Last Tuesday was the 32nd anniversary of the 1985 magnitude 8 earthquake in Mexico, an earthquake that
killed 10,000 people and left 30,000 injured. Mexico is one of the most
seismically active places on Earth. Last
Tuesday was also when Mexico experienced a 7.1 magnitude earthquake that has
killed over 300 people. The country has an elite team of rescuers known as ‘the
moles’ and the search for more survivors goes on. Unfortunately the death toll
is likely to rise as rescue efforts become recovery activities. And yesterday Mexico had another earthquake, this time a 6.1 magnitude. My thoughts, and I am sure many others too, are with all those effected by this dreadful disaster.
Last Wednesday I was reminded of
the devastation a different earthquake had caused. This was the magnitude 7.6
earthquake that shook the Kashmir region along with parts of Pakistan, India
and Afghanistan on October 8th, 2005. This earthquake killed 80,000
people and over 4 million people were left homeless. Unlike Mexico whose health
and general infrastructure is better prepared to deal with such disasters, the
death toll in Pakistan was so high in part, because there were no drugs, medical
equipment or associated relief infrastructure. My colleague, Dr Ayaz Abbasi was there at the time
providing help to those caught up in the disaster.
Last Wednesday he told stories of
that time as part of his presentation at the Wrightington, Wigan and Leigh
(WWL) NHS Hospital Trust Annual Public meeting. He told of his despair of
treating patients in crude conditions, sewing up wounds with ordinary cotton,
and without the benefit of any anaesthesia being available. It was an emotional re-telling of
his experience. Dr Abbasi is now the Clinical Director of the Accident and
Emergency services at WWL. The A&E Department is one of the best in Greater
Manchester, and indeed is consistently in the top 10% of all high performing
emergency departments across the NHS. He was justifiably proud of the team he
works with and what they had been able to achieve.
Dr Abbasi was equally proud of the
wider NHS – he urged the audience to recognise what a fantastic service it was
and that there was no other health care system in the world that was able to
provide the level and quality of health care to people in the way that the NHS
does, and does so consistently. He wasn’t blind to the problems that the NHS
faces. The demand for care is constantly increasing, a growing part of the
population is getting older, presenting with more complex needs, and health
care professionals can do more with technology, pharmacology and interventions
than they have ever been able to do. When the NHS was first created it had a budget
of some £437 million (roughly £15 billion at today’s value) - now the budget is
some £124 billion a year, and even this huge resource doesn’t always go far
enough.
In his talk, Dr Abbasi recognised
that we needed to reshape the way in which NHS services are delivered. The
current Government is committed to ensuring this happens through the development
of new care models and treatment in the community and closer to people’s homes.
However the change required is going to take time. There are 3 times more
doctors and 4 times more nurses working in hospitals than in the community. Partly
this is a consequence of the way the training and education of health care
professionals still remains highly centralised. I fail to see what added value those responsible for the commissioning of education and training of health care professions, bodies such as Health Education England, really bring to ensuring the workforce needs
of local health economies are appropriately met.
Last week, I received an invitation
to join other members of the Nursing Midwifery Council (NMC) Thought Leadership
Group in a couple of weeks’ time to review the responses to the consultation on
what the future graduate nurse might ‘look like’ and what the educational programme
to achieve this might also ‘look like’. Of course whilst it’s a real privilege
to be able to help shape the future health care workforce in this way, I am
slightly challenged by the notion that the NMC is just one of many different
regulatory bodies determining the scope of professional practice for the various
different health care professions. I am not convinced that such tightly differentiated
approaches to regulation and the establishment of individual boundaries of care
is helpful of even necessary. Dr Abbasi in his talk rightly acknowledged the contribution
the whole team made to ensuing high quality, safe care was available to all patients
whatever their need. Perhaps the various heath care regulators could learn
something from the way in which integrated and inter-professional health care is
being delivered in the WWL A&E department.
And like Dr Abbasi, I think that the
NHS is a wonderful institution, even with all its challenges. As a health care
system it provided superb care for both the Kevin’s in Scotland, my Mother in
Wales, Mark, Daniel, Jack and Christine in England, and of course my brother
Christopher, who 10 years ago yesterday, lost his battle with a long standing
illness, and died. For me, his passing will always feel premature. Rest in peace Christopher.
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