THE NHS - THE GOOD THE BAD AND THE HOPELESS

 RADICAL CHANGE IS NEEDED FOR THE SUPPLY AND TRAINING OF NEW DOCTORS AND NURSES FOR THE FUTURE NHS

Britain needs more Home Grown Doctors and Nurses for the future

The present system needs radical changes and I present some radical ideas about solving the recruitment problems.

THE CHANGES

Stage One MD Degree

Two Years A level courses become Stage One of the MD Degree.

Students study the basics of Biology, Key illnesses, Pharmacy, Anatomy.

The demand for three A level grades to enter Medical School is dropped. In place are Phycological testing and Emotional Testing. Henley Business School are experts in these fields and should be consulted.

Stage 2 MD Degree

Existing Centres of Excellence Medical Schools should wherever possible be enlarged. Virtual lectures extended.

Year 2 concentrates of Causes and Remedies of illnesses. Early signs and Spread of Infections.

Stage 3 MD Degree

One Year spent in a General Practice surgery helping the Doctor by observation and routine tasks such as injections, blood tests, dressings.

Stage 4 MD Degree

One Year spent in a Hospital under supervisions.

Assisting with basic medical duties such as – Monitoring Patients, Drips, Supply of medication under supervision.

Emphasis on Medical Specialisms selected by the Student Doctor.

Practical Examination on General Practice and Hospital Practice.

COMMENTS

Reduce the number of years for MD Degree and Nursing Degree

Reduce emphasis on Exam grades at A Level

Reduce the costs to the Students

Speed up supply of Doctors and Nurses

Nurses Degree reduces to A Levels + 2 years training in hospitals.

THE NHS – THE GOOD, THE BAD AND THE HOPELESS

Some of the problems

There is no doubt that since the beginning of the Global Covid 19 Pandemic - The staff of the NHS have performed admirably in every respect amidst enormous pressures almost to breaking point.

I slalute every one of them. However, do not let their brilliant efforts hide the fact that in many instances the NHSas an Organisation including Hospitals, Doctors Surgeries, IT systems, Procurement, Logisitics, Administration, Recruitment and Training is…..Bad if not Hopeless. Too many Executives eaerning 6 figure salaries and generous pensions without performing to justify their incomes. Too many high paid Civil Servants that do not understand the workings of Healthcare. Too lack of emphasisi on Preventative Care instead of costly and time consuming Remedial Care. ( My Paper 2016 – Strategy for the NHS. )

Let us start with A & E or Minor Injuries. Today, my Wife fell in the garden. Shee gashed her leg badly. A neighbour who is a a Healthcare worker advised that she should go to the Minor Injuries Clinic at the local Hospital.

When my Wife arrived at  the Minor Injuries clinic, she was told that she could not enter because it was by appointment only.

She should have rung 111. After objecting to this because her leg was bleeding, the Receptionist let her in.

She informed my wife that she would have to wait 4.5 hours before she could be seen by a Nurse or Doctor.

The Reseptionist tells people without an appointment tha tthey have to make a 90 minutes round trip to A & E at Stole Mandeville Hospital or a 60 minutes round trip to a hospital neart Slough.

Such is the Ethos of Patient Care today at Wycombe Hospital.

If it is shortage of Staff - reread Part One of my article.

Now. Take a look at what is going on in our Surgeries.

I visitred ny Doctor recenetly and the Docto asked me to make an appointment to have a Blood Test and a routine B12 injection.

I asked the Receptionist if she would book me an appointment.

No she said. We have a new system. You must book an appointment on our website. OK I said.

When I logged into the website I was asked a number of non relevant  questions. No where could I book an appointment or a B12 injection. I completed an enquiry form.

The next day I received a telephone call from the Surgery.

The Receptonist said – We have a new system. We will book your next blood test on the date of your birthday. I said That is in November. My Doctor want a blood test soon.

The Receptionist said – Perhaps your Doctor has not caughtup yet with the new system. 

