This is an open letter to the PM and the 4 UK Health Ministers, which I will also be publishing on NHSreality in two months time, hopefully with your replies. Please forgive it’s length but health is complex….
If you wish to see the evidence and chronology of the last 6 months NHS’ disastrous decline, please look at www.NHSreality.wordpress.com and list the “posts” or Media links..
- I am asking for an honest debate on a sustainable philosophy for the Health Services. This has occurred in other countries such as NZ and Scandinavia who have reluctantly but pragmatically faced reality and rationed health care overtly.
- I also maintain that there is no longer an NHS, but that voters have not yet grasped this and don’t do so until they are ill. Their relatives wonder if treatment was good enough, but dead patients fortunately don’t vote. This NHS regionalization demise was predicted by Aneurin Bevan (In Place of Fear A Free Health Service 1952 Chapter 5 In Place of Fear) (But no local finances should be levied, for this would once more give rise to frontier problems; and the essential unity of the Service would be destroyed. (note 7))
- The theme of NHS reality is to firstly encourage digital audio exit interviews from any NHS staff for anyone to hear. Such interviews rarely happen in the Health Service, and although I do know of the occasional Trust that has started doing exit interviews I am not convinced that there is a summative and depersonalized annual report to Health Boards reflecting their content. They have never been public, and in most organizations they don’t need to be… because there is not the culture of fear there is in OUR NHS.
- I submit to you that if CEOs, Chairman and Board members submitted themselves to independent exit interviews, made these interviews available “on line”, and encouraged their staff to do the same we might quicker change the cancerous culture of fear currently prevailing. You would need to give them permission to allow their staff to use the word “rationing” even if to deny it is needed!
- Something dramatic needs to be done to change the culture, improve morale and foster the debate. My website is one idea, and a relatively lost voice, and although I have many professional followers through Linked In, Twitter and Facebook, the site will never be enough in itself. It needs leadership from yourselves, and then a takeover of NHSreality by representatives from the BMA, Patients Association, RCN and NHS Federation Managers etc. (for free of course, once they have endorsed NHSreality!)
- It would also help if all politicians and board members were open about whether they had Private Medical Insurance or have personally used Private facilities in the last year. If we are to have Health Boards and Trusts run by people with a completely different personal/family safety net and set of expectations, this needs to be public.
- I submit that the debate will eventually conclude that we will need to ration health care overtly rather than covertly, systematically and nationally rather than by post code/region, and remove regional differences for “important” conditions which people fear. This is especially sad since Bevan’s book title was “In Place of fear: (and chapter 5) A free Health Service”. Thus we should re-introduce prescription charges across the country, and Introduce co-payments for appointments and home visits. (With re-imbursement one month later for those on lowest benefits packages) We should show the cost of every service so that it is evident to the patient, even if they don’t pay for it. The argument in Wales and Scotland should be about whether there is more long term gain by encouraging autonomy than state dependency: not about the cost of administration of prescription charges. Every Politician and Board member should answer the question: “Are some services which are so cheap and that everyone should pay for them, whatever their means?”
- We should restore choice across the UK. Choice does need an oversupply of capacity, and that means training far more professionals, particularly doctors and nurses, and re-financing the expansion of GP premises. I would recommend a shift towards graduate entry to Medical Schools as at this age (22-25 years) males compete more for places and we may get nearer 50% men at entry. Hopefully, eventually “good news” media stories will dominate the critical ones on NHSreality, and the turnaround could begin. Sterile debate such as that stirred by the Week in Week Out program in Wales recently need to be improved. The program never mentioned choice, or free prescriptions! This program, chaired by a facilitator who was not well enough informed, without reference to the philosophy of “In Place of fear” (Read the complete chapter here) or comparison to other countries who have managed the turnaround, and without the politicians in power agreeing to be present, do not help OUR NHS.
- Last but not least, please amend employment legislation, (or the size of the entity providing care?), so that the terribly high sickness and absenteeism rate of the NHS can be addressed.
I and many other physicians are ashamed. We recognize the decline and are lucky enough to be informed. This means we ask the right questions, and are able to be assertive when and if needed, and the service is now designed for assertive people. Many of us advise patients to ensure they have “advocates” when in hospital, and never to assume the system(s) will work. In May my 88 year old dementing mother (In Norwich) had a psychological assessment but no recommendation for treatment (or not) followed as promised. (Eventually I found out (3 months later), by phoning her GP that a recommendation for medication in June had not been acted on! (looks like the drugs recommended are bogus anyway – as a GP I always suspected this) My mother was certainly not able to remember reliably – so I was her advocate and back up. This sort of story is commonplace throughout a failing organization.
I will continue to run NHSreality, pending your response. You are welcome to become followers either directly, through FaceBook, Twitter or Linked In.
Politicians like yourselves need to start the honest debate, and use and explain philosophical principals such as utilitarianism.
Explain exactly what is not available to patients in different parts of the UK, in advance, so that they can plan for these omissions.
Speak out to encourage digital audio exit interviews for all staff, board members, to be placed in the public domain if they agree – without sanction.
Each Health Board or entity should individually declare whether or not they have Private Medical Insurance, updated annually.
Re-introduce prescription charges across the country. Introduce co-payments for appointments and home visits.
Show the cost of every service so that it is evident to the patient, even if they don’t pay for it.
Ensure choice (or restrictions on choice) is available equally across the country.
This means you need to train far more professionals and aim at overcapacity.
Amend employment legislation so that the employer can let go of staff with persistently poor attendance records.
David Cameron -Prime Minister: Reply from Downing Street – defers decision to Mr Hunt
Jeremy Hunt – Minister of Health and Social Security: An attempt at comprehensive
Reply from England whose letter says: “The Government is clear that there will be no compromise on the fundamental values of the NHS: a universal, tax funded service, with equal access to all, free at the point of use and provided according to clinical need rather than ability to pay. These values inform all that the Department does and will not change.” This is a liturgy of denial. He does not address the issues.
Mark Drakeford – Wales Health Minister:
Reply from Wales whose letter wishes me well in my attempts to raise these issues and encourage public and professional involvement. He also adds “Let me provide you with a personal assurance that I have not made use of private Medicine, nor do I have private health insurance.” He does not address the issues.
Edwin Poots – Northern Ireland Health Minister: No reply by 20th February 2014.
Alex Neil – Scottish Government Cabinet Secretary for Health and Wellbeing:
None of them say whether or not they support exit interviews made explicit on NHSreality. None of them address how they will initiate the cultural change needed. None of them address the better value of graduate medical students and the generational under capacity and none of them use autonomy as a desirable goal. Their lack of ideas on how to change is plainly evident by the re-stating of the platitude by Jeremy Hunt (bold type) and no politician or administrator has been able to say how many of their Trust Boards or Commissioning Groups have Private Medical Insurance or what their overhead is now compared to Aneurin Bevan’s 3% in 1952.