Curate's Egg
Here's an intelligent article by Gillian Bowditch writing in The Sunday Times in which she argues that the NHS is like the curate's egg - good in parts.
Now I've been a supporter of the NHS all my life, but that doesn't mean to say I'm not critical of the way in which services are delivered at times and the tendency of people to put the NHS on a pedestal while insisting that the solution to every challenge or problem is more money and resources.
As if the scandal of up to 1200 unnecessary deaths at Mid Staffs Hospital, in a time of plenty, never even happened.
The NHS is the best and worst of systems, but to survive it must adapt
By Gillian Bowditch - The Sunday Times
Shadow health minister Jackie Baillie blamed the SNP for the failures of the NHS in Scotland
If the NHS was a patient, the diagnosis would be dissociative identity disorder, or multiple personality disorder as it used to be known. Psychiatrists are sceptical about the existence of this controversial condition but Scotland’s “best loved” institution exhibits all the classic symptoms.
There was another bout last week. An Audit Scotland report into the NHS allowed shadow health minister Jackie Baillie, who was standing in at first minister’s questions, to paint a picture of an NHS in which progress has been slow, significant change is needed, little planning is in evidence, services are at risk, targets have been missed and budgets squeezed. It is an NHS that most of us recognise.
The same report allowed Alex Salmond, the outgoing first minister, to claim that the NHS has improved outcomes for people with heart disease, reduced healthcare-associated infections, increased in-patient satisfaction, considerably reduced waiting times and presided over a 38% fall in deaths from heart disease in a decade. This too is a side of the institution with which most of us will be familiar.
Like a Dickensian novel, the NHS is a place where extremes meet. It gives us the worst of times and the best of times, often in the same treatment episode and sometimes on the same ward. This curate’s egg of a health service allows politicians to pick at the bits that illustrate whatever point they wish to make.
Where both Salmond and Baillie concur is that the NHS in Scotland is facing a funding crisis. The SNP sets the blame squarely at the door of the Westminster government. The Scottish Labour party blames SNP mismanagement. However, Scotland spends £1,300 more per head annually on public services than the UK average. The NHS budget is topping £12bn, accounting for 35% of all Scottish government spending. The comparable figure for England and Wales is about 15%. Critics say increases in budgets will be eroded by inflation, but inflation is at a historic low.
As with any sufferer of dissociative identity disorder, the NHS is riddled with such paradoxes and contradictions. The first great myth is that it is a national institution or a single entity. In reality it is as fragmented as the Labour party, a series of fiefdoms presided over by managers and consultants of widely varying abilities. The fashion for “evidence-based medicine” and “multidisciplinary teams” implies a cohesion and consistency which simply do not exist in reality.
Then there is this idea that the public have some kind of ownership of the health service. We don’t. We may care deeply about it, as the referendum campaign demonstrated, but anybody who has ever waited in a chilly room in a flimsy hospital gown to be prodded by a clinician with the interpersonal skills of a droid feels as empowered as a day-old kitten.
We are awed and overwhelmed with gratitude when the NHS works as it should, but alienated and impotent when it fails. These are not the traits of ownership.
We rarely engage with it unless we, or a loved one, is ill and that is not a time when we are able to make a cool, rational appraisal. Despite the sometimes heroic efforts of the many excellent people who work in it, we know it is often not good enough yet we cling to the belief that we have a health system second to none.
Perhaps I am overly jaded but having witnessed the untimely death of my mother, admitted for a relatively minor, non-life threatening condition earlier this year to a hospital ward where care was perfunctory and basic human needs went unmet, where despite the pledges of politicians elderly men and women were expected to sleep cheek by jowl in open bays off corridors, I no longer care to defend the hoary old shibboleths of the NHS.
There is much talk of “patient empowerment” and “patient choice” but it’s all doublespeak. In the 21st century, when you can have 15 types of coffee in your local cafe, you don’t have a choice at the time that you need it most. You go where the ambulance takes you, you take what you’re given and you’re expected to feel grateful for the inappropriate food and the scant attention afforded to you.
