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Helen Barratt: In praise of the NHS

3 Jul, 08 | by BMJ

Studying for an MSc in Public Health this year, with students from a range of backgrounds, has been refreshing after years of learning and working with medics. However in classes, ‘doctor bashing’ has been de rigueur. I don’t for one moment claim that we’re above censure, but the criticism levelled at the profession has become a bit wearing.

In the UK, this isn’t just confined to criticism of doctors, but headlines about problems within the wider NHS provide daily fodder for the media, and seem to have replaced the weather as a favoured topic of conversation. In this, the week that has seen the Darzi report published, and later the 60th anniversary of the founding of the NHS, the BBC is running an online forum asking about ‘NHS experiences’ which has so far attracted thousands of comments, and also commissioned a poll asking the public for ‘their biggest fears about hospital’ .

At a recent dinner with non-medical friends, the conversation was dominated by NHS tales, all naturally worse than the last, from how someone had had to move wards during a hospital admission, to how it had taken a GP two consultations to prescribe medication for a rash. Similarly, at another party, I got talking to an American lady. Despite living almost over the road from one of London’s most highly regarded teaching hospitals, she told me that if ever she or her family were ill, she would insist her insurance company flew them straight to Baltimore so they could be seen at Johns Hopkins Hospital. I never found out what the insurance company thought about her plan.

I’m not claiming that doctors always get it right, and I’m not going to trot out arguments about how hard the staff work – most readers will know that. The NHS is by no means perfect: I’ve seen it fail not only my patients, but also my family and friends. We do though have a system in the UK which provides world-class care to the vast majority, largely free at the point of need, and regardless of the ability to pay. Contrast that with the USA, for example, where 47 million people don’t have healthcare coverage, let alone access to hospitals such as Johns Hopkins.

Perhaps this week, as we approach the 60th anniversary, we could have a moratorium on moaning about the NHS, just for a few days – let’s reflect on its good points, however briefly!

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  • Roshen Mathew

    Without question the NHS does a fine job in adhering to its basic principles of providing health care to all. What it needs to incorporate to ensure more quality healthcare is strict protocols to see doctors and involved health personal follow norms to ensure patient satisfaction. As for the American lady who asked to be flown to Baltimore for treatment, it is almost sure such an act of negligence would be detrimental legally to the doctor involved if it were in the USA. This fear of being sued for malpractice ensures better care in health systems of USA, if the patient has health coverage insurance. Taking to task administration and health personal involved for unnecessary delays and negligence would ensure better health care in the functioning system of the NHS.

  • Dr P Umesh Prabhu

    We have so much to celebrate about our NHS that I don’t know where to begin.

    No other Western country has managed to spend 8.5% GDP on health care which provides healthcare for the 90% of the population. Vast majority care is of very high quality and vast majority of patients get the best possible care.

    NHS is the largest employer in the UK and probably the second largest employer is the World! There are 1.3 Million people work in the NHS.

    Over the last 10 years, as far as patients are concerned NHS has improved a lot and here are some examples:

    1. Waiting time has dropped from 2 years to 18 weeks.
    2. A&E Waiting has dropped significantly.
    3. Outcome for Cancer, Coronary care, Mental Health and many other conditions are much better.
    4. Hospitals are cleaner and more patient friendly.
    5. There are more doctors, nurses and other staff who are much better paid.
    6. Patient involvement, empowerment is much better.
    7. More importance has been given to patient safety, quality care, clinical governance, clinical risk management and performance management.

    Of course, it is not perfect and we still have challenges like MRSA, access, confusion around private and public sector. Patient safety is still a big challenge and we have not yet perfected the art of performance management of clinicians that can help us to identify ‘poor performance’ early so that doctors and nurses can be helped, supported and patients can be protected. We must make sure that public money is properly used and the NHS is much more efficient and cost effective. The clinicians must take on the leadership role in the NHS to take it to the new heights.

    In this 60th year of our beloved NHS, let us all celebrate, work together and make sure that this great Institution goes from strength to strength and NHS becomes the best healthcare provision in the world that will be copied by many other countries.

    NHS must be for the patients, by the patients and with the patients and it is their well being and their safety which must be in the heart of our NHS.

    Dr Umesh Prabhu
    Consultant Paediatrician
    Clinical Director (1992-1998)
    Medical Director (1998-2003)
    NPSA Board Member (2001-2003)
    Trustee for AvMA
    Member of Rochdale PCT PPI Forum
    Bury

  • Simon Bailey

    I think there is much importance in acknowledging both the achievements of a system like the NHS, but I would be wary of banishing a constructive critical dialogue. An organisation the size of the NHS has such a daunting job to do with so many different needs to meet, as such, while the complaints of friends round the dinner table can very quickly get boring, they are exercising both a consumer’s right and offering valuable lessons in critical self-reflection. The media seem to delight in painting simplistic broad strokes and casting villains and victims everywhere they go. My partner has just started her F1 training and amongst other things is considering general practice. Thanks to the Daily Mail she has to defend accusations that she would only be doing it for the supposed £250,000 salary. However, while medicine may be the current favourite media whipping boy, it is certainly not alone in suffering from these persistently black and while representations. Medicine at its best has long provided object lessons in lifelong learning, and a great part of this involves criticism and change. Think about the anti-psychiatry critique of the 1960s or later the Black report for examples of ways in which sometimes radical criticism can affect large scale institutional and cultural change.

    Lastly, to Roshen Mathew’s comment that fear of lawsuits improves practice, I could not disagree more whole-heartedly. I think that such a fear has the potential to alter the relationship between doctors and patients in such a way as to create nothing but suspicion, mistrust and negative practice. I can think of nothing worse than the UK heading in the US direction, yet it seems that these changes are already underway.

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