Monday, 15 July 2013

Is Scotland's NHS Fit For Purpose? No.

The images say 'get involved' and 'it's your NHS'. Many people get involved volunteering in hospitals but it's certainly not our NHS.  It belongs to accountants, managers and the elite who sit on local health boards.

How does the present Scottish (and possibly English) NHS prioritise consultant appointments?  Could it be by the number of consultants we have in a specific area or are they arranged to fit with targets?  Perhaps a little of both these reasons and others too.

Originally this post was to highlight the lack of success the UK has, in comparison with many EU countries, in treating many cancers, but it's now personal.

A dear friend found a lump in her breast the evening of Thursday 27 June. By luck we managed to see her doctor the following day and her doctor said she would made urgent application for an appointment with a consultant at either of our local hospitals.  The appointment has arrived and it is to be Wednesday 31 July - four weeks and two days from seeing her GP. Meanwhile she has to struggle with the mental stress of the wait, while she also copes with a long term serious back issue; a result of being an efficient PE teacher for many years.

In last Friday's Scottish Daily Mail there was an article (unfortunately not online), which highlighted the plight of couples who wait months for IVF treatment on the NHS.  It seems the legal profession have become involved and intend to sue the Scottish Government for the delay caused to certain couples.

Yesterday I spoke with another friend who has been working in a Scottish A & E department because it was short staffed owing to sickness and holidays. She is a fully qualified intensive care nurse. Although she doesn't know my retired PE teacher personally, she is aware of her prolonged health problems and naturally I told her of the latest development.  In her professional capacity she replied nearly 5 weeks was well within the 6-week target set by government for urgent appoints, but then gave her personal opinion.

The NHS needs to be completely rebuilt. In Scotland we provide world-reknowned training for doctors and have plenty completing courses year after year.  Yet our hospitals don't have enough medics because it's health boards which decide how many are required and their figures do not necessarily result from supply and demand, but cost.  So urgent requests for appointments with cancer specialists are treated as quickly as possible but with too few consultants available to reduce the waiting time.

I asked what would have happened if she had gone to A & E to say she'd found a lump on her breast.  The reply was that she would have been told to make an appointment with her GP who would then decide if she required to see a consultant. But, toothache, ingrown toenails, staved thumbs, sore throats, vomiting due to drunkenness are just a tiny sample of problems which receive immediate attention at A & E.

Obviously patients with heart related problems take priority over most - because minutes can be invaluable in some cases - but why can't cancer patients be treated with a similar urgency?  The stress of waiting must be hellish for many and each day must feel like a week or longer.

 I think finding a lump anywhere requires immediate attention and if a GP suggests it requires urgent investigation, we should have a system where the patient receives just that. Other Europeans countries offer a far superior cancer services so why can't we?  It's not a question of money because vast amounts of money has been ploughed into the NHS and services in some areas have not improved.

If we want the best health service in the western world, we need to reorganise our priorities and start offering full services outside of the Monday to Friday 9 - 5 system. Shamefully, machinery lies idle in all our hospitals from 5pm on Fridays until 9am on Mondays - a third of a week.

We have the people to give us a top quality service, but refuse to employ them and thus many go to work in the US, Canada, Australia, New Zealand and the middle east.  These countries and others get the benefits of their training while Scottish hospitals are left short staffed and with specialists unable to see an 'urgent' cancer case for nearly 5 weeks.


JRB said...

Thank God for Scotland’s NHS. They have pulled me back from the pearly gates on more than one occasion. Without them I would not be here, passing comment.

So I cannot agree with the sweeping generalisation of your title – “Is Scotland's NHS Fit For Purpose? No.”

Had you asked – “Are Scotland’s NHS Clinical Staff hamstrung by Administrative Bureaucracy and Political Lethargy? Yes” – then I would have agreed with you.

May I wish your friend all the very best, I can fully appreciate her anxiety.

Macheath said...

JRB, you have hit the bureaucracy nail squarely on the head.

To my certain knowledge, in at least one major Scottish hospital, an army of hostile and obstructive administrative staff stand between patient and consultant.

A relative of mine compares the set-up to a Renaissance court, where access to the sovereign was controlled by a chain of officials of increasing importance, applying palace protocol regardless of the nature or urgency of the petition.

She should know; when she finally reached the consultant after two months of of lost letters, clerical errors and postponed appointments, he immediately admitted her for emergency - and, fortunately, life-saving - surgery.

subrosa said...