This is Bonkers !!

These are just two simple examples of poor Customer Patient Service.

Now, add the Millions of lost hours for dealing with Cancer, Hip Replacements, Knee Replacements, Heart Conditions and so on.

Waiting times in some cases 2 years .

Why is this ? The NHS answer – We have been coping with the Pandemic.

I say – What happened to your crisis contingency Strategy ?

The NHS Management had spent many hours on Planning for Emergencies. Why didi they not plan on a Worse Situation Solution to a Normal Emergency Solution.

Whtat would have happened if there was a Nuclear Bomb on London ? What if the Black Death returned to London and Manchester. I say it was lack of planning because the truth is – The NHS were totally unprepared – Lives were lost because of the NHS and The Government.

Now, if you try to telephone your local surgerg you may be holding on for, in my case for 25 minutes and the give up. Why ca't surgeries use Facetime, Microsoft Team and other Video links for Doctors to speak direct to a Patient ?

Another weakness in my view is – Recepionists who try to Triage you when you telephone.

They are not mefical practitioners. If a Patrient feels they are ill – the Receptionist should accept that the Patient feels ill.

What is the cure for the Problems facing the NHS ? My answer lies in the Supply and Training of Home grown Doctors and Nurses as I have outlines above.

WILL ANYONE LISTEN ?  NO - I DOUBT IT. THE GOVERNMENT WILL PREFER TO LISTEN TO HIGH PAID SPECIAL ADVISERS or lauch another review which will take 3 more years to report.

WE NEED ACTION NOW !

A RELOOK OF MY 2015 ARTICLE ABOUT THE NHS STRATEGY

THE FUTURE STRATEGY FOR THE MAINTENANCE OF FREE UNIVERSAL HEALTHCARE IN THE UNITED KINGDOM - FROM THE CRADLE TO THE GRAVE

2016 - 2021

Creating a Healthy Lifestyle and Providing Universal Healthcare - The Challenge for the New Government 2015

The Post WW2 Concept of a National Healthcare Service From the Cradle to the Grave

was one of the greatest new Concepts ever in the World of Healthcare. Britain can stand proud for establishing this brave new service and the Labour Party can also feel proud for putting the Concept into practice.

Over the decades of my lifetime this Concept of Universal Healthcare free at the point of need has been continually eroded by Conservative Governments and Labour Governments.

The NHS has become a political football as the parties vie for Public support.

In 2015, let us be clear about certain facts -

The NHS is not free from the cradle to the grave and it is not entirely free at the point of need

Most people pay for Dental treatment.

Most people pay Prescription charges except in Scotland and Wales.

Many people are forced to pay for Private Hospital care and Private operations because the NHS waiting times are so long.

There has been too little priority given to Preventative Medicine within the NHS mandate forcing people to pay for services in the Private Sector - we do not have the Budget 

Care for the elderly within the NHS is totally inadequate and care within the Communities is very poor with low benchmarks for qualifications for Community funded care. So, most people in need lose out.

Most Elderly care is provided by the Private Sector at enormous cost to the individual- £30,000 - £50,000 per annum. The recent cap at £70,000 by the Government is still excessive.  This is a National Disgrace. The various Post War Governments are at fault because they should have made better provision in National Insurance Deductions and other Insurance Schemes to cover the cost of Elderly Life Care. Most people are not Actuarial Minded People. They have relied - at their downfall - on the Government to protect and look after their wellbeing in Old Age. We must be able to calculate a better more sustainable Cost / Benefit Scheme for the future.

A typical NHS Trust gives this advice to those seeking care support - Most people have to fund all or part of their own care and support. Local authorities have a duty to assess everyone's care and support needs. For the Middle Classes this means - you are on your own to find the money somehow ! Tough. So much for the original ethos of the NHS.

We need a new Healthcare Insurance System - in addition to National Insurance - whereby people can top up their funds to support Private Healthcare in the future - if needs be. This should be a State Scheme in addition to BUPA and other schemes.

