Two-Tier Tears.
‘Two-tier’. ‘Post-code lottery’. ‘Deserving Poor’. It seems the media will never run out of nomenclatures for invoking the spirit of ‘someone, somewhere, is getting more than you’. Society no longer appears capable of debating anything without identifying the loser, the under-dog.
Sir Bruce Keogh has finally finished Stage One of his recipe for transforming ‘Emergency Care‘ whereby he establishes specialist units for specialist emergency care – heart attacks to this one, stroke victims to that one, and the media are fretting about those with hacking coughs left in the queue for non-emergency care…….’hospitals will close’, whoo, hoo.
Couldn’t the media, just for once, look at the positive side? ‘Emergency Care’, or as it is to be renamed ‘Major Emergency Care’ to differentiate it from that splinter in your foot which may feel like an emergency to you, is to be relocated into regional centres. Regional centres near major road conurbations, with heli-pads for the air ambulance. It really doesn’t matter a fig if they are ‘easily accessible’ to the poor and huddled masses, since no one other than visitors will be trying to make their own way there. If you want to design a national free health service for the benefit of the visitors, then save your breath, ‘cos I shan’t be listening.
What he is suggesting is the system that works very well indeed in France. Unfortunately, he seems to have omitted some of the small details that makes it work.
We have local hospitals for those who are laid up with both legs in plaster and unable to get to the bathroom on their own. Any system needs that. Those local hospitals have things like x-ray departments for the use of the local doctors whilst they find out whether the pain in your leg is a broken bone, or perhaps bone cancer. If it turns out to be bone cancer, then you are whisked off to a speciality cancer hospital. Of which there are five in the whole of France. Tough luck on your visitors if your home happens to be miles from any of them. There are bonuses though.
For a start, the local hospital doesn’t have to employ an expert in everything you could possibly get wrong with you. They are experts in following instructions, and total experts in nursing care. If the experts in the speciality hospital, neurological, cardiac, or whatever, find that although you are a bit more than a broken leg, your neurological problems are pretty run of the mill, merely requiring observation and someone qualified to communicate with the experts in the regional neuro unit as to treatment then you will likely be shipped back to your local hospital with instructions for your treatment. We don’t look on that as a two-tier system with the implication that we are getting less than optimal treatment, we look on it as a welcome sign that we are not at death’s door…
Here in France, there is a third tier, one that may not be so easily set up in England – and that is, what happens when you have been stabilised and the Doctor’s instructions are not likely to change on a daily basis, and it is just left to the nurses to deliver the medications and change the dressings daily? In England, you remain in what amounts to a serviced hotel – the nurse comes round twice a day with a trolley and doles out your pills or injections, one at a time; later another nurse comes round with another trolley and changes your dressings. In between, your ‘cleaning woman’ – if you are lucky – pushes a desultory mop around the floor, someone else wipes a cloth round the bathroom you use; three times day a tray of what passes for food is put in front of you; and in between you struggle to find anything worth watching on the TV or read books that you regret bringing in with you – and wait for the surge of other people’s visitors to burst through the door (after they have found a parking place) to share their germs with you and everyone else.
The defining moment here is – ‘can you get to the bathroom on your own’ – once you can do that, you go home. Hospitals are only for the immobile and terribly sick. I was home eight days after major surgery – and that was delayed by unforeseen complications – normally it would have been five days. It works, and works brilliantly, because of several factors that I would commend to Sir Bruce Keogh.
One. What used to be called ‘District Nurses’ in England. It is where all those highly qualified theatre nurses go when they get married and want to work locally and within school hours (barring emergencies). They work from home; they are armed with mobile phones, and they work in trios – any problems and you phone them – ‘three of my stitches just fell out’ – one of them will be at your door within twenty minutes – and good luck getting the qualified nurse to your bedside in a British hospital within 20 minutes…..
Meanwhile, they arrive every day, perform everything that would be done for you in hospital with regard to injections and changing dressings – they don’t have to carry anything with them, because everything they could possibly need for your specific circumstances arrived at your home from the local pharmacy – right down to a pair of scissors, and protective gloves, even a supply of rubbish bags in which to seal up the detritus, I kid you not – before you got home. Meanwhile your nearest and dearest, or your next door neighbour, or whoever, has the job of cleaning your bathroom, delivering your food, and getting the remote control to work….and you only have your own germs to deal with. When it comes to taking out your stitches – they open the pack marked stitch removal, which contains a sterile disposable version of everything they need and do it right there on your own bed. They don’t need ‘access to your medical notes’ by some complicated ‘electronic system’, on account of patients retaining their own notes here, so they are right there, next to your bed.
