Dr Fraser will see you now

21 July, 2014 (12:29) | All articles | By: Stuart Fraser

The National Health Service is a wonderful thing. Without it my poor nine-year-old would be suffering and maimed for life because of his badly broken arm. With it, he has been treated and will recover. You can repeat that central fact again and again: we all know people who would be dead or in pain but for the care of the NHS. It is a wonderful thing.

But couldn’t it be better?

I’ve had to go near our enormous industrial general hospital twice in recent weeks, and the overwhelming sense, each time, was of a service clinging on by its fingertips, overwhelmed by the demands upon it.

A friend was taken into hospital this weekend but as I write does not know what course his treatment will take because ‘consultants don’t work at weekends’. If only pain and suffering stopped for the weekend too. Consultants at NHS hospitals earn between £75,249 and £101,451 a year. Frankly, for that, I’d make them work every weekend. In their vests. Who the hell do they think they are? Everybody else has to work at weekends.

My father, 86, still hasn’t heard the results of his tests about which I wrote a few weeks ago, by the way. He’s given up phoning his surgery now.

Poor Brother Fiddle has to wait until September for an emergency appointment to examine potential glaucoma.

Last week, a relative was casually told by one hospital which did not really know his case, nor make the effort to find out much about it, that he had developed secondaries to the cancer from which he is suffering. Back under the care of his own hospital a week later, he was told this was nonsense. There were no secondaries. You can, I am sure, imagine the mental turmoil he and his family have been through.

I will never forget the day I met my dying mother, immobile and helpless in her wheelchair, in our industrial general hospital for her appointment which was, of course, delayed: in the hour before I got there not one single person came to tell her what was happening, offer her a cup of tea, check she was OK, give her a smile. Nothing.

A relative with a tumour was told she’d have to wait to hear the results of a crucial scan until her doctor returned from a week’s holiday.

My Jamie had to wait more than five hours to be seen for his operation on his arm, performed under general anaesthetic – so by the time he was treated he had gone more than 12 hours without food and drink. During his long wait not one member of staff volunteered information or sympathy or explanation. Not one.

Another family waiting for treatment actually consulted me and my partner about whether they should go through with it as they had been waiting so long the patient was feeling unwell. There was nobody else to ask.

These two cases, last week, were because there had been an emergency that required attention – nobody told us this, of course, I had to ask. Anyway. An emergency. In a hospital. Well. Who could have seen that coming, eh?

Aren’t emergencies what hospitals are there for? Shouldn’t staffing, planning and equipment be organised on the basis that there will be an emergency, because it is a hospital, and all other treatments staffed and organised on that basis so they can go ahead without causing the suffering of delay and cancellation? If that leaves people standing around doing nothing because they’re lucky enough not to have an emergency, then celebrate the fact and do it all again tomorrow.

It costs money and facilities, of course. But my anecdotes have one other thing in common that is not necessarily to do with cost: the person, the patient, is lost in the system, the machine.

The NHS needs reprogramming to put personal, individual, careful, sympathetic person-centred care back at the top of its agenda. At the moment, it works from the top down – the system is programmed to cater for the pay, the hours, the conditions of itself from the top down. It needs to be reset, so it works from the bottom up and everything and everybody, from cleaner to consultant, is at the service of the patient, and the patient’s needs and care inform what they all do, and when they do it.

It can all be solved.

Dr Fraser will see you now. Pop your clothes off and join me behind the screens. Here is my course of treatment.

1: Cap drug prices, as in France or India or a few other enlightened countries. The pharmaceutical corporations will howl and threaten. Fuck them. I’m not saying remove their profit. I’m saying cap their profit.

If a corporation withdraws life-saving pain-easing treatment because it’s not making enough money from the misery of its patients, send in the Army. Take the pills at gunpoint. But it wouldn’t be necessary. You’re telling me pharmaceutical companies would turn their backs on sales to the third biggest organisation in the world? Would they hell, not at any price.

