The NHS is seventy. Of the great post-war nationalised bureaucracies,it survived; British Railways and the National Coal Board didn't. Whether it deserved to is a good question ...
Much has been said about how much better our health is now, than that of our forefathers seventy years ago. Sure, going to the doctor has helped this, but most of those alive in 1948 had got through a world war (many two), and were still subject to food rationing. (Imagine McDonald's in a world of food coupons...?).
Moreover, the NHS bureaucracy has led to a complacent view that 'things are done right' when they clearly aren't: ask anyone who's ever complained through PALS, or read of some of the horrors inflicted 'out of kindness' at Gosport. One local radio show challenged users to call in and suggest ways the NHS could be better, which is difficult when the program is full of self-congratulatory clips from self-nurses and doctors eating cake. For the record, here are my suggestions for improvements that are desperately needed:
1) Have one, single care record for each patient. At the moment, a patient has a record at each trust they attend - so the patient has to tell the doctors what happened somewhere else. You even get ludicrous situations such as patients having MRI scans on the same part of their bode on successive days, because they turn up in a different hospital and they can't see the one taken the day before. One, single record will ensure that every practitioner treating a patient sees all the available information on them.
2) Hospitals to track patient histories to identify cases of incorrect diagnosis, and statistics on these to be recorded and used for performance assessment. No-one knows how many patients suffer due to an incorrect diagnosis, but when this happens NHS resources and funds are not being correctly put to use. Knowing that it happens and when enables investigation as to why; understanding why will allow for better use of resources and improved patient care.
3) Ban NHS staff from using private health care; also extend this ban to civil servants in the Department of Health, MPs, and members of the House of Lords. A nurse I know needed an operation, and it was arranged for her to have it privately, funded by the NHS. How the heck will NHS staff, or those responsible for deciding how the NHS works, understand how the average NHS patient is treated if they don't use the service themselves?
4) Have an effective complaints process: the PALS one doesn't work. When a complaint is raised it should be investigated by someone independent of the team being complained about; alll PALS do is refer the complaint to that team. (When we complained about a consultant, all PALS did was to offer us a meeting with that individual. there is no way a bank, or the police, for instance, would ask a complainant to meet the person they are complaining about).
5) Be able to provide evidence to patients that specialists can do what they say. When we employ a builder to work on our house, he will exepct to have to provide evidence - case histories, perhaps, or even the name of someone he has worked for: NHS patients are expected to take a doctor's competence on trust. WHY?
6) Don't indulge in news management. Bad news about the NHS often comes out when there is another big story; '250 misdiagnoses by a Belfast neurologist' was recently trumped by an announcement of problems in breast cancer screening that the DoH or NHS had clearly been hanging on to until the right moment for it's release.
7) Have a single appointments system, with a single, 24 hour call centre for appointment queries. Why does every surgery or clinic have a different appointments system, with, often, just one person on the phones, who goes home at 5? Banks provide one number that you call them on, and people available at any time of day. A single appointments system would also allow staff to arrange all of a patient's appointments at one place on the same day!
8) Open up clinics offshore for routine non-emergency treatments - hips, knees, whatever. Operations don't need to be done in the UK; offshoring is common in the finance and IT sectors, why can't it be done in medicine?
9) Integrate doctor and pharmacy IT so that doctors do not prescribe meds that aren't available. Viv and I have twice had to buy (not so good) off-the-shelf alternatives when prescribed something and are told by the pharmacy that the drug isn't available.
10) Manage waiting areas to improve the patient experience. Appointments run late, that cannot always be avoided - but patients should be able to judge how long they have to wait, so they can go for a few minutes' fresh air (why are NHS waiting rooms always airless?), for a coffee, or to the loo, perhaps. Maybe patients should be told what their 'slot number' is for the doctor, and the number of the patient being seen be displayed?
Another option, to reduce delays when one doctor overruns, would be for patients to see one of a small team of doctors, the next patient in the queue going to whichever doctor is free next.
11) A change of attitude to complaints or mistakes is needed. Complaints or mistakes should be events from which lessons are learned, processes changed, and improvements implemented. At the moment complaints are brushed off, and mistakes, if noted by a junior colleague, ignored, as the junior colleague will not want to get a reputation for damaging a senior specialist's career. (Patient safety does not seem to get the focus it should at present.)