There will always be a few people, in any system, who have no family, no neighbours who will help out – and for those people, the local ‘Retrait‘ is the answer. What is known as ‘an old people’s home’ in England. They already have a trained nurse on the premises, they already have cleaning staff and kitchens to produce food – two or three beds in a separate wing, et Voila! you have what we used to call a ‘convalescent home’.
By the time they have finished with me, those nurses will have been here every single day for four months – but that is a heck of a lot cheaper than keeping me in hospital for four months, and will have achieved the same result of medications and nursing attention – any problems, and they call out the Doctor. Besides which, the food is a million times better at home. I swear French hospital kitchens employ an army of vengeful Algerians Hell bent on making the French pay for past atrocities.
Now that I’ve saved the NHS billions on storing hospital notes, and more billions on providing hotel services for people who just need a dressing changed every day and maybe an injection or a couple of pills, and I’ve got those highly trained nurses back to work whilst the kids are at school – what to do with all the surplus money?
Well, you still have the problem of patients needing to access those out of the way specialist hospitals – as I have to next Monday. Which is why they will send a taxi to my front door to get me there – no need for an ambulance, I’m ‘walking wounded’ so just an ordinary taxi will suffice. The health service will pay for it – on the grounds that if I need to access a specialist hospital, it can only be because I am really sick, therefore shouldn’t be expected to struggle with buses or trains…..
You can afford to do that when the only people going anywhere near a hospital are the really sick.
I don’t expect it will ever happen in the UK though – the British seem to be wedded to the idea that a hospital is like the House of God, and everyone should crawl on their knees to pay homage to the great men inside – and that a hospital is a place that should be local and provide cosseting and pillow pumping on demand.
The Keogh blueprint for remodelled A&E also attempts to sidestep the fundamental political problem inherent in any NHS reorganisation: communities and their MPs take to the streets at any mention of a hospital closure. Under the two-tier plan, none of the current 140 A&E departments in England would close.
But the proposals will still be controversial because some A&Es will be seen to be downgraded. About 40 to 70 will become “major emergency centres”, where the seriously sick and damaged are taken by ambulance for hi-tech treatment for heart attacks, stroke and trauma, bypassing other closer hospitals on the way. The 70 to 100 remaining A&Es will become ordinary emergency centres, which will cope with problems requiring less specialised care.
Whilst I’m happily having this little rant – can anybody explain to me why we expect a hospital to feed us free of charge? Or more to the point, why some of those on pensions or benefits are expected to hand their pension books over on the grounds that they shouldn’t be ‘paid’ twice for food – whilst the rich continue to be fed for free in hospital? What’s the ideology behind that one?
I ask because the French demand that you pay for the unmitigated rubbish that they put on a plate in front of you…..they do have one neat trick though, that the NHS could easily copy. If you don’t eat whatever is deceitfully described as ‘the food’ on your plate, for whatever reason, they take it away – but return with a small bottle of juice with a straw. Most people will drink even if they don’t feel like eating. That ‘juice’ is a 400 gram protein drink – at least no one comes out of hospital malnourished.
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November 14, 2013 at 10:21 -
An excellent insight. Would that you were in charge of our NHS, Anna.
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November 13, 2013 at 23:26 -
I don’t know where this Obesity Epidemic comes from, I see a few people who might be a bit overweight and a few who could be described as obese but certainly no epidemic. The French system sounds eminently sensible for health care and I think we once had something like that with the cottage hospitals and proper district nurses, all gone now. We never had these specialist hospitals but then we didn’t have the treatments then either, I suppose the nearest was the TB hospitals. I think politicians know what needs to be done but, as mentioned above, who has the courage to do it?
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November 14, 2013 at 10:20 -
@ I suppose the nearest was the TB hospitals @
We used to make films set in those:
http://thefilmreview.com/reviews/comedy/twice-round-the-daffodils-review.html
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November 13, 2013 at 21:37 -
Anna:
Having lived over the last 20 years in France before coming back to England after a lifetime’s Crown service overseas, I endorse all you say about the French medical and care system. I fear that the British seem to have lost the ability to care for others and work for reasonable reward, without envy and benefits-reward. Sad indeed. -
November 13, 2013 at 19:52 -
My dad was given boxes of protein drink when he was in hospital. Nobody seemed to notice that he had a collection of ten un-opened on top of his bedside cabinet.