Corporations are already seeing profits fall because patents are running out. Good. That’ll help them get used to it. Nothing new for them in a drugs price cap.

You’re telling me pharmaceutical corporations need to make big profits to fund research and development of new products? In January 2011 the Obama administration created a new US state research centre because pharmaceutical corporations were spending twice as much on promotion as on research and development.

Pharmaceutical corporations can’t afford a cap? Pfizer made £1.3billion profit in the first three months of this year. The lobby groups, the US PIRG Education Fund and Citizens for Tax Justice, found that in 2013 Pfizer operated 128 subsidiaries in tax havens, announcing $69billion in offshore profits. Novartis, the Swiss giant, had first quarter profits of $2.97 billion.

Cap drug prices. Cap drug prices now.

2: Cut top salaries. 8,000 people in the NHS earn six-figure salaries, according to a Telegraph report this winter. Cut £10,000 from each of them, and £5,000 from all consultants, and if they withdraw life-saving pain-easing services because they’re not making enough money, put them in prison.

But they’ll take their expertise elsewhere? Then fuck them. As soon as the world’s health markets are flooded with former NHS workers putting greed before care, all salaries will fall. And their departure will enable us to recruit younger, more dedicated professionals who start at a lower rate and will welcome the chance to forge a career with a reward that is extremely generous, even if it is £5k a year less than before.

Oh, and use some of the savings to print the names, addresses and photographs of everybody who’s left because they’re earning £10k or £5k less and that’s more important to them than using their gods-given talents to help people.

3: Scrap the internal markets and the illusion of patient choice. It’s a nonsense.

Estimates of the cost of the imposition of Thatcher’s crazed free-market dogma vary massively and are hotly disputed. There is, however, no dispute about the fact that the internal market enables the flow of taxpayers’ money to private business.

Estimates of the costs tend to be based on comparisons of the cost of administering the service before the internal market was introduced in 1990, at around 5% of the total budget, and the costs of administration and bureaucracy since, now about 15%. One estimate puts this figure at £4.5 billion; another as high as £10.9 billion.

There is no doubt, however, that the internal market costs us billions. It’s just a question of how many. So scrap it. I’m with Dr Jacky Davis of the campaign group NHS SOS, who said: “We’re wasting £10billion a year at the moment in the English NHS on a system that nobody wants except the private sector.”

Scrap separate Trusts, scrap internal competition, scrap it all. Put everything together under one administrative umbrella, everything, and re-open district hospitals. Then we might once again have a National Health Service.

The internal markets, the reforms, the drug prices – all of the above are expenses we have to pay for a substandard service so that the MPs who sit on private sector boards, the political parties that accept corporate donations, can pay back their friends from the funds that should be caring for people.

4: Introduce a New Zealand-style no-fault state-administered system of compensation for medical accidents: their central pot, administered independently of politicians, costs money, of course it does. But because this system precludes the involvement of lawyers or court cases to argue expensively over fault, and awards compensation on a nationally-agreed scale, there is a massive overall saving on the way we deal with such problems.

In 2012, the House of Commons Public Accounts Committee put the cost of compensation payments at £15.7 billion for 2009-10, a third of that going to lawyers. So cut that third out, put the remaining £10billion into a New Zealand-style fund and – hey, let’s not be callous about this – put £40 or so into a national help fund for impoverished lawyers.

5: Scrap this Government’s unwanted NHS reforms right now. Fine the politicians who voted for it so we can recoup at least part of the £1.1billion it has cost so far to allow GPs to manage their own budgets, for example.

The National Audit Office, reporting in July 2013, said the Department of Health had no robust figures to back its claim that the total cost of the reforms would not exceed a predicted £1.7 billion.

Hundreds of millions were spent on making NHS staff redundant, yet a quarter of them were re-employed immediately and many trusts were left short of staff in front-line services – immunisation was highlighted by the NAO as a particular cause for concern.

