NHS: Rebuilding a Functional Service

As I said in my last post, the organisational structure of the NHS, both medical and administrative, is dysfunctional. Unless you are addicted to queues, waiting lists and  needless suffering. Failure to actually deal with these issues, apart from tinkering, promises and announcements, now threatens the very future of the NHS as a public service. Handing over to the private sector to set up an insurance based US style model is a real threat. Yes it would be political suicide, but with the state of the national financial model on the edge of serious failure, there may suddenly be no alternative.

So to avoid disaster there must be a plan.  Here is an outline of one to get the debate going.

Let us first deal with what has to go. The entire GP system, with separately contracted self-employed doctors trained and paid for by taxpayers, yet increasingly unavailable to most of them, goes. As does the the hierarchical structure of  of the medical profession.  Care, cure, remedy and repair are about teams not ranks.

Hospitals that close at night and at weekends, on the model of a department store, when only emergencies are accepted out of hours, must end. Not least because it costs more to shut them than to keep them open, but primarily because it hobbles outcomes and is nectar to lists.

Finally junior staff, over-worked with very long hours and so underpaid many leave, will stop. As will doctors currently ranked as ‘consultants’ working limited hours for the NHS and moonlighting up the road at a private clinic, mostly treating patients recruited from one or other of their bulging NHS lists.

First what we will call Family Healthcare. This is where it all should start. The initial call and consultation with a doctor. The tests. The diagnosis. The ancillary services and treatments. Scans, blood tests, biopsies, x-rays. The pharmacists, physios, counsellors, therapists. Referrals to specialists at hospitals only when diagnosis certain. Initial consultations with doctors from family to senior level, all at this single Community Health Centre open 24 hours for accident and  emergencies and fully operational for  12 hours each day. Trauma requiring admission would go to the District General Hospital, which would have no A&E department open to the public. Specialists would hold clinics in the health centre and family doctors would always see ill patients, for example with a fever, in their homes.

Next comes the District General Hospital which would be open 24/7 fully staffed and operational, running three 8 hour shifts for everybody. Senior doctors would lead teams in which each member, from the most junior nurse upwards, would be seen as a critical and important contributor. Of course there would be respect for all and experience would be valued and rewarded, but the hierarchical pyramid of today’s NHS would be gone. All doctors would be doctors. Surgeons would be doctors, not Mr or Mrs because they were once barbers or butchers of whatever the tradition is. We need timely treatment, not tradition.

The specialist and teaching hospitals would remain the most advanced destination for the most serious conditions, as they are now. Nurses and doctors would continue to study and qualify as now, but additional intermediate qualifications would be available over a shorter learning time for assistant physicians, either as an end in itself or as a stepping stone to full qualification later. All medical training would be free but those who receive it would be debarred from private practice. Any switch later would require a payment to taxpayers of then cost of training a replacement.

It is obvious that most of this, even as a sketchy outline, is way beyond anything being discussed or planned at the moment. Much of it would be impossible under the current funding model anyway, so it must be read in conjunction with my earlier post on NHS funding.

But if nothing is done except a little of this and that, the days of any return of the NHS as we once knew it, are gone. Moreover the current creaking, decayed national treasure, with its lists and queues and suffering, will finally fall over. So the choice is getting a grip or political oblivion for the government in power when it topples. All politicians should be worried, but the Tories should be very worried indeed.


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