familiar books, your own bed, the company of your family at all hours, and a normal routine. If you want to watch the late night movie with a fag in one hand and a glass of whisky in the other – you are now free to do so!

Whichever route you follow out of hospital, your nursing care follows you – they arrive at exactly the same time they would in hospital, perform exactly the same functions – and if your condition worsens for any reason, then the Doctor arrives at your bedside, exactly as they would do in hospital. Everyone knows what is going on, because everyone has access to your notes – they are with you, the most obvious place for them to be!

It works like clockwork – and it all seems so blinking obvious that I wonder why no one ever thought of it in the UK.

Oh! they did. It’s what they used to do. That’s why the BBC are discussing it this morning as a ‘backward step’ for the NHS as a result of this announcement from Mike Farrar. 

“Hospitals play a vital role but we do rely on them for some services which could be provided elsewhere. We should be concentrating on reducing hospital stays where this is right for patients, shifting resources into community services, raising standards of general practice, and promoting early intervention and self-care.

East Yorkshire’s main hospitals say delays in discharges are costing them £8 million a year. Chief executive Phil Morley said:

“There are delays because there is nowhere suitable for patients to go or there is no care package, such as a home help, in place for them to go back to their own homes.

“It could be because of a piece of equipment they need.

“We also have sad cases where relatives dump patients in hospital while they go off on holiday.

“There are difficult gaps in the system and there’s an argument about who pays for patients to be cared for after hospital.

“Until then, they will sit in an acute bed.”

From September to November this year, one in nine patients taking up a bed did not need to be in hospital.

Today we also learned that the number of patients developing life threatening infectious diseases as a result of their stay n hospital has doubled in two years.

Then this from Prof Steve Field, Chairman of the independent NHS Future Forum:

“The old hospital based system has to develop into a more preventative, community based system.”

The ‘old’ hospital based system – it’s all of 30 years old! It needs to un-develope.

Bring back the District Nurse. Give her a house in the District. Tell the Doctor he’s on 24/7 call – not on office hours. Give the notes back to the patient where they belong. Crank up meals on wheels, and home services – and put the patient back where they belong, in their own home, with their own family, and their own germs when they need nursing care rather than intensive care.

Whilst you are about it – stop taking drunks to hospital. They’re not sick, just drunk.

DaveDecember 31, 2011 at 22:31

I’m firmly of the opinion that decimation is the only solution. All the
admin staff names go into the hat. The lucky 10% whose names are drawn are
sacked on the spot. Tell the others to organise themselves. Come back in two
weeks and repeat. It’s amazing how hard people will work when their jobs are
at stake. Once the management have been re-organised have a look at the impact
on patient care. It shouldn’t have made any difference.
Next- close down
all the meeting rooms and install lockers for the staff to keep their work
wear. It’s unhygienic for hospital staff to travel to and from work in their
overalls.
Next- get Tesco to look at installing their stock ordering system
into hospitals. If they can run a multi-billion operation and know exactly how
much stock is on the shelves at any time, and then buy stock at the best price
and have it delivered on time every time, they should be able to sort out the
incredible waste in the NHS. The NHS buyers can apply to Tesco for retraining,
but probably won’t make the grade.

lilithDecember 30, 2011 at 11:03

I asked a nurse how much time the ward manager spent on the ward. She told
me she “visits once a week for about an hour”. Oh, say I, does she manage many
other wards? What is she doing the rest of the time? “No, just one ward, she
is in meetings the rest of the time”.

MudpluggerDecember 30, 2011 at 08:56

The key problem with the NHS is not the doctors, not the nurses, not the
contract cleaners, not the adminstrators, not the managers – it’s the ‘sacred
cow’.
The sacred cow that is the status of the NHS has become some a toxic
political subject that no government has the balls to address and sort
out.

From the cosy cabal of physicians, their palms crossed with unquestioned
gold bribery since 1948, through the armies of over-qualified but
under-delivering ‘nursing’ staff, the legions of pen-pushers all frightfully
busy doing non-jobs, the brainless buyers who overpay for everything from
grasping suppliers, to the scandalously underused but outrageously over-priced
capital equipment. The whole organisation needs a drains-up, zero-base
rebuild.

The French approach does indeed sound an attractive alternative but, given
the 5-year horizon between UK General Elections, which party will ever grasp
this poisoned chalice and thus ensure the full might of all those vested
interests are brought to bear, guaranteeing electoral defeat ? That’s the
‘sacred cow challenge’ and why it will never be achieved.

AbleDecember 30, 2011 at 07:32

I’m a nurse of ‘mumble’ years experience (I’m still young in my head, which
is all that counts.) The issues raised here are all true. The problem is that
the NHS, as with most of British institutions, has been taken over by the
progressive bureaucrats.

The number of hospital beds per head of population has been systematically
cut for years. The community hospitals have all but disappeared. The long stay
mental health hospitals were destroyed years ago. All of this is well known,
and was done in the name of supposed ‘efficiency’, ‘cost saving’ and ‘patients
rights’. All without any real thought as to the consequences, all without any
basis other than political ideology.

