An Unhealthy Health Service

The UK’s National Health Service used to be one of the best (if not the best!) in the world. As one who cannot afford private medicine, I have watched its recent deterioration with growing concern…. What has happened to our NHS? Dr Andrew Brown, “a middle-aged GP working for the NHS in an urban environment somewhere in this sceptred isle”, has recently written about some of the problems:

“One of my partners, an excellent and caring GP on whom we have long relied as a rock of the practice, went on sick leave today due to stress. Another partner is away on holiday, but no doubt we shall cope. This follows on from my own bout of depression last year, although I managed to keep going despite feeling horrible. And a third partner has been struggling with the demands of the job for a long time. We are not conspicuously happy bunnies.

“Meanwhile, we keep getting warning messages every time we log on to our clinical computer system. Our licence expired at the end of June, and the warnings point out that unless the licence fee is paid soon the software will stop working on 30th September. That means that we will no longer be able to access our clinical records or issue repeat prescriptions for our patients. It would be almost impossible to practise medicine safely. Under our new contract it is the PCT who are responsible for paying this fee. Our practice manager has been emailing the four people who might be able to help for several weeks, and getting nothing but “out of office” messages saying that they will be unavailable indefinitely. The PCT has been reorganised yet again, many people have left and the new people do not know what they are doing. I also hear (both from my practice manager and from a consultant friend) that the hospital medical secretaries are leaving in droves. Those that remain are now in a typing pool and no longer accept responsibility for any consultant’s patients. It is becoming almost impossible to chase things up and find out what is happening to our patients’ hospital care. A strategy intended to save a little money will have a significant and possibly dangerous impact on patient care. And out of hours care, that used to be effectively run by GP co-operatives, is now run on the cheap by PCTs using nurses and computer protocols to replace doctors wherever possible. My consultant friend also tells me that all the Matrons at his hospital were recently told to reapply for their jobs, and half of them were made redundant. He did not think this was a good way to treat respected senior nursing colleagues. And the effect of Choose and Book has been to destroy his sub-specialist clinic (since patients can no longer be referred to him by name) and he has lost contact with all the patients he had been following up for fifteen years.

“But to listen to the politicians one would believe that all was for the best in the best of all possible health systems. Lessons will be learned from any minor problems that may currently exist, and every day in every way the NHS is getting better and better. The politicians may have caused significant harm to junior doctors and their training by the recent MMC/MTAS fiasco, but they don’t seem particularly worried. Panglossian reports and mission statements paint a picture of a health service that I don’t recognise. And the Government are currently blaming GPs for the effects of the contract that they forced upon us three years ago, and now want us to work even harder. Many of us doubt the impartiality of the General Medical Council who have decided that the burden of proof in fitness-to-practice cases will be reduced from “beyond reasonable doubt” to “balance of probabilities”. Having made that decision they have the chutzpah to consult us on the exact wording, which is rather like asking turkeys to vote on the merits of stuffing and cranberry sauce. We are also promised that appraisal and revalidation will be toughened up, to keep us on our toes and deter us from our serial-killing aspirations. All this will do nothing to improve the mental health of the doctors in our practice.

“So what’s to do? My consultant friend went through a sticky patch of mental health recently when faced with the destruction of his sub-specialist clinic, the barriers to his research, the loss of his secretary, and many other measures which affected his ability to provide first class care and carry out first class research. Despite being a professor with good interpersonal skills, he got nowhere when trying to discuss these problems with the hospital management. Similarly I think that my depression was caused in part by the fact that I had been vehemently opposed to the new GP contract. I had even played a small part in campaigning against the contract, but all was in vain. The Government were adamant that the new contract must be accepted, and agreed the necessary compromises with our negotiators to ensure that GPs would vote for it. I suspect that the sense of failure and powerlessness that this caused was at the root of my depression.

