Posted by: Witch Doctor | August 15, 2009

The Transatlantic Healthcare War


So, there’s a Transatlantic War on about healthcare, My Black Cat.


It’s a good thing that Daniel Hannan is shouting his mouth off about the pitiful NHS.

He has a right to say it.

It’s a good thing that Sarah Palin is using the word “evil” to describe a public health insurance scheme.

She has a right to say it.

It is a good thing that Newt Gingrich is likening the NHS to an Orwellain nightmare.

He has a right to say it.

Even if they are thought to be disagreeable, biased or wrong.

That right is called freedom.


A war like this might focus minds in the UK.

It is a pity that Twitter has chosen the name WeLoveTheNHS.

Many who have very close experience of the NHS both professionally and as patients do not love the NHS at all – they love bits of it, are indifferent to most of it, and hate some of it. – however, they love the principle of the NHS and because of that they believe in the NHS.

The Twitter site might reflect public opinion more accurately if it had been called WeBelieveInTheNHS or WeLoveTheNHSConcept.

Then it would have been more credible.

The NHS, like any healthcare system, will never be perfect but it could easily become excellent and the envy of the world.


At the moment The Witch Doctor is looking after a relative who had an operation last week at what used to be a large teaching hospital but which now is being rebuilt as an excellent Ambulatory Care / Day Surgery Unit, (not using PFI incidentally). Due to coexisting medical conditions, a possible problem was anticipated. Because of this, the surgery was performed by the consultant himself and in the short time since the operation, the patient has been reviewed by the consultant and will be seen again early next week. Arrangements have been made for him to be seen at a hospital at any time over the weekend should any problems arise. So, right now, The Witch Doctor and the patient love the NHS. The care has been exemplary. Even if anything goes wrong, everything has been done that can be done.

A consultant delivered service.

An excellent service for the common good paid for by the patient, The Witch Doctor and the rest of society over many years.

The patient will not be billed, there will be no insurance claims to fill in, there will be no sneaky small print exclusions in insurance policies to read, and there will be no financial worries.

The NHS at its best.

It is not always like this. The Witch Doctor has not had a member of her family die due to neglect within the NHS but one of her children damn well nearly did. Blatant neglect. I don’t feel ready to tell that story yet and I probably never will but it will stay with me until the day I die. I know what it is like to spend nights resting but not sleeping on the floor of a nearby hospital room wondering and waiting for the worst. I know how Dr Rita Pal and Angus Dei and many, many others must feel about the neglect and consequent death of their loved ones and I think I know what might be driving them each in their own way to try to do something about the system.

I have more stories of neglect of close members of my family and friends. Often the neglect is scattered throughout episodes of otherwise excellent care. The neglect has the potential of undoing all the good that has been done by the professionals and makes a monkey out of the sophisticated procedures that have been skilfully and expensively carried out.

And yet I believe in the NHS.

As a doctor too, I have seen neglect unravelling all the excellent care that has been given.

I have seen neglect by staff who were called nurses who should not have been, who were more interested in chatting up members of staff and gossiping about the most recent “Big Brother” episode than attending to a comatose patient’s mouth hygiene.

I have seen neglect by doctors whose consultant led service might as well have been led from the committee rooms of the moon – so distant were they from the patient signed in under their names.

I have seen neglect from administrators who organise contracts where operating theatres are only cleaned up to a certain height and everything higher up is forgotten about resulting in organisms including MRSA dripping from the lights on to the operating table. I have seen the consequences to patients of that neglect.

I have seen neglect from a chief executive whose attitude to a request from consultants concerning the most basic needs, was to demand never-ending information in the form of written documents giving stated case after stated case for obvious, necessary and not even expensive requirements. The same chief executive who ran a “tighten the screw till they squeal” policy and would frantically use intimidating techniques to get things done that they had previously refused to do, at the eleventh hour before King’s Fund accreditation.