I do not blame the Consultants, Doctors or Nurses  I do blame the  Politicians and the Professional Medical Bodies. WHY ?  Rather than continue the Blame Game - here are some practical solutions -

The solutions will have to incorporate money of course -

 Why not have Quantitative Easing ((QE) for the National Health Service ? The Bank of England poured some £400 Billions into the Banking Sector.

 Or, why not launch Healthcare Bonds which people can invest in - such as a 5% 5 year Bond.

The key problem originates far deeper in the structure of recruitment and training in the NHS. For, example - we know that most hospitals have to recruit Agency Workers to fill their gaps in staffing - most of the time at great expense to the NHS. 

The Royal College of Nursing has estimated that the NHS will spend some £ 1 Billion in 2015 on Agency Nurses

A recent Report by the Public Accounts Committee found that the NHS spent £2.6 Billion on casual Consultants in 2014 a rise of 25% compared with 2012 / 2013.  Shocking !

It pays to be  Temp and on the Agency Books if you want to earn more money.

We need a new approach to the Training of Medical staff and revision of  the reward structure vis a vis NHS personnel and Agency personnel. 

Firstly, it is ludicrous that many University Hospitals demand three A Grades for entry into their Medical Doctor Degree Programmes. This cannot be that a student with fire and dedication in his or her heart to serve but only has three B Grades would not make a good doctor. No, it is because the Teaching Hospital will say that they do not have sufficient teaching staff and facilities.

This vicious circle cannot continue into the future.

In future, to qualify as a GP with a MD Degree, the training course should be revised as follows -

The Second Year of A Levels would become Y1 of the MD course. The student would have to study 3 approved Medical subjects such as Biology, Physics, Chemistry. There would be 4 more years at a Medical School followed by 1 Year as an Intern shadowing a GP at a local surgery. The Intern could deal with minor ailments to release the GP to deal with the more serious cases and emergencies. This would help to speed up the Medical Training Programme for future Doctors. There is no doubt that there has been major advances in the use of Diagnostic Tools which should aid future Doctors whilst dealing with patients. There are too many holidays in the University Academic year. Students should be assigned to Doctor's surgeries to gain practical experience for part of the summer recess.

Also, future advances in Medicines and Medical Drugs should help to reduce referrals to hospitals and A and E Departments. There should be a radical reappraisal of the Cost/Profit/Pricing Ratios for drugs produced by the large Pharmaceutical Companies. Research and Development costs must be continued to be recognised with tax breaks but the aim should be to reduce the overall cost to the NHS Budget.

The role of the Hospital Carer should be enhanced in the supportive role to the Nursing Staff. The role can be upgraded and also in some instances act as a bridge towards a Nursing Qualification.

Most Carers are compassionate, dedicated, loyal, hard working people - just the right personal qualities for possible future Nursing Practice. For example -

A new.Certificate in Hospital Care might be developed. On completion by the Hospital Carer He or She would become a Certified Hospital Carer with an increase in remuneration and the holder of the Certificate would have entry into a State Nursing Course to become a Qualified Nurse. No need for GCSE examinations except the Candidate must speak fluent English Language,.

The Hospital Carer Training course ( One Year Part -Time ) would include -

On the job hospital experience

Online learning

Some weekend Seminars

End of year examination

Subjects - Basic Foundation Nursing / Patient Care Skills

Part funded by the State

This might help in the recruitment of Carers and Nurses. A much cheaper source than Agency Workers.

There are other supportive roles that could be explored to ease the burden on the NHS staff and facilities.

These might include if available without any detriment to their existing worthwhile commitments -

Saint John's Ambulance - Staff and Assets

British Red Cross - Staff

The Royal Army Medical Core - Staff and Assets

The Voluntary Workers Sources

We need a linked up comprehensive Service which is highly responsive to patient demand

The recent overload on NHS Ambulance Services cannot be sustained into the future. Why not co-op Ambulances from some of the above facilities if available ?