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November 14, 2013 at 11:02 -
They probably did but:
a) there is no box to tick for ‘patient has not eaten’
b) there IS a box to tick for ‘distributed box x 1 protein nutrition’.There. Box ticked, so if necessary it can be demonstrated that the job was jobbed.
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November 13, 2013 at 18:49 -
Oh don’t get me started on the “One size fits all” bollox with average this and that.
Mate Mike and I are both the same height, Mike is of a very slim build, and would take him all his time to weigh 7st in his stocking feet. I on the other hand have hands like shovels, and am broader across my shoulders than Mike is around his waist.Our ideal weight would be around 11st-7, Mike at that weight would positively waddle down the road, whereas I would look like I’d spent 2 years in a Siberian gulag. Clearly one size does not fit all, but there’s no telling the bean counters.
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November 13, 2013 at 17:11 -
Nice that they give you that bottle of protein drink if you don’t eat ur food ! I’ll wager they leave it somewhere w/n arms reach. In the UK your arms have be at least 6 foot long for when that nurse moves your drink because it’s in HER WAY !!!
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November 13, 2013 at 16:07 -
My short stays in rural France left me with a serious respect for many French organisations. Often they make things seem so easy and natural that when something works well it almost looks like a happy accident. It took a while to realise that many times it was no such thing, rather it was the result of common sense, organisation and experience.
The problem is that such a system as the french one would never work in England. The management would be inept and out for personal gain so spend time empire buliding and diverting front line funds to their pet projects, friends and pockets, while most employees would lack the sense of dedication, obligation and responsibility displayed by the french. The french seem to have a sense of satisfaction from personal achievement and gain self-respect by doing their job well, however lowly that job may be. It’s an attitude that is sadly lacking in the UK nowadays as older people retire and are replaced with the morality free generation. -
November 13, 2013 at 15:42 -
If we were starting again to create a national health service, we wouldn’t design it like the one we’ve got. But getting from the one we’ve got, to the one we need, is nigh-on politically impossible.
Almost every feature of the NHS you may examine cries out for action, the solution usually being obvious, yet no-one has the cojones (or political suicide-wish) to make a start on any of them and, as the population ages and medical expectations increase, it can only get worse. Rather like the state pensions problem, if you keep kicking the can down the road, the eventually essential action hurts far more, but who is prepared to take the pain now ?
Having a spouse who works within the NHS, I hear about the internal truths to add to my own external impressions – and that only makes it worse, because if you ever ‘got the drains up’ on this NHS behemoth, the unseen contents would definitely make you ill.
We have a veritable herd of sacred cows here, none of which may be sacrificed or even milked without severe damage to the ‘farmer’, and therein lies the problem. -
November 13, 2013 at 14:41 -
As an engineer, I was always told “If it ain’t broke, don’t fix it.” I think the NHS needs fixing, but as an engineer, I haven’t got a clue how to do it.
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November 13, 2013 at 14:21 -
The problem is that the NHS is the best health system in the world so it is very difficult to improve it.
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November 13, 2013 at 15:00 -
Are we seeing lots of irony today? Or am I being thick? (Envy of the world, you know – but nobody is clever enough to emulate us)
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November 13, 2013 at 13:50 -
You sum the problem up in your first four/five words: “Two-tier” and “Postcode Lottery”. We see the same in education: there must be an end to the scandal whereby half of all children make below average progress.
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November 13, 2013 at 14:17 -
Isn’t it a simple fact of arithmetic that at least half MUST be below average in order for the average to be calculated?
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November 13, 2013 at 14:56 -
Is Lake Wobegon joke, yes?
But has what to do with Anna’s piece? -
November 13, 2013 at 14:57 -
You may joke, but a friend came close to having her child put on the at-risk register simply for being ‘below the average weight’ according to the chart – the clinic manager responsible has since been elevated to the higher echelons of local NHS administration.
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November 13, 2013 at 16:12 -
Given that we have an Obesity Epidemic then I fear we will all need to eat more in order to avoid finding ourselves at “below average weight”. Therein lies the wisdom of crowds.
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