7 Ways of Fixing the NHS

Note for USA readers: the National Health Service is a very large bureaucratic health-care system that was started in Britain in the late 1940s as a way of providing medical care to everyone that was free at the point of delivery. In other words, in Britain, when you get sick or hurt nobody asks for your credit card.

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There are many problems with this, not least the gob-smacking cost of it (c £106 billion per year) which comes out of our taxes – the NHS is very far from actually being free. However, when my late husband had lung cancer ten years ago, he had treatment from the NHS worth around $1 million at today\’s rates and we didn\’t have to pay a penny or sell our house or go bankrupt. I am enormously grateful for that.

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You can think of the NHS as a bit like a police force. You could have crime insurance and the insurance could pay for you to employ your own bodyguards or detectives from a specialised company when there\’s a crime wave in your area or when your child\’s just been kidnapped. Or you could pay more taxes and there would be a State-operated and run police-force which would protect you without you having to pay them directly. Alas, demand for both socialised policing and socialised medicine seems to be effectively infinite.

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I was thinking about all this while sitting next to my mother in a large NHS hospital after she had a mild stroke. Any kind of sleep or rest was impossible and she was terribly agitated by all the noise and activity. I\’ve written about the scandals going on at the moment. So here are some ideas for improvement.

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1.  Find another way to attract nurses\’ attention apart from beeping. The number of little boxes on stands with flashing lights going beep in a four bay ward is staggering.  A nurse eventually rushes in, presses buttons, checks patient, sighs, presses more buttons. The beeping stops and the nurse rushes off. Three minutes later the beeping starts again. A particularly aggressive beeper was attached to a little sensor on a patient\’s thumb to check how much oxygen was in her blood. Every time it slipped from her skinny thumb, the alarm went off.

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2.  People like my mother are a nightmare for hospitals. She had a stroke, she needed immediate medical care and she got it. But she has Alzheimer\’s and vascular dementia, keeps waking up frightened, not knowing where she is, hates the hospital, hates the busy nurses walking around, hates the hospital food and refers to any non-Caucasian (and often considerably sicker) patients as \”Filthy\” because she\’s lost most of her social inhibitions. The Caribbean and Indian nurses are incredibly patient and understanding, but find it understandably a little wearing. I find it very embarassing. Maybe UKIP could set up some immigrant-free hospitals? Good luck staffing them.

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3.  Round up all senior NHS managers, if necessary at gunpoint. Yes, especially former Communist Sir David Nicholson,  He Who Must Not be Sacked of mid-Staffordshire hospital scandal fame. Lock them in a room with no water, food or toilets. Present them with ten 30 page folders of forms to fill in while answering phones, talking to anxious relatives and taking difficult, unco-operative old ladies to the toilet and back at a snail\’s pace. None of them can leave until all the forms are done.

Bring in fully-rested inspectors to check they\’ve done it right and make them do the whole lot again if they haven\’t. They have to go through all this every single time they introduce a new form for nurses to fill in.

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4.  When you do feed the Senior Management, give them hospital food.

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5.  Let them watch nurses being handed wads of money while they get a grudging couple of quid. Then tell them half of them will be fired tomorrow to save money.

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6.  Obviously all NHS managers should spend a year as a Health Care Assistant first. All of them should spend at least one week every  year doing the job again at the worst performing hospital they deal with. No, of course they can\’t have private healthcare.

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7.  While you\’re at it, also sue the makers of the bins labelled \”quiet-closing bin.\” Or lock them for 48 hours in an echo chamber surrounded by their quiet-closing bins, clanging shut every thirty seconds or so. Whichever.

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One kind Asian nurse looked at me and said \”In my country, much less paper. We say: more paper, less care.\” Then she shrugged and went back to filling in the forms, while the beepers beeped and the quiet-closing bins clanged around her.

How to find the Bad Guys in the NHS scandal.

After the wonderful tribute to the NHS during the Olympic Opening Ceremony (if you\’re American, you may not have seen it – see a clip here, buy the full DVD here), the NHS has been basking in its popularity.

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Unfortunately, there has been trouble brewing in the NHS for years. Its proudest boast is that it\’s free at the point of delivery. This means that at exactly the moment when you\’re most likely to be unable to pay for medical treatment, you won\’t have to pay for it. When you\’re ill, the NHS treats you for nothing.