However,the emphasis must be on Preventative Medicines and Cures through Healthy Pursuits - such as reducing Obesity , Drug Abuse, Smoking and Alcohol problems.

Creating a Healthy Lifestyle should be the Strategic Objective of the NHS and the Government..

There are many excellent 50 Plus Sports and Leisure Clubs scattered across the United Kingdom who are providing the facilities  - without any Government financial aid -  for the 50 - 90 generations to remain physically active and to enjoy a regular social life.  These 50 Plus Clubs should be encouraged to expand throughout the Country. There should be a closer linkage between these Clubs and the Healthcare Profession to encourage a Healthy Lifestyle. This will help to drive down the cost burden on the NHS. I suggest that the Government should use the examples of the 50 Plus Clubs in Publicity Campaigns to encourage active participation in sporting and social activities for the Older Generations.

Wycombe 50 Plus Club in High Wycombe Buckinghamshire would be an excellent Case Study. It is a flourishing example of how older people can enjoy life to the full and how their positive frame of mind can overcome illness and traumas. Not only do members remain fit but many participate and serve the Community as unpaid Volunteers - including the local NHS Hospitals and Fund Raising Organisations.

In the Technological  Age of Computer Programmes, Centralised Television Broadcasting, Lecture Broadcasts to thousands of viewers, Practical Workshops outside of Hospitals - it should be possible to train many more Medical Staff as a result of Remote Learning Methods - Webcoms - Internet Conferencing. Knowledge Exchange Programmes, Multi - Screen Communications and Portable Devices.  We need more Doctors , Nurses and Support Staff.

Wow is me ! You will hear them say - We have done it our way for over 200 years .Yes you have - and look at the mess we are in.

The current trend to demand a 3 year University Degree for Nursing is also short sighted. We need more British Trained Nurses.

We should count the second year for A Levels as Year 1 towards a Degree. Hence a Student Nurse will only study 2 years at University for  Degree if he or she wishes.

However, a person can still practice Nursing after 2 years. The difference will be that a varied pay structure.for Senior Nurses classification and Junior Nurse classification

.

We need to build on extra Training facilities at certain locations for the Practical Work which is required. This will involve more Capital Expenditure for the NHS. This can be funded either by QE, Healthcare Bonds or Borrowing over a longer period of time.

Finally, an increase in National Insurance might be required.

The problem with the Pension / Healthcare Plan since WW2 has been - it has been under funded.

Government should be open and tell the Public the actual reasoning behind Pensions and  Healthcare Funding in the future. Be honest and be realistic. We cannot have Healthcare on the cheap particularly with the Elderly accounting for a greater share of the population in the Upper Quartile of the UK population.

Living longer and Healthier is a trend that we need to celebrate. But we citizens must pay a proper amount of taxes to make the NHS affordable in the future. It is our collective failure to contribute the right level of funds for decades that has caused the shortage of funds to sustain a full free Healthcare service.  

In the future I would like to see Elderly Care provided by the National Health Service. Yes, let us put into practice  -

Healthcare from the Cradle to the Grave. This is a humane and honourable Objective for the NHS to observe.  Life itself is worth paying for - and everyone in Society must play their part. I fear that some people are more interested in Wealth than Health. If an individual  holds a British Passport - he or she must pay British Taxes. If a Company makes Profits in the United Kingdom, they must pay British Taxes. No ifs or buts !

Please refer to my article - The Greed Society 2015 to see how extra funds can be raised to help finance the NHS of the future.

Government must always remember that the ordinary Citizens of the United Kingdom did not cause the Financial Crisis. They have suffered enough.

In 2014 A and E Departments  suffered their worse overloaded year. It is not the fault of the Medical Profession.

My Radical Suggestions for the NHS must include the involvement of the General Practitioners.