I have seen an essential service almost crippled because excellent consultant staff who were so overworked where they were and so much in demand elsewhere that they took themselves off within weeks of each other to move on to jobs where they were appreciated and were not worked both mentally and physically into the ground.

I have seen neglect occurring because patients are not being fed. I have sat in a ward feeding a relative during breakfast, lunch and dinner. I have watched carefully what was going on in the ward. I have calculated the time it takes to feed patients who cannot feed themselves. I have counted the number of such patients. I have counted the number of available staff. I have counted the number of meals. The arithmetic was clear. Not all patients could be fed. In this instance the nursing staff and other ward staff were not talking about “Big Brother.” They were efficient, professional and dedicated staff being asked to do the impossible. In essence they were being abused and as a result so were patients.

I have seen a deteriorating comatose patient dumped from one hospital to another. Not only dumped in the wrong ward but dumped in the wrong hospital. When asked to see the consultant in charge of the said patient no-one knew which consultant was responsible or why an ambulance had brought the patient there. I have seen young trainee surgeons come to the rescue of the patient. But it was a medical problem not a surgical one. The young surgeons were the only ones prepared to take any responsibility at all.

I have seen medications that were prescribed and required immediately, not being given till 18 hours later because a committee had decided they should not be routinely accessible in the ward because of their cost. Apparently the medical staff could not be trusted to prescribe the way management dictated. Sure, on paper, the drugs were available – somewhere, but nobody knew how to work the system to get them nor did they appreciate the importance of timely administration for that patient.

I have seen important specimens taken in theatre lost in transit to laboratories and the patient consequences of that.

I have seen pharmacists being given more authority than they are qualified to have. I have seen them interfering with prescribing for extremely ill patients in the name of cost effectiveness. I have seen them telling junior doctors to change drugs that their seniors, based on the patient’s deteriorating clinical condition, have prescribed.

I have seen the consequences of telephone consultations being used in acutely ill patients.

I could go on.

And on……….

And yet, still I believe in the NHS.

I believe in the NHS because huge numbers of the staff working there across all specialties are totally dedicated in doing the very best they can for patients.

Because of this I believe the NHS can be easily mended.

And it could be the best healthcare system in the world.

I have spent much time considering why the neglect happens and believe I know what can stop the neglect.

The neglect is due to lack of attention to detail at the coalface and is the result of prioritising those activities that are not even in the mine, far less the coalface.

There are many reasons for this lack of attention to detail but you can be sure that, more money, more managers and management courses, more leaders and leadership courses, modern matrons, won’t stop the neglect.

You can be damned sure too that Appraisal, Revalidation and the relentless witterings about The Patient Experience, Hospital at Night, Patient Choice, Patient Pathways,  Skills Escalators, a Health Service of all the Talents, Competent Clinical Decision Makers etc etc ad nauseam, won’t stop the neglect either.

It comes down to leaders.

Not “The Leaders” who have been selected by Common Purpose as “suitable” for “leading beyond authority”

Not the leaders who attend leadership courses run by King’s Fund either – or any other leadership course for that matter.

But the leaders who are already in situ, up and down the land in surgeries, in clinics, at the bedside, in operating theatres and in departments.

Those already leading and keeping the show on the road as best they can in spite of all the extraneous background noise from the government and in spite of those members of their own professions who have become the obedient instruments of government.

These lowly leaders need to be identified, listened to and supported, because most of them know exactly what needs to be done, and how to do it cost effectively.

Local chief executives, medical and nursing directors need to get off their butts and find them: because, since these leaders have chosen not to climb up the slippery slope of self-gratification, they are invisible.

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  1. This is exactly how I feel, WD. There’s so much that needs sorted in the NHS and yet the ideal is a great one and it does do a lot of good. It’s trying to get the balance between criticising it where it’s weak, and avoiding playing into the hands of those who would abolish it in favour of private healthcare. Difficult..

  2. […] I have seen all this neglect before. […]

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