Tuesday, 18 July 2017

Breathtaking incompetence - a monumental shambles in their hands

I've been reading Rachel Clarke's book over the last few evenings and this is what has inspired me to ramble on the blog today.  The mixture of humanity, sharp analysis and reasoned argument makes Rachel's excellent book absolutely essential for anyone interested in medicine, the NHS or healthcare.  The way in which the government have ignored precisely this kind of incisive intelligence sums up why we are in a right mess today.

It's worth going back to square one and analysing just how fast so many situations on the NHS have deteriorated.  Generally before the Conservatives took power in 2010, many of the crises which exist today did not exist.  The disastrous recruitment situation regarding junior doctors, consultants, nurses, physios, OTs and GPs did not exist pre 2010.  The number of small GP practices closing has rocketed since 2010.  The social care crisis has been a recent phenomenon in the context of huge real terms funding cuts.  The  deterioration in AE waits and elective treatment performances have all happened post 2010.

Certainly nothing was perfect pre 2010 and disasters did happen, however it is fair to say that the system wide failure that we see today definitely did not exist in that period before the Conservatives took power in 2010.  This is a point which Rachel Clarke makes eloquently in her book, despite all the hot air spewing forth from Jeremy Hunt's orifices, nothing solid has actually been done that has improved the reality of the care on the front line of the NHS.  All we have seen from Hunt is smoke, mirrors, propaganda and dangerous arrogance.

Nowhere is this better demonstrated than in junior doctor recruitment and retention.  Things were steadily declining from around 2012 onward, then Jeremy Hunt bullied and imposed a contract upon doctors, unsurprisingly things have only got worse as a result.  Current recruitment data is dire, almost one in 5 paediatric jobs are unfilled and specialities that were previously massively oversubscribed cannot even fill their training numbers.  The ins and outs of the contract debate are complex, Rachel's book portrays a very accurate picture of events.  The imposition of a contract remains a great example of Hunt's overt ineptitude and arrogance in one, it can never make sense to force something upon ones employees, particularly when recruitment and retention was in such a dire state in the first place.

There has been too much ineptitude from the likes of Hunt, the Department of Health and their minion NHS England to summarise it all without writing several volumes of dense text.  However it remains clear that until we have some candour and apologies from the dictators at the top of this authoritarian shambles then things will only continue to get worse.  Fundamentally leadership is about listening and the current leaders at the top of the NHS have their earplugs in.  The bottom line is the NHS is crumbling because our political system has failed.  You get what you pay for in life and there are no magic solutions, meaning promising the hollow gimmick of '7 day services' without any funding or staffing to enable it can only result in a dismal own goal.  Until our leaders are honest about what can be sustained with skeletal funding then we'll continue to see the service crumble and staff flee for greener pastures elsewhere.  Rachel Clarke has hit the nail on the head and Jeremy Hunt should be deeply ashamed of himself, alas for that to occur he would have to exhibit a degree of insight, something he has not demonstrated to this day.


Anonymous said...

Pre-Coalition, things weren't great, and conditions were begining to get worse, however that decline has accelerated under the present government. Unfortunately, anyone pointing out the trend in health policy-with its ultimate goal of an insurance-funded/privately-delivered health system-is likely to be dismissed as a conspiracy theorist.

Things are now very bad but they are going to get a whole lot worse!

The JD contract has been a disaster and its impact is being felt across the UK. Those running healthcare-at national level and within hospitals simply dont care, they are only focused on sweeping problems under the carpet and hitting impossible targets. Why would an intelligent JD sign up to 7 years of speciality training to endure the ordeal that the average DGH acute consultant faces?

I've not followed the in-fighting among JD reps around the way the BMA handled the dispute. Some of it smacks of student union politics and petty in-fighting between the sort of people who've never truely represented the best interests of juniors. However, without doubt, those representing our profession, nationally, have let juniors down. These roles attract the politically ambitious and many medical leaders have betrayed the profession, in pursuit of personal reward.

My one concern is that personalising this, as some sort of dispute between Jeremy Hunt and doctors is an error. 99% of medics are ambivalent about medical politics. Most senior doctors are, instinctively, Tory or Lib Dem supporters. The JD contract dispute and the destruction of the NHS are very political issues. Those leading major UK politiccal parties have been complicit in a policy to introduce health insurance and outsource the provision of healthcare. Making this out to be one man against doctors is a mistake. This has nothing to do with Jeremy Hunt-he is just a bit player, who'll walk off to lucrative sinecures, when he quits politics. He'll be relaced by another careerist, in the back pocket of the corporate lobbyists but the same policies will continue. Hunts successor will have lots of warms words about working with health professionals, but pay will continue to flat line, rota gaps will get worse and we will continue to see worse care, in an overstretched service.

Healthcare isn't unique, we are seeing similar policies across the public sector, from education and housing to the justice system. The public want decent services but they vote for political parties that promise low taxes and a magic fix, with yet more managerialism. Medics that I speak to, from across England, describe conditions identical to Mid Staffs, yet there are medics in leadership positions, within healthcare, who allow this to continue and medical politicians are silent about the impact this has on our patients.

The NHS has always had its faults but its light years better than healthcare provided by large corporates. We really need all doctors to pull together. The petty squabbles between medical politicians detract from this. We really need to get together and fight for a properly-funded NHS, delivering safe care before it is too late. We should fall for the tired tropes about unlimited demand and unaffordability, whilst there is money for management consultants and large corporates, we cannot say that the NHS is unaffordable. There are some things the NHS cannot provide and there is way too much wasted on the contrived purchaser/provider split, but universal healthcare is possible and its worth fighting for.

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