We’ve been away – Deerhurst (where we went every summer when the girls were biddable enough to come), Minneapolis-St Paul to visit the cousins, Gore Bay to see Bob and Shelagh and the extended family they have been so generous to include us in… Ottawa to see Dad, Lloyd, Gwen and Pieter… I will show photos in a minute…
But today, a paeon to the NHS. What a complex, wonderful, hopeful, (sometimes awful) institution. What great/sometimes less than great care we provide (or in our case, provided!) The BMA and the DH are talking again and 7-day working for non-urgent care is again on the agenda. Well, for us, in anaeasthesia and intensive care it was never off the agenda – we don’t need a ‘profound culture change’ to provide it. Bring on ‘patient power’ and Martha Lane Fox to inform the National Information Board – hug your staff close Jeremy, or you won’t get what you want from them.
I came to the UK in 1982, became a consultant in 1991, retired, hurt, burned out, in 2013. In that time there were nearly 20 re-disorganisations of the Health Service and reports about how to make it better: the 1980 Black report revealed the discrepancies between health and class, the Griffiths report in 1983 suggested that Florence Nightingale would look for people in charge, in 1986, nurse education became the responsibility of universities for the first time, in 1989 (when Britain was still spending about only 5% of its GDP on health care) Ken Clarke suggested a purchaser/provider split, with a new deal for GPs – in 1991 an internal market was established with regional health authorities co-ordinating local priorities; in 1993, Calman re-organised medical training (so that there were no more R-10s, as David Sackett wondered at when he came to the Cochrane centre in that year. In 1998, the Bristol Heart surgery scandal erupted, and medical practice (with Shipman as well) changed – more scrutiny, less time for training with the WTD. The election of the Labour government in ’98 led to increased funding, innovative thinking about reforming the way medicine was practiced, the Modernisation Agency, networks to help standardise care and improve scrutiny – all the while against a background of constantly shifting organisation and policies about how healthcare could be financed (Regional Health Authorities? Strategic Health Authorities? Primary Care Trusts? Monitor? CQC? Payment by Results? NHS Constitution? CCGs? mega-Manchester?) And in 2010, despite a promise of no ‘top-down’ re-organisation from the Conservative politicians, there came a re-organisation ‘so large it (could) be seen from outer space’.
Enough! The UK now spends about 9% of its GDP on health care. It’s not perfect – far from – but with all the sound and fury, some things remain true. People get sick. They need care. They come and get care. They don’t have to pay. Let’s stop fighting about it. It’s not the ‘how’ it’s the ‘what’, ‘who’, ‘why’ – let us get on with it. And let those doing a good job know they are, and those who aren’t – or can’t – give them a way in to best care without ‘shooting them out of the cannon.’