Wednesday, 29 July 2020

NHS Perspective

Let's get this straight, so the absolutists are dealt with from the start; I think the NHS is a great idea. But the way it is run is typical of an uncontrolled bureaucracy; it is dysfunctional and too often not capable of fulfilling its primary role.

A graphic example of this was of course, the recent decision to send elderly patients, untested, to care homes (whilst simultaneously diverting PPE away from said homes). There is no way to view this as anything other than completely crazy.

Prior to 1948, more was done as a collective effort at local level, with well intentioned doctors. What often was the outcome was that local hospital you may dimly remember. The one that was closed by the bureaucrats to 'centralise' 'healthcare provision' in 'supercentres' that would be better able to provide a full range of services. Plus save money.

Well, that hospital was probably paid for by local subscription, by people keen to ensure they had medical assistance locally. And the NHS gladly received it, without paying anything for it, when the NHS was set up. Seemed a good deal at the time, bearing in mind the state would now provide and cover the costs.

Up until they don't. Then the hospital gets sold and the proceeds, for no discernible reason, went into the NHS coffers. Not back to the local community, who had more claim to the title.

Like many other successful projects of the Left, such as destroying education (except for an elite) and increasing the power of the bodies surrounding and controlling elected politicians, the NHS now has an almost perfect system, within the parameters of state control.

Set up specifically to treat sick people and make them well, hospitals have transmogrified into industrial warehouses. Naturally, some medical staff do stick to some of the traditional tenets, but it soon gets beaten out of them (or should they highlight medical negligence, with dismissal).

Under the auspices of a managerial class, hospitals are now concerned with output while talking about outcomes. Once a patient came into a hospital and the objective was to discern what ails them, to take them through restorative medical treatment, whether drug treatment or surgical, and once satisfied to allow them to return home.

Now the 'customer' is a number, a nuisance. Something to get out of the system as soon as possible - a successful outcome, for the system. A single discipline will consider the subject, for example, if a GP refers a patient believing the cause to be cancer, you go to oncology. If the condition is not cancer, they will not be passed on until every possible test has been done to prove cancer.

This may be detrimental to health of the 'customer' but it is clean for the system. Treatment, once decided on, will be monitored for cost control and the pressure is on the 'free up the bed'. Discharge will be effected as soon as possible and without reference to the suitability to the 'customer'.

An elderly person may be given the news that they can go home with great enthusiasm and not a little hurry up, at 2am on a Friday, when they have no money. Hospitals are keen to get people out before the weekend, when there will not be enough staff on to cope. Once again, all thought is on the effects on the system.

Once gone, a green tick is applied to the chart and the system clocks up another success. Now the bed is free for the next person who relapsed through having been discharged too early. There is no penalty for that and, while being an annoyance to the system, it still keeps it clean. (What do you mean, what about the patient?)

Hospitals are not about healthcare any more, they are about getting people through the system as quickly as possible. We are to be grateful they exist. But they are supposed to exist to treat the sick, that is their raison d'etre. But what is wrong with you when you come into contact is no longer, really, of interest. 

This is just a snippet to provoke thought on the subject, because it is extensive and constantly feeds bad practice and wrongly focussed effort. This bureaucratic maladministration is causing so much harm and is way beneath the talents and abilities of the British people. 

Consider how Grenfell happened and the pathetic response to it. Watch the reality programme about the ambulance service and have the sympathy for the pressure they are under evaporate, when having just heard they now have no ambulances available, but have sent two ambulances to a suspected heart attack, because that is 'protocol'.

The NHS is a great idea, but you know, instinctively, that no private company could survive operating as it does. It doesn't need to be privatised, it just needs to be run properly. 

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