Sunday, 24 September 2017

Mirror, mirror on the wall, is the NHS still the best health care system of all?

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.