Recently, I sat next to a young entrepreneur at the Converge Challenge Awards dinner at Heriot- Watt University. The awards were established to help develop high-tech start-ups by graduates of our top academic institutions. Madhu Nair and his colleagues at Saccade Diagnostics won in 2013 for their pioneering work in developing a diagnostic test for mental illnesses such as schizophrenia, bipolar disorder and severe depression. The test, which works by tracking eye movements in patients, is being developed from research carried out at Aberdeen University.
It would be welcomed by NHS psychiatrists treating patients who may be borderline, with symptoms that are not classic or which have been masked by the consumption of drugs or alcohol. Ask the average patient if they believe such diagnostic tools should be available on the NHS after they have undergone a rigorous evaluation and they will say yes. Ask the same person if they believe in the privatisation of the NHS and they will be vehemently opposed.
Any Scottish high-tech entrepreneur will tell you that working with the NHS to develop new treatments or models of service delivery is nigh on impossible, in part because of the knee-jerk hostility of politicians to “privatisation”. But privatisation is only the outsourcing of work to people who can undertake it more effectively and less expensively than the public sector. There are some amazing advances in medicine taking place here in Scotland, but they are often adopted more quickly overseas because the lumbering monolith that is the NHS cannot adapt.
The Audit Scotland report highlights the increasing pressure the NHS faces from an ageing population, the increased drugs bill and preventable conditions related to obesity and alcohol misuse. But while we swallow the sugar-coated myths of the NHS, politicians endlessly play the blame game while consoling themselves that there is no real public appetite for the difficult business of radical change.
Scotland’s health system will have to change, regardless of the politicians. A more reflective and engaged electorate, in evidence during the referendum, may ultimately find that if their elected representatives continue to bottle it, they will themselves have to take the tough decisions around accountability, performance and public funding questions.
According to Anna Gregor, former lead cancer clinician for Scotland, one health statistician has calculated that if health care provision does not change, by 2025 every school leaver in Scotland will be required to work for the NHS to deliver the service. Perhaps that’s how the SNP plans to eradicate unemployment.
We need to wake up to the fact that this “free” service is costing us dear, and that some people are paying with far more than hard cash.
@GillianBowditch
If the NHS was a patient, the diagnosis would be dissociative identity disorder, or multiple personality disorder as it used to be known. Psychiatrists are sceptical about the existence of this controversial condition but Scotland’s “best loved” institution exhibits all the classic symptoms.
There was another bout last week. An Audit Scotland report into the NHS allowed shadow health minister Jackie Baillie, who was standing in at first minister’s questions, to paint a picture of an NHS in which progress has been slow, significant change is needed, little planning is in evidence, services are at risk, targets have been missed and budgets squeezed. It is an NHS that most of us recognise.
The same report allowed Alex Salmond, the outgoing first minister, to claim that the NHS has improved outcomes for people with heart disease, reduced healthcare-associated infections, increased in-patient satisfaction, considerably reduced waiting times and presided over a 38% fall in deaths from heart disease in a decade. This too is a side of the institution with which most of us will be familiar.
Like a Dickensian novel, the NHS is a place where extremes meet. It gives us the worst of times and the best of times, often in the same treatment episode and sometimes on the same ward. This curate’s egg of a health service allows politicians to pick at the bits that illustrate whatever point they wish to make.
Where both Salmond and Baillie concur is that the NHS in Scotland is facing a funding crisis. The SNP sets the blame squarely at the door of the Westminster government. The Scottish Labour party blames SNP mismanagement. However, Scotland spends £1,300 more per head annually on public services than the UK average. The NHS budget is topping £12bn, accounting for 35% of all Scottish government spending. The comparable figure for England and Wales is about 15%. Critics say increases in budgets will be eroded by inflation, but inflation is at a historic low.