JRB, it would be interesting to know how many people aren't as 'fortunate' (poor word I know) as yourself and are not treated as an emergency.

Perhaps my title is a generalisation, but the NHS does not provide as good a level of service as many other EU countries. It's not that we don't invest in it.

Of course I would also agree with your assessment.

In the case of my friend, she telephoned the department immediately and asked to be put on the cancellation waiting list. She told me the woman on the other end told her wearily that there was no point in doing that as there were already 22 people on the list for this month and 9 already for next month.

subrosa said...

It's certainly not improved since we had 'managers' Macheath. A few years ago I had to have scan so I attended the appointment and had it done. Two weeks later another letter arrived giving me another date for a scan. I phoned to say I'd already had one and was awaiting results, only to be told I should attend.

Off I went. Reception accepted the letter and told me to sit down. Eventually a nurse came and asked me to go with her to an unoccupied room. At this became nervous and wondered what was going on but she wouldn't say. All she would say is that the departmental manager would be coming to see me. After around 15 minutes this suited and booted man appeared, sat down with a serious face and informed the there had been an administrative error as my scan had been doubled booked.

My anger was palpable. Not at the fact it had been double booked but the way in which it had been handled. I asked him why it was necessary he had to 'break the news' to me when it would have been far less stressful to have a receptionist or nurse do it. 'It's my job' I was told and in the next breath he said (I'm paraphrasing), 'Your comment isn't an official complaint is it?'. He was more concerned about me making a complaint than the fact that my GP had yet to receive information about the first scan. As it was there was nothing serious, but like your friend, it could have been.

Anon said...

"Many go to work in the US, Canada, Australia, New Zealand and the middle east."


Sack all those expensive and nasty administrators and the NHS will recover quickly.

Sadly, the SNP does not seem to agree with me.

As far as education is concerned, the best of Scotland's teachers are nearly all working abroad.

Again, the problem is lousy administrators.

- Aangirfan

JRB said...


‘Fortunate’ :)

I suppose under the circumstances - having needles, cannulae, tubes and catheters inserted into every orifice and however many thousand volts repeatedly fired through one’s chest - could be described as ‘fortunate’.

… but it also goes to show that at least one section of Scotland’s NHS is fit for purpose.


subrosa said...

Auch JRB you knew what I meant in my haste surely.

It seems the NHS in your area is certainly efficient. My ex in-laws lived up your way and received the most excellent care in their ailing last few years. I couldn't fault anything. Come to think of it, my mother in law, when she found a lump in her abdomen, was in Aberdeen hospital within 24 hours. Three days later it was diagnosed as advanced ovarian cancer and beyond surgery. Her care was wonderful and the contact medical staff kept with us was second to none. Very different to what happens in this area as I know from experience.

But, the standards throughout the country shouldn't vary so much.

I do understand how grateful you are for such a service and have an idea of what you go through, but you are fortunate to be in a part of Scotland where it works. Care of cardiac patients in this area was so bad a few years ago that patients opted to travel to Edinburgh for treatment. Many still do.

subrosa said...

No politician agrees with me either Aangirfan yet the evidence is all around. Funnily enough there has never been ann independent study of the number of medics we train then employ. Perhaps they don't want taxpayers to know the answer.

Apogee said...

Perhaps we need to realize that the
medical business is very similar to the automotive business in how it operates. When you think about it from that perspective, we realize just how many parallels there are.
Our expectations are far higher than they should be, you will ask your mechanic more searching questions than your doctor, and treat him with considerably less reverence,why? they both do the same type of job. Would you be more critical of the doctor if you paid the bill yourself?Probably. But most people hesitate to ask a doctor about anything to do with their condition, partly because the doctors don't like questions.And they let you know! But it is your right to ask questions and expect
correct answers.Perhaps if the population of this country asked and kept asking,politicians as well as medical staff, until they got correct answers, the problems we have would start to be corrected.

Stewart Cowan said...

The NHS in Wigtownshire is a joke. Everyone I speak to hates it. I was denied treatment and told to find a new practice for complaining. But there's no point as the local Health Board is in on it.

Doctors are a joke round here. Overpaid fools, terrified of breaking every fascist DoH diktat (I have experience of one of the more human GPs "breaking the rules" to help me and being clearly troubled.)

The Gov't always whines on about equality. So why does a GP "earn" three or four times what a teacher, copper or fireman gets paid?

To keep them on side and keep the death, destruction and subversion going on?

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