A patient’s-eye-view of an upended NHS England

By Harry Hagopian
February 14, 2018

I respect my new GP. He is a much younger version of the one who saw me through a rough chapter of my life when I spent more nights in hospital wards than in my own bed. My GP is also amiable, helpful and knowledgeable. Having worked and trained in a hospital before becoming a General Practitioner, he has witnessed a lot of human illnesses, traumas and fears.

But my GP is also frustrated because of the stress of working in the English NHS and trying to cope day-in-day-out with a conveyor belt of patients who have few precious but sparse minutes to explain their symptoms, get a diagnosis, pick up a prescription and walk out of the surgery. Easy? No. Hard? Yes.

During my most recent appointment, as I waited to be called in, the reception manager handed me an iPad and invited me to fill in a survey about the performance of the practice that I have been visiting for almost four decades. I was asked to use three words to describe their performance. I chose Empathy, Care and Understanding.

Now those three words are not the medical ones that some other patient might have chosen for the survey. But I chose them because a surgery – and a GP – is much more than pills, vaccines or tests. They are often the bridge between the deep frustration often experienced by human beings (no matter how young or old) and the hope we all chase during those harsh moments. Sometimes just seeing the GP is enough to inject a man or woman with a dose of renewed zest and refreshing energy.

This is why I regularly become irate when I watch on the television all those tired patients who cannot receive their treatment promptly and who at times are unable to access their physicians. Just as I became irate when our Foreign Minister promoted his infamous red bus and promised that Brexit will help the NHS claw back £350 million a week after we had left the EU. Really? I think many of us – whether Remainers or Brexiteers – have seen through this political piffle that was meant to help sway our referendum vote in an exiting direction. And to add insult to injury, Nigel Farage and President Donald Trump plunged into the argument, with the latter tweeting that immigrants are the reason for the meltdown of our health service. A clear example of Fake News.

However, and much as we are stoical about the NHS, it is undeniable that this winter has been another example of how overburdened the health service feels – whether because of an exotic variety of flu, or because there are no beds available in the wards, or when fire fighters have to replace ambulances that are unable to cope with the rush of emergency calls. So what can be done to help save the NHS and pull it away from those who are slowly edging us toward a privatised health system and private insurances?

Amid the welter of current suggestions about financing a public health service sustainably (which is the key question), let me raise three issues which are controversial, but which need to be considered carefully as part of a necessary debate about the future NHS. 

First, it is noted by many in the profession that a significant number of beds are occupied by elderly people who are often also drawing their last breaths. Sadly, this is happening across many Trusts because there is a painful shortage of suitable accommodation for them at the last stage of life. So they often end up long-term in different wards. A lot of those men and women have often been active and productive members of society and are now drifting away without society showing them enough gratitude in their twilight years.  But should this dilemma – between the compassion we feel and the reality of our modern needs – not be addressed so medics and nurses can focus on those who have a chance of getting better rather than taking care of those who only need empathy, compassion and palliative care? This problem needs to be resolved by seeking bold solutions outside the current parameters.

Second, we must also ensure that hospitals and clinics, as well as walk-ins and A&E departments, are not over-stretched by meeting the needs of people who do not suffer from life-threatening physical ailments, but who need shelter or a free bed, or who otherwise have what in reality are non-serious and non-emergency ailments. After all, not only are we living longer and therefore need the NHS resources much more frequently, the fact remains that many more people – including EU and EEA citizens – are now benefiting fully from our health service. With Brexit at our doorsteps, should we not have the foresight to plan for the future instead of blithely promising funds (that we need for other services, too) and change that we seemingly lack the political will to apply? The question here is who drives ‘reform’ and how the larger economy can take health seriously.

Third, however, the critical point (that my pharmacist wholeheartedly endorsed in a recent conversation) is as to whether we should levy a special tax payable by all those who earn over a certain amount per annum that would go toward sustaining the NHS in the long term. I realise that hypothecation can create dangers as well as opportunities, and that raising taxes per se is not the preference of all political parties, nor of many taxpayers for that matter. But I am confident that most people earning a decent income will be willing to contribute to the coffers of the Exchequer if it is made crystal clear that the monies collected will be earmarked toward helping firewall our NHS. We simply cannot afford to allow this system to splinter, with increasing numbers of nurses and graduate doctors leaving the profession.

My pharmacist also reminded me of the fact that we in the UK depend to a large degree on costly imported medicines because we lack enough manufactures in the UK. So we often run out of stock and are not wrong to worry what will happen post-Brexit. Moreover, it seems the cost of those medicines goes up and down as suppliers attempt to increase their profits. The outcome is that very expensive medicines increase the debt burden of the NHS. Changes to investment, production and procurement are a serious matter in this area.

The National Health Service has become for many people across the UK a belief system of sorts. But in reality it is more than an idea. It was for me a life-saver on two separate occasions. And for many people, it is the embodiment of a human right that we all are meant to be proud of let alone enjoy in our developed societies. But such a human right clearly implies a collective societal responsibility.

So will we stop making interest groups richer? Will patients suffer for longer periods? Can we reform the system in a way that the patient – me, you, our kith and kin – benefit from the outcome? Or will we lurch from one crisis to another, from one winter season to another, and from one expensive cancer treatment to another, until such time as HM Government of the day claims that privatisation is the only egress to the dilemma?

I am confident that many medics and nurses, as well as ancillary staff and large numbers of the UK population, will oppose privatisation since it goes against the grain let alone against Nye Bevan’s own philosophy when he set up this wonderful – and unique – NHS in 1948.

But all this needs resolve and not drift, courage and not shilly-shally. After all, when talking of empathy, care and understanding, tough love is at times the best kind of love.

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© Dr Harry Hagopian is an international lawyer, ecumenist and EU political consultant. He also acts as Legal Consultant to OTS Solicitors in London (particularly on Brexit & immigration issues). He is an Ekklesia associate and regular contributor (http://www.ekklesia.co.uk/HarryHagopian). Formerly Executive Secretary of the Jerusalem Inter-Church Committee and Executive Director of the Middle East Council of Churches, he is now an international fellow, Sorbonne III University, Paris, and author of The Armenian Church in the Holy Land (The Russell Press).  Dr Hagopian’s own website is www.epektasis.net -- follow him on Twitter here: @harryhagopian and on Facebook here: https://m.facebook.com/MENA.analysis/

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