As with any sufferer of dissociative identity disorder, the NHS is riddled with such paradoxes and contradictions. The first great myth is that it is a national institution or a single entity. In reality it is as fragmented as the Labour party, a series of fiefdoms presided over by managers and consultants of widely varying abilities. The fashion for “evidence-based medicine” and “multidisciplinary teams” implies a cohesion and consistency which simply do not exist in reality.
Then there is this idea that the public have some kind of ownership of the health service. We don’t. We may care deeply about it, as the referendum campaign demonstrated, but anybody who has ever waited in a chilly room in a flimsy hospital gown to be prodded by a clinician with the interpersonal skills of a droid feels as empowered as a day-old kitten.
We are awed and overwhelmed with gratitude when the NHS works as it should, but alienated and impotent when it fails. These are not the traits of ownership.
We rarely engage with it unless we, or a loved one, is ill and that is not a time when we are able to make a cool, rational appraisal. Despite the sometimes heroic efforts of the many excellent people who work in it, we know it is often not good enough yet we cling to the belief that we have a health system second to none.
Perhaps I am overly jaded but having witnessed the untimely death of my mother, admitted for a relatively minor, non-life threatening condition earlier this year to a hospital ward where care was perfunctory and basic human needs went unmet, where despite the pledges of politicians elderly men and women were expected to sleep cheek by jowl in open bays off corridors, I no longer care to defend the hoary old shibboleths of the NHS.
There is much talk of “patient empowerment” and “patient choice” but it’s all doublespeak. In the 21st century, when you can have 15 types of coffee in your local cafe, you don’t have a choice at the time that you need it most. You go where the ambulance takes you, you take what you’re given and you’re expected to feel grateful for the inappropriate food and the scant attention afforded to you.
Recently, I sat next to a young entrepreneur at the Converge Challenge Awards dinner at Heriot- Watt University. The awards were established to help develop high-tech start-ups by graduates of our top academic institutions. Madhu Nair and his colleagues at Saccade Diagnostics won in 2013 for their pioneering work in developing a diagnostic test for mental illnesses such as schizophrenia, bipolar disorder and severe depression. The test, which works by tracking eye movements in patients, is being developed from research carried out at Aberdeen University.
It would be welcomed by NHS psychiatrists treating patients who may be borderline, with symptoms that are not classic or which have been masked by the consumption of drugs or alcohol. Ask the average patient if they believe such diagnostic tools should be available on the NHS after they have undergone a rigorous evaluation and they will say yes. Ask the same person if they believe in the privatisation of the NHS and they will be vehemently opposed.
Any Scottish high-tech entrepreneur will tell you that working with the NHS to develop new treatments or models of service delivery is nigh on impossible, in part because of the knee-jerk hostility of politicians to “privatisation”. But privatisation is only the outsourcing of work to people who can undertake it more effectively and less expensively than the public sector. There are some amazing advances in medicine taking place here in Scotland, but they are often adopted more quickly overseas because the lumbering monolith that is the NHS cannot adapt.
The Audit Scotland report highlights the increasing pressure the NHS faces from an ageing population, the increased drugs bill and preventable conditions related to obesity and alcohol misuse. But while we swallow the sugar-coated myths of the NHS, politicians endlessly play the blame game while consoling themselves that there is no real public appetite for the difficult business of radical change.
Scotland’s health system will have to change, regardless of the politicians. A more reflective and engaged electorate, in evidence during the referendum, may ultimately find that if their elected representatives continue to bottle it, they will themselves have to take the tough decisions around accountability, performance and public funding questions.
According to Anna Gregor, former lead cancer clinician for Scotland, one health statistician has calculated that if health care provision does not change, by 2025 every school leaver in Scotland will be required to work for the NHS to deliver the service. Perhaps that’s how the SNP plans to eradicate unemployment.
We need to wake up to the fact that this “free” service is costing us dear, and that some people are paying with far more than hard cash.
@GillianBowditch