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I have good cause to be very grateful for this: when my husband Chris fell ill 13 years ago with lung cancer, he had what the director of a famous US cancer clinic called \”the gold standard treatment\” which would have cost us at least $250,000 at the time (more like a million dollars now). He didn\’t have to make the choice too many American cancer victims have to make, between having treatment and beggaring his family. The entire cost of his operation, radiotherapy and chemotherapy was borne by the NHS.

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No, he didn\’t get better – like most people then with the kind of cancer he had, he died 18 months later. But me and my three children (14, 12 and 6 years old) weren\’t homeless or destitute either.

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However, there is no such thing as a free lunch and the NHS isn\’t free either. It\’s hugely expensive. UK citizens pay for it through taxes. It\’s a massive bureacracy, employing 1.7 million people and costing £106 billion per year, or thereabouts. Like most large bureaucratic institutions it\’s very hard to know what\’s going on inside it.

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There were signs of trouble when Chris was in hospital all those years ago. The oncology ward at the Royal Cornwall Hospital, Treliske, where he was treated for his cancer was spotless, well-run and caring. The consultants were expert and the nursing was excellent.

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Unfortunately the first ward he was on before he was diagnosed, a general one, was a rat\’s nest. It was disorganised, dirty, untidy. The food was terrible. I have very low housekeeping standards, but the showers and toilets he was expected to use were so filthy, I brought cleaner and bleach in and scrubbed them. I also brought him food every day because he couldn’t eat the stuff he was offered. Later, while he was having radiotherapy at Derriford hospital in Plymouth, he caught intestinal worms.

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The trouble has clearly got a lot worse since then. There have been some horrific scandals – Mid Staffordshire hospital for instance – where, in 2007, patients were left dirty, hungry and so thirsty they drank from flower vases. Some of them died. This was at a time when the Labour government was pouring money into the NHS and imposing a complicated set of cost-cutting targets and management systems.

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The NHS bureaucracy is protecting its own and bleating that nobody should be \”scapegoated\” ie blamed.  Conversely, the media are baying for blood – not unreasonably asking why Sir David Nicholson. the person who was in charge of the Strategic Health Authority overseeing Mid-Staffordshire at the time, is now head of the whole NHS Commissioning Board. There\’s huge confusion over how these scandals could have happened. People blame something called \”the culture\” or even the nurses.

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OK, so this is my take. Every single account of shocking neglect I have read has included the words \”staff shortages.\” Not only were the wards dangerously understaffed, most of the staff they did have weren\’t even nurses, they were unqualified \”health care assistants.\”

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Wherever a ward is disastrously understaffed, a kind of evil selection takes place, as I said on Facebook. Good nurses either leave because they won\’t lower their standards, burn out trying to maintain them or complain and are forced to resign. Those who stay will be the ones who don\’t care, keep their heads down and get on with box-ticking. Over time this means that the only people working on that ward will be unprofessional, uncaring and possibly even sadistic.

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Meanwhile the professional bodies were corrupted and went over to the management side – while the management are exclusively focussed on cutting costs. Nobody paid any attention to the relatives who annoyingly moaned about urine-soaked sheets, because cost-cutting came first. How do you cut costs in a huge labour-intensive organisation? Easy! You cut staff because your wages bill is always going to be your biggest item.

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So it\’s also easy to find out who to blame. Look for the managers who were rewarded for cutting costs, as many of them were. Look at what happened to the hospitals where they did that. If there were excess deaths (ie more people died in the hospital than you\’d expect) you know who to blame.

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Fire them. In the worst cases, prosecute for criminal neglect and manslaughter.

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We could start with Sir David Nicholson

Danny Boyle and the Isles of Wonder Olympic Opening Ceremony

I\’ve been a total Olympics curmudgeon and was truly dreading the expected naff Opening Ceremony. Oh God, what if it was as dully naff as the ghastly games logo or, shudder, as wierdly naff as Wenlock the one-eyed scary mascot?

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I even felt sorry for Danny Boyle, director of one of the most feelgood movies of all time \”Slumdog Millionaire\”,  having to try and outdo China in the precision child-dancing event. Poor chap, must have been drunk when he agreed.

