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Patients First – A personal view of the ailing NHS

When my husband was dying three years ago we experienced the trauma created by a chaotic system of so called joined up care in the community.

We witnessed lack of communication between services at the most basic level, astounding waste of professional time and money in the same assessments being repeated many times, delivery of equipment which was inconsistent with his developing health problems, absurd restrictions on professionals carrying out basic procedures, gross over-prescribing of medication based on a computerised repeat prescription system and most distressing of all, lack of access to urgent care.

Following his death, I had a number of meetings with senior professionals from all levels of health and community care involved in his case, and it was our hope that improvements would be made in the future.

The current crisis in the health service is not simply a matter of money or an ageing population. Within the multi-faceted maelstrom the focus has shifted from putting the needs of patients first to one of money, resources and “systems”.

Examples include:

  1. Patients who are medically fit for discharge from acute hospital beds, but not fit to return home to look after themselves.

It can take days or weeks for community care to be implemented even after patients have been sent home.  These patients need continuing care.  This used to be done by smaller nursing units housed in convalescent homes, nursing homes and cottage hospitals, no longer in existence.  A return to these GP linked local residential nursing units could help to relieve the pressure on beds in large acute hospitals.

  1. Patients clearly need 24 hour access to primary care to ease some of the burden on A&E units.

A & E departments also need more doctors, nurses and beds to provide the patient care they were trained for.  Surely, instead of reducing the number of A&E units and locating in city areas we should be increasing them and the staffing levels within them. If necessary  additional A&E admission wards could be built alongside them.

  1. Medical staff at all levels in the service are apparently under unprecedented pressure. This was illustrated last year when junior doctors took industrial action in protest against the imposition of new contracts. Rather than expecting more from existing medical personnel, the service should be increasing the number of trained doctors and nurses working within it, so that all staff can work efficiently within safe limits for the benefit of staff and patients

  2. Millions of pounds are wasted in tiers of “intermediate” services designed to filter but also effectively delay patient access to health care professionals.

Delay in treatment potentially prolongs the period of ill health, can result in readmissions, clogs up the health service and costs millions of pounds in staff who are unable to provide advice or treatment directly to the patient. Sick people need access to medical staff with the qualifications to make medical decisions.

  1. In our experience medical staff did what they could, but availability to treatment was often decided by a tick-box culture which could not take the needs of the patient into account.

This “system led” culture persists at every level of patient encounter – one example being the 111 service –  patients usually have to go through an automated telephone multi-layer queueing system to speak to an operator and then, despite explaining symptoms, they are asked a battery of questions totally unrelated to their individual problem.  While designed to ensure safety, these procedures waste much time, delay patient access and often result in referral through to the emergency services when consultation with a doctor is what is needed.

While more money and systems can be poured into this acutely sick patient, until the whole structure of the NHS alters to put patient needs at the head of the agenda,  money and vital professional resources will continue to be wasted at all levels in the system.

Patients need doctors and doctors need to be able to make medical decisions based on a patient’s presenting medical needs at the time.   While recognising that the NHS is grossly underfunded in relation to the demands place upon it, putting patient needs first should be the starting point for assessment and treatment of this severely ailing service.

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