“One of my patients has a paranoid personality disorder and was always getting into trouble. He would misinterpret events and think that people were getting at him. He has been banned from his local supermarket because he argued with some workmen there, and has had a similar disagreement with staff at his bank. However with the passage of time and prescription of zuclopentixol he has improved. “I’ve learned from experience” he told me recently. “I don’t argue any more, it just gets me into more trouble”. My consultant friend is less paranoid, but he has also learned from experience. “I don’t try to argue any more” he told me, “I just get on with doing the best I can for the patient sitting in front of me at the time.” I take much the same line myself. We seem to be suffering from learned helplessness and, by heck, we’ve had some good teachers!”

So, there you have it…. doctors suffering stress and depression … PCTs being “reorganised yet again, many people have left and the new people do not know what they are doing” … hospital medical secretaries “leaving in droves. Those that remain are now in a typing pool” … “out of hours care, that used to be effectively run by GP co-operatives” being “run on the cheap by PCTs using nurses and computer protocols to replace doctors wherever possible” … senior nursing staff being made redundant … Choose and Book destroying continuity of care … “significant harm” being caused “to junior doctors and their training by the recent MMC/MTAS fiasco” … Government “blaming GPs for the effects of the contract that they forced upon us”…. and there are any number of other things Dr Brown doesn’t mention, including the current state of our Ambulance Service and the fact that our NHS now has more administrative staff than beds, and employs one manager for every three doctors!

The Squirrel and The Grasshopper

The squirrel works hard in the withering heat all summer long, building and improving his house and laying up supplies for the winter.

The grasshopper thinks he’s a fool, and laughs and dances and plays the summer away.

Come winter, the squirrel is warm and well fed.

The shivering grasshopper has no food or shelter, so he dies out in the cold.

THE END

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THE UK VERSION:

The squirrel works hard in the withering heat all summer long, building his house and laying up supplies for the winter.

The grasshopper thinks he’s a fool, and laughs and dances and plays the summer away.

Come winter, the squirrel is warm and well fed.

A social worker finds the shivering grasshopper, calls a press conference, and demands to know why the squirrel should be allowed to be warm and well fed while others less fortunate, like the grasshopper, are cold and starving. The BBC shows up to provide live coverage of the shivering grasshopper, with cuts to a video of the squirrel in his comfortable warm home with a table laden with food. The British press inform people that they should be ashamed that, in a country of such wealth, this poor grasshopper is allowed to suffer so, while others have plenty.

Ken Livingstone, in an interview with Trevor McDonald, rants that the squirrel got rich off the backs of grasshoppers, calls for an immediate tax hike on the squirrel to make him pay his “fair share”, and increases the charge for squirrels to enter inner London.

The Labour Party, Greenpeace, Animal Rights, and The Grasshopper Council of GB demonstrate in front of the squirrel’s house. The BBC, interrupting a cultural festival special from Notting Hill with breaking news, broadcasts a multi cultural choir singing “We Shall Overcome”.

In response to pressure from the media, the Government drafts the Economic Equity and Grasshopper Anti Discrimination Act, retroactive to the beginning of the summer.

The grasshopper is provided with a council house, financial aid to furnish it, and an account with a local taxi firm to ensure he can be socially mobile.

The squirrel’s taxes are reassessed. He is taken to court and fined for failing to hire grasshoppers as builders for the work he was doing on his home, with an additional fine for contempt when he told the court that the grasshopper did not want to work. His food is seized and redistributed to the more needy members of society (in this case, the grasshopper). Without enough money to buy more food and to pay the fine and his newly imposed retroactive taxes, the squirrel has to downsize and start building a new home.

The local authority takes over his old home and utilises it as a temporary home for asylum-seeking cats. The cats had hijacked a plane to get to Britain as they had to share their country of origin with mice, and, on arrival in Britain, they had tried to blow up the airport because of Britain’s apparent love of dogs. The cats had been arrested for the international offence of hijacking and attempted bombing, but were immediately released because the police fed them pilchards instead of salmon whilst in custody. Initial moves to then return them to their own country were abandoned because it was feared they would face death at the hands of the mice.