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However by half an hour into the thing I was excitedly on Facebook, cheering. At one point (the punk bit with weird people in white feathered helmets pogoing on stilts to Pretty Vacant…(wtf?))  my staid 22 year old son besought me \”Mu-um, PLEASE don\’t dance!\”

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Four years ago, Boyle clearly took a long hard look at Beijing\’s extravaganza of an Opening Ceremony and went \”Nah.\”

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With the coolth born of a smaller budget and native genius, he completely changed the rules and told us a mad, true and personal story about ourselves as a nation: the change from green-and-pleasant land to Satanic mills to the Windrush to the NHS to the music boom and then…

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All the way through, ordinary volunteers were doing the work. My daughter\’s roller derby team, the London Rockin\’ Rollers, were the skating ninja nurses of the NHS  seeing off the skating dementors (or as I prefer to call them, politicians) with the help of a splendid squadron of Mary Poppinses. You watching, Cameron? Eh? You welching incompetent, you?

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And the climax? Sir Tim Berners-Lee, the inventor of the World Wide Web, at his desk in front of a keyboard and monitor, sending a tweet! \”This is for everyone…\”

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There were things to criticise, of course, but usually they were the safe options (did you know that St Jude is the patron saint of lost causes? ) There were things that shouldn\’t have worked but did – like my favourite, the admirably deadpan HM The Queen in a peach cocktail frock accompanied by two corgis, setting off to jump out of a helicopter with James Bond. There were bits that probably only made sense to the Brits (though Mr Bean slipping into the orchestra for Chariots of Fire with Sir Simon Rattle as straight man probably had \’em laughing even in North Korea– \”See, Glorious Leader, THAT\’s how the flag got switched!\”) There were bits that quietly showed two traditional fingers to people all over the world. There were bits that brought everyone together, singing \”Na na na na…\” Well, everyone knows the words to that.

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There were bits that may even have been educational for the watching world – yes, Washington, the NHS, for all its faults, is something we\’re PROUD of; yes,Beijing, WE did fields to mills first.

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Most gloriously of all, Boyle completely subverted the whole neurotic argument about who gets to light the cauldron, all the celeb-obsessed, tabloid-fuelled nonsense.

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I loved the beautiful symbolism of the whole torch ceremony – flame transported by speedboat with David Beckham steering (ish); Sir Steve Redgrave carrying the torch to the seven nominated young athletes in their cool tracksuits (no, really, check \’em out and we\’ll say no more about the white-and-gold look). The seven youngsters simultaneously lighting individual bronze petals, the flame circling and the full array lifting individual flames into the air to form one blazing cauldron…

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The last time I cried at a cauldron-lighting was that breathtaking fire-arrow arcing across the sky at Barcelona.

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I\’m crying again as I write this which is really embarassing, damnit.

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The reason being, of course, the boldest subversion of all. Boyle took a global sports festival devoted to a world of elite athletes finding out who\’s really top, and gave it a deep dark egalitarian edge. Without in any way doing down the extraordinary achievements of the athletes, he reminded us about the extraordinariness of ordinary people.

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The spirit that went through the whole wonderful theatrical bonkers event was, like the equally bonkers torch relay, a magnificent trumpeting organised roar of support for, and by, all of the rest of us.

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Arise, Sir Danny Boyle.

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(PS When\’s the DVD coming out?)

Proud of the NHS

I spent the weekend in St Michael\’s hospital, a small cottage hospital in Hayle, Cornwall, and I\’m now going to have a bit of a boast about just how good the much-criticised tax-funded British National Health Service can be.
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There they cut a slit in my arm, bolted a metal plate to my broken ulna and then sewed it up again with an even bigger, heavier back slab cast over my elbow. I also reacted quite badly to my painkilling medication and spent yesterday evening lying flat on my back so I wouldn\’t be sick again, with an anti-emetic and a saline drip to rehydrate me.
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And it was a delightful experience. Really it was. The whole place had a calm airy feel to it and was spotlessly, shiningly clean. And the staff were just wonderful from start to finish. Not just highly competent, conscientious and on the ball. Of course, they\’re paid to do a job of caring for their patients and \”care\” is a word so over-used nowadays, it seems to be too exhausted to mean anything.
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But the doctors and nurses at St Michael\’s picked the word \”care\” up, dusted it down and set it on its feet again as the English for the old Latin word \”caritas\” meaning compassionate love.
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Did I need to take my credit card out? No. It cost me nothing.