Weak is an inadequate word: cowardly and lacking any leadership or sense of long term duty to the truth is more like it. But Gillian Bowditch is right, and if Scotland has problems with it’s spending, Wales has a problem with expectations, ignorance and lack of debate. Politicians of all regions have a problem with honesty, thinking longer term, and questioning something they know is failing from the multiple letters they must receive. The Media has also got a problem, as they have failed to get the appropriate sustained debate that is needed.. Are they also in denial, or is health just too complex, nuanced and polysyllabic for them all? is an illustration of the effect. Its endemic and universal failure, (see end of post). NHS reality calls on the wives of politicians, health managers and administrators to speak out. It seems no one else will. How health stories can swiftly turn all too real –
When it comes to the NHS, it is hard to know what will be the straw that breaks the camel’s back. We can be fairly certain that when it does, the camel will spend more than four hours in A&E, before being shunted into a corridor on a trolley by a harassed junior doctor working above his pay grade while trying to locate a suitable bariatric bed and a surgeon who can carry out humpectomies.
One thing everyone is agreed on is that the current model of healthcare is not sustainable in the long term. The question is: how sustainable is it in the short term?
Last week Audit Scotland published the latest of its excoriating reports into the health service. Looking specifically at the Scottish government’s 2020 Vision — the blueprint for a new, integrated care system whose laudable goal is to allow Scots to live longer, healthier lives at home — the watchdog says the shift to new models of care is not happening fast enough to meet growing need.
The new models of care in place are small scale, geographically limited and unevaluated. Audit Scotland says the Scottish government is not providing the necessary leadership to make its proposal work, has no clear measures for success and doesn’t know how much money it will take, or whether the funds can be found from existing and earmarked resources. It is more a dystopian nightmare than a vision.
There is a vast unmet need for care in Scotland. People who rely on carers to get them up in the morning and feed them are, in some cases, waiting more than a year to access services.
More than 300 Scots died last year while waiting for care packages to be approved. In the words of Gordon Aikman, who has campaigned tirelessly on this issue: “There is a real human cost. It is vulnerable people sitting in puddles of pee.”
The number of frail elderly people over 85 with complex health needs is expected to increase by 64% by 2030. If current levels of demand continue, an extra 2m GP consultations a year will be required by then, along with a 33% increase in the number of care packages required and a 35% increase in the number of care home places needed.
But we are facing a GP recruitment crisis. One in five surgeries in Scotland is short of at least one doctor, and 42 of Scotland’s 987 practices have been placed under the control of health boards, a measure used in emergencies and special circumstances. The situation is expected to worsen, as 34% of GPs are over 50. If the recruitment crisis continues, the Royal College of General Practitioners has warned Scotland will be short of 740 family doctors by 2020.
Alan McDevitt, chairman of the Scottish general practitioners committee of the British Medical Association, has expressed surprise at how quickly the GP recruitment crisis has led to instability in the system. “We knew it was coming but we didn’t think it would happen quite so fast,” he told GPs recently, warning that the “nightmare scenario” would be queues of ambulances containing elderly patients lined up outside hospitals.
Shona Robison, the health secretary, claims Audit Scotland’s report does not fully take into account the extra £250m allocated for health in the 2016/17 budget, but that is like offering a computer to a starving child. Money isn’t the answer any more.
We spend 35% of Scotland’s budget on health and this year we will spend more than £12bn on the health of 5.34m souls. According to Dr Anna Gregor, formerly the lead cancer clinician for Scotland, health statisticians have worked out that if we carry on with the same healthcare provision as we have now, the increasing demand will mean that by 2025, every school leaver in Scotland will be required to work for the NHS.
How health stories can swiftly turn all too real (The Times Notebook 14th March 2016)
Just after 9am in central London last Thursday, Rita, my mother-in-law, was put under for a 12-hour operation at the Royal Marsden Hospital. The warning signs of rectal cancer had been missed by her GP over 18 months, despite heavy bleeding and discomfort, and the tumour had grown, and the cancer started to spread.
At precisely the same time, two miles away, James Titcombe rose to speak about the death of his son, Joshua. He told the Patient Safety Summit that clinicians had missed warning signs of infection soon after his birth, despite attempts to alert them, and that Joshua died after eight days of suffering.
But the tragedy was made far worse, he said, by the fact that the hospital didn’t learn from it. A report would conclude that 11 babies and one mother died at Furness General Hospital because of a “lethal combination of failures” at every level of the system.
All would have been saved if the lessons had been learnt earlier. A culture of blame, evasion and inertia stopped that happening.
When I visited Rita on Saturday, she was in pain but stable. Surrounded by tubes in the ICU, she talked of her gratitude to the surgeons and nurses. “They’ve been heroic,” she said through a haze of morphine. “They couldn’t have done more.”
Heroism isn’t enough for safe care unless the system is capable of learning from its mistakes. The conference heard that 7,500 die annually in England because of avoidable error. It also
heard about a suite of measures aimed at reducing this, including a “learning from mistakes” league table, an independent accident investigation branch, and safe spaces for clinicians to speak up about errors.
Rita will live with the complications for the rest of her life, most of which wouldn’t have arisen had the cancer been spotted sooner. But have these mistakes triggered learning? The responses we have received so far suggest not. Which is why the sooner the new measures feed into a culture of true learning, the better.