The cats devise and start a scam to obtain money from people’s credit cards.

A Panorama special shows the grasshopper finishing up the last of the squirrel’s food, though spring is still months away, while the council house he is in crumbles around him because he hasn’t bothered to maintain the house. He is shown to be taking drugs. Inadequate government funding is blamed for the grasshopper’s drug ‘illness’.

The cats seek recompense in the British courts for their treatment since arrival in UK.

The grasshopper is arrested for stabbing an old dog during a burglary to get money for his drugs habit. He is imprisoned, but released immediately because he has been in custody for a few weeks. He is placed in the care of the probation service to monitor and supervise him. Within a few weeks he has killed a guinea pig in a botched robbery.

A commission of enquiry, that will eventually cost £10,000,000 and state the obvious, is set up. Additional money is put into funding a drug rehabilitation scheme for grasshoppers, and legal aid for lawyers representing asylum seekers is increased.

The asylum-seeking cats are praised by the government for enriching Britain’s multicultural diversity, and dogs are criticised by the government for failing to befriend the cats.

The squirrel, the dogs, and the victims of the hijacking, the bombing, the credit card scam, and the robberies have to pay an additional percentage on their credit cards to cover losses. Their taxes are increased to pay for law and order, and they are told that they will have to work beyond age 65 because of a shortfall in government funds.

The grasshopper dies of a drug overdose. The usual sections of the press blame it on the obvious failure of government to address the root causes of despair arising from social inequity and his traumatic experience of prison. They call for the resignation of a minister.

The cats are paid a million pounds each because their rights were infringed when the government failed to inform them there were mice in the United Kingdom.

THE END

“Tough on Crime”?

Do you feel, as I do, that those convicted by our legal system are frequently ‘let off’ with too light a sentence? Do you think, as the mass media would like you to believe, that our judiciary is to blame? Read on…..

“It used to be the judge who decided on the sentence after an offender was convicted, although the choice was limited. At the beginning of the 19th century there were 220 offences that carried the death penalty and the task for the judge was to decide whether to commute this to flogging and, if so, how many strokes of the cat o’9 tails should be administered. When imprisonment replaced these more robust punishments Parliament usually enacted a maximum sentence for particular offences, leaving it to the judge to decide the appropriate sentence within that maximum.

“More recently Parliament has legislated over what some consider to be the judges’ territory by laying down rules that significantly restrict the judge’s discretion. Statutes provide alternatives to custody – fines and a wide variety of community punishments. Judges are directed which to choose. We are forbidden to impose a sentence of imprisonment if there is a viable alternative and, if we do impose a sentence of imprisonment, we are directed that it must be the shortest commensurate with the seriousness of the offence. The sentence that we impose will not normally be carried out, for in most cases statute provides that the offender is to be released on licence after he has served half the term of imprisonment imposed. [emphasis mine]

“But the media are always on the look-out for a sentence that they can castigate as ‘letting an offender walk free’. A few months ago the Recorder of Cardiff had to sentence a sex offender who had carried off a young girl in his van and subjected her to a serious indecent assault. He ruled that he was a dangerous offender and imposed one of the new indeterminate sentences, directing that he would have to serve at least 5 years before he could even be considered for release. This brought a storm of press protest with comments such as ‘judge allows sex beast to walk free after 5 years’. The Home Secretary commented publicly that he considered the sentence ‘unduly lenient’. What the press did not say was that there was no likelihood that this offender would be released after 5 years because this would not be considered safe. The 5 year 108 day minimum term had been correctly calculated by the judge, who was subject to the constraints that I described earlier. It represented an 18 year sentence, discounted by one third to give credit for the fact that the offender had pleaded guilty and then halved to reflect the fact that prisoners who are not dangerous are released on licence when they have served half their sentence, and finally reduced to reflect time served on remand.”

[The text quoted above is taken from http://www.judiciary.gov.uk/docs/speeches/lcj260207.pdf]