The Price of Empire Building.

Over the past 20 years, the NHS has systematically â and I use that word deliberately â 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 âuncaringâ 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 donât 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 â 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 â the NHS hospital.
The NHS holds all your medical records â 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 ânursing careâ as opposed to âDoctor careâ. Today we are told that her elderly and infirm patients are âbed blockingâ, that nurses donât 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 âhot water, towels and get out of my wayâ! Now we are told that the end of a pregnancy is a medical emergency that only the NHS can cope with â 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 âwe can provide everything they do more cheaply in one placeâ. It is quite illogical â we might just as well force all supermarkets out of business, close down the grocerâs shops, ban home cooking, and announce that in future everyone will eat at the National Feeding Centre. I shouldnât 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 donât 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 â 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 â you leave hospital.
If your family are unable to deliver âsocial careâ â assistance in feeding, dressing, getting to the toilet â 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 â 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 â you are now free to do so!
Whichever route you follow out of hospital, your nursing care follows you â they arrive at exactly the same time they would in hospital, perform exactly the same functions â 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 â they are with you, the most obvious place for them to be!
It works like clockwork â and it all seems so blinking obvious that I wonder why no one ever thought of it in the UK.
Oh! they did. Itâs what they used to do. Thatâs why the BBC are discussing it this morning as a âbackward stepâ for the NHS as a result of this announcement from Mike Farrar.
âHospitals 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 Yorkshireâs main hospitals say delays in discharges are costing them £8 million a year. Chief executive Phil Morley said:
âThere 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.
âIt could be because of a piece of equipment they need.
âWe also have sad cases where relatives dump patients in hospital while they go off on holiday.
âThere are difficult gaps in the system and thereâs an argument about who pays for patients to be cared for after hospital.
âUntil then, they will sit in an acute bed.â
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:
âThe old hospital based system has to develop into a more preventative, community based system.â
The âoldâ hospital based system â itâs 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 heâs on 24/7 call â not on office hours. Give the notes back to the patient where they belong. Crank up meals on wheels, and home services â 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 â stop taking drunks to hospital. Theyâre not sick, just drunk.
December 31, 2011 at 22:31
-
Iâm 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. Itâs 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 shouldnât have made any difference.
Next- close down
all the meeting rooms and install lockers for the staff to keep their work
wear. Itâs 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 wonât make the grade.
December 30, 2011 at 11:03
-
I asked a nurse how much time the ward manager spent on the ward. She told
me she âvisits once a week for about an hourâ. Oh, say I, does she manage many
other wards? What is she doing the rest of the time? âNo, just one ward, she
is in meetings the rest of the timeâ.
December 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 â itâs the âsacred
cowâ.
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 ânursingâ 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 ? Thatâs the
âsacred cow challengeâ and why it will never be achieved.
December 30, 2011 at 07:32
-
Iâm a nurse of âmumbleâ years experience (Iâm 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 âefficiencyâ, âcost savingâ and âpatients
rightsâ. 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 â try delivering
care when youâre the last in line for any help). I trained and worked for many
years in London teaching hospitals, then for family reasons (we couldnât
afford to live in London) moved to a smaller city. I started on a ward, doing
the patient care, feeding, education, dressing â I was gradually ostracized
and encouraged to leave, why? because I didnât stand around and discuss
Eastenders, didnât 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 â 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 â as well as posts
for diversity/health promotion/smoking cessation ânursesâ 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 â 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 wonât be. This country is no longer the
one I was born in, and yes, I am leaving the NHS as soon as I can.
December 30, 2011 at 07:15
-
Following the NHS concept through to its logical conclusion, shouldnât we
have just one hospital in the middle of the island⦠Somewhere near Leamington
Spa?
It would be so efficient!
December 30, 2011 at 00:33
-
And please give over on the notion that doctors should be cheap, humble and
compliant as they must be âdedicatedâ.
December 30, 2011 at 00:31
-
1. When does the 24 hour doctor sleep?
2. Many patients are virtually
âveinsâ 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
âfamiliesâ these days?
4. Interpreters?
5. People who like doctors and
nurses to âpop inâ from time to time.
6 etc.
December 29, 2011 at 20:56
-
1.2 million people canât be wrong.
Or can they?
Thatâs 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 portersâ unions, with a lot of emotion buttons primed to be
pushed.
Iâll be very surprised if any serious reform dents this beast and
itâs 70+ years of growths. Itâs just too big, unfortunately.
Too big to
turn?
December 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.
December 29, 2011 at 19:40
-
Bring back the ward matron.
December 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. âWe are busy you knowâ said the âdoctorâ 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, sheâd 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 doctorâs 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).
December
29, 2011 at 17:24
-
What happened to all the old convalescent homes?
December 29, 2011 at 17:35
-
They got better.
(Sorry.)
December 29, 2011 at 13:11
-
Anna, I can confirm everything you are saying about medical care here in
France.
My next door neighbour â in her 90s â 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 â who lives in the village â 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 âcare in the communityâ should be all about.
December 29, 2011 at 12:40
-
What the BBC call a âbackward stepâ sounds very sensible. In fact the
phrase should be applied to all the disastrous âforward stepsâ 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!
{ 17 comments }