But hey! Don’t take the word of this amateur. Listen to the Royal College of General Practitioners, whose chair Professor Claire Gerada said: “This is a flagrant waste of money.” In a poll on its website gponline.com, respondents were asked if the Government’s NHS reforms were a waste of money. 95% – ninety-five per cent – said ‘yes’.

6: Collect together all the public relations, marketing and media strategists employed by the NHS. And then sack them.

A BBC report in 2013 revealed London hospitals alone had paid £13million over three years on PR. Across the city 82 press officers were employed at an average salary above £37,000.

Sack them. Make multi-billionaire newspaper owners like Rupert Murdoch employ them on local newspapers to cover councils, courts and the actions of local democracy so that people are re-engaged with the world around them and start taking part in the lives of their communities again.

If any NHS Trust has spent money on anything like a logo, for example (like Chelsea Children’s Hospital, who paid more than £10,000 for a logo and ‘branding merchandise’), sack those responsible and burn the logos and ‘branding merchandise’.

Before 1981, the NHS across the entire country employed 8 – that’s eight – press officers in total.

7: Use some of the savings we’re identifying here to make more savings.

For example, pay half of the press officers’ salaries to junior doctors to stand in A&E and, when Mrs Miggins turns up demanding treatment for flu or Timmy Miggins turns up because Mummy’s worried about the cut on his ickle finger, tell them to fuck off or they’ll be arrested for wasting everybody’s time and money.

Use some of the money to put up big posters at the doors of casualty departments saying: “If we treat you and the doctor says this was not a real medical emergency, we’ll charge you every single penny piece the treatment has cost you, you dickweed.”

All simple, isn’t it? But all those companies and lawyers and corporations and consultants who bankrolled the Tory Party want something back for their investment, so we’ll have to wait a while yet to put people first.

The old argument

It’s all the old argument, isn’t it? Idealism against expediency. What you say is all very well, Stuart, but it’s not like that in the real world. For all that, nobody has ever given me a good reason why idealism is wrong.

What a baffling thing is the human race. James Garner died this week, and Twitter’s been broadcasting a lovely picture of him holding hands with the black actress Diahann Carroll during the 1963 march on Washington by civil rights protesters, a simple act of decency on the side of right against might that, at the time, might have cost him his job, his future, even provoked violence against him. But he did it.

History is of course full of the most noble acts by the finest people, but it is also full of the vilest acts by the most disgusting people. None of this is new, but what is upsetting is that we have learned from, or desire to change, none of this: Putin can still lie because good is afraid, Israel can still murder because good is cowed by money and influence, the poor and weak must still suffer not because they are wrong, or evil, or deserve it, but because they are poor and weak. So much for history. So much for the human race.

For what it’s worth

Don’t suppose there’s much point adding my few pathetic words, but for what it’s worth: what Israel is perpetrating in Gaza is a crime against humanity. The savage cruelty of their indiscriminate killing is an atrocity.

A nation part-built by survivors of the greatest crime ever committed against humanity is disgracing the names and memories of those millions of victims of the Nazi holocaust by turning weapons of mass destruction upon women and children.

The world’s – especially America’s – explicit permission for the appalling suffering of Palestinian families is shaming. Shaming.

Nothing that terrorists have visited upon Israel deserves the deaths of innocents, the robbing of homes, the theft of land, the construction of walls and barbed wire. Two wrongs have never made a right, and Israel’s fascist brutality is making the situation worse. Has done since 1948.

Israel refuses to understand that there will be a reckoning. A terrible reckoning. And the world does not understand that standing by Israel’s terrible crimes has been bringing upon it a wider reckoning.

Allergies

Fair play to my Jamie following his arm-breaking fall from the monkey bars. During his long wait in hospital for his operation, he was asked if he was allergic to anything. “Yes,” he said. “Monkey bars”.

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