I worked as a Community Nurse but left because the caseload was literally
dangerous (there are lots of staff in the community but the absolute majority
are either non-clinical, managerial or health care assistants – try delivering
care when you’re the last in line for any help). I trained and worked for many
years in London teaching hospitals, then for family reasons (we couldn’t
afford to live in London) moved to a smaller city. I started on a ward, doing
the patient care, feeding, education, dressing – I was gradually ostracized
and encouraged to leave, why? because I didn’t stand around and discuss
Eastenders, didn’t leave the patient care to the health care assistants, and
when there was a mess I got down on my knees and cleaned it instead of passing
it to a cleaner who covered 4 wards (yes, I made them look bad). I moved to
another ward area with mostly like minded staff – guess what? Yes, they
retitled the ward insisting everyone reapply for posts, and all the good staff
were let go because they were short of funding (this in a hospital which was
at the time recruiting 8 matrons, for a 300 bed hospital, and not the
old-fashioned ones who worked, just renamed administrators – as well as posts
for diversity/health promotion/smoking cessation ‘nurses’ all on salaries
three times a ward nurses). When you drive out staff with the care ethos and
encourage those that stay to work as they do, what do expect as an
outcome?

My personal and professional opinion is that the NHS is no longer fit for
purpose. We all hear of staff being cut but they always come from front-line
clinical care areas, never managers, never clerical, never non-clinical
advisors – no, their job numbers are increased (from a junior nurse to the
chief executive of an average hospital are at least seven layers of
management, who do.. absolutely nothing). When the public realises that they
are funding jobs for the girls and that care is the last priority n the modern
NHS there should be riots but there won’t be. This country is no longer the
one I was born in, and yes, I am leaving the NHS as soon as I can.

SadButMadLadDecember 30, 2011 at 10:12

Great insight into how it really is.

You’re right about the progressive bureaucrats. They get everywhere and
destory organisations from within without even realising that they are doing
it.

right_writesDecember 30, 2011 at 07:15

Following the NHS concept through to its logical conclusion, shouldn’t we
have just one hospital in the middle of the island… Somewhere near Leamington
Spa?

It would be so efficient!

john malpasDecember 30, 2011 at 00:33

And please give over on the notion that doctors should be cheap, humble and
compliant as they must be ‘dedicated’.

john malpasDecember 30, 2011 at 00:31

1. When does the 24 hour doctor sleep?
2. Many patients are virtually
‘veins’ from which blood tests are extracted.
If they have their notes at
home how do they get their prothrombin time etc?
3 How many people have
‘families’ these days?
4. Interpreters?
5. People who like doctors and
nurses to ‘pop in’ from time to time.
6 etc.

binaoDecember 29, 2011 at 20:56

1.2 million people can’t be wrong.
Or can they?
That’s one number for
the total NHS staff including GPs, but excluding service contractors and
suppliers.
This is a scarily large collection of vested interests, from
pillmakers to porters’ unions, with a lot of emotion buttons primed to be
pushed.
I’ll be very surprised if any serious reform dents this beast and
it’s 70+ years of growths. It’s just too big, unfortunately.
Too big to
turn?

CascadianDecember 29, 2011 at 19:43

My goodness, next thing you will want the assembled doctors, nurses, and
what-all they call themselves these days to CARE for you. When in reality they
have been trained only to tick boxes, sign reports and get huffy when asked to
do something.

Single Acts of TyrannyDecember 30, 2011 at 06:39

“get huffy when asked to do something”

Ha ha. so true. Here’s a tip which works well with the lower order
drones, don’t ask, tell them to do something. They are so conditioned not to
think but to obey you can usually make it happen.

DamoDecember 29, 2011 at 19:40

Bring back the ward matron.

Single Acts of TyrannyDecember 29, 2011 at 19:00

I entirely agree with you. When Mrs SAOT was in hospital some time ago I
had to literally frogmarch a doctor to her bedside after two hours of asking
for pain medication. “We are busy you know” said the ‘doctor’ who was
discussing Eastenders with the nurse when I marched her to the drugs cabinet
with threats of security ringing in my ears (I figured that by the time the
elderly security duffer gor there, she’d have the drugs anyway so my expulsion
from hospital would be worth it).

When young master SAOT was in hospital for a check I genuinely had to see
the doctor’s credentials as I thought he was a homeless mentally ill person.
He was in fact a junior doctor who has not thought to, you know, shower,
shave, comb his hair or wash and press his clothes for quite some time.

(And if you are a junior doctor complaining about hours now, comb your
hair, iron your shirt and wash. It is amazing how much more seriously you will
be taken).

DemetriusDecember
29, 2011 at 17:24

What happened to all the old convalescent homes?

EngineerDecember 29, 2011 at 17:35

They got better.

(Sorry.)

ivanDecember 29, 2011 at 13:11

Anna, I can confirm everything you are saying about medical care here in
France.

My next door neighbour – in her 90s – is a little frail and had to go into
hospital several months ago. She was in hospital for three days then returned
home. Now the nurse – who lives in the village – arrives to see her every
morning, the doctor calls in about twice a week and every day her daughter
walks up the hill bringing lunch, not just for the two of them because there
are usually, at least. three or four others there having lunch with her.

Ihis is surly what ‘care in the community’ should be all about.

Ed PDecember 29, 2011 at 12:40

What the BBC call a “backward step” sounds very sensible. In fact the
phrase should be applied to all the disastrous “forward steps” taken in our
names by decades of Fabian centralisation & bureaucracy. It could become
the rallying cry of all wishing to be rid of suffocating state
control.
Long live The Backward Step party!