‘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, etVoila! 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.