I suggest that Doctors should still work a 5 day week but that the week should be be re-defined as follows - A Rotational 5 Days. For example - Monday to Friday, Tuesday to Saturday, Wednesday to Sunday This will mean that there will be  Doctors on duty every day of the week. 

At present if a Patient in need telephones the Surgery Emergency Telephone number. an Automated Voice tells them to telephone 111 for help.  111 then asks a lot of questions and invariably refers the Patient to Accidents and Minor Injuries Clinic at the local hospital.

No wonder A and E Departments and MINOR INJURY Clinics are overrun at the weekends.

Currently A and E Departments have a 4 hour waiting time target. I would hope that transferring some of the burden to the Surgeries in the future would mean that the waiting time target could be reduced to 2 hours maximum. with an attempt to lower this still further over time.

Minor Injuries should be re-classified so that they can be referred by the 111 Service to Local Surgeries and not to the over loaded A and E Departments.

 Practice Nurses should also be part of this 5 day Rotational Plan

Finally, there is the question of Private Healthcare. If people can afford to pay for Healthcare, then it is their right to do so - provided the Private Sector does not drain the NHS of Doctors and Nurses. It is a delicate balance that must be retained. In a way the Private Sector saves the NHS money and resources. In view of the importance of Healthcare to everyone rich and not so rich, the Government should cap charges in the Private Sector.By doing this, it might be feasible for the NHS to use beds in the Private Sector if necessary and available at the same level of cost as it would cost within the NHS. I can see nothing wrong with this Policy. There will be cries of - You are Privatising the NHS. 

This is rubbish. It is just facing up to practical reality. There is a place for Public and Private Healthcare In Britain Today

Conclusion - It is not just a question of funding for the NHS as we look into the future. It is a question of Strategic Direction across the whole range of Medical Services,

Policies should start with Vision which in turn translate into Strategic Programmes. I have provided some Vision - now what about some definitive Policies and Strategic Programmes from the new Government which will be elected in May 2015. My advice to the New Government  - Be Creative, Innovative and provide the Country with a flourishing new style National Health Service and stop playing Political football.

The Romans got it right many centuries ago. Mens Sana in Corpore Sano -  A Healthy Mind in a Healthy Body. This was their philosophy and approach to Health

 Preventative Medicine was the key to Health.  Can we learn from the Romans today ? I wonder.

NHS DOCTORS MUST NOT WORK ALSO IN THE PRIVATE SECTOR WHEN THERE IS A LARGE WAITING LIST FOR NHS OPERATIONS.

SIMILARLY, NHS NURSES SHOULD NOT WORK IN THE PRIVATE SECTOR WHEN THEY ARE NEEDED IN THE NHS.

BY TRAINING MORE UK NURSES, THE NHS WILL REDUCE DEPENDENCY OF COSTLY AGENCY NURSES.

EXTERNAL CONSULTANTS WHO ADVISE COMPUTER SYSTEMS THAT DO NOT WORK, SHOULD RETUREN THEIR FEES TO THE NHS.

THE NHS NEEDS TO RECRUIT MORE HIGHLY TRAINED IT STAFF WHO HAVE THE CAPACITY TO IMPROVE IT SYSTEMS AND MAKE THEM MORE COST EFFECTIVE..

Will the Establishment have the vision to strengthen the NHS from Bottom to Top as well as from Top to Bottom.?

in the past Reform of the NHS has tended to concentrate on the Organsisational Structure 

TOP TO BOTTOM. IN FUTURE I SUGGEST REVIEWS SHOUOD START AT THE BOTTOM AND WORK UPWARDS. IF THE GROUND STRUCTURE IS WEAK, THE BUILDING WILL FALL DOWN.

Let us wait and see. 

2021 - 2031 will be make or break years for the NHS. 

My Hope is that Britain will once again have a " From the Cradle to the Grave" free NHS properly funded by the Taxpayers.

PS - I am not a Politician, Celebrity, Millionaire, Healthworker, Footballer - I am purely 

MR RAYMOND ORDINARY BRITAIN.