The End of the NHS?

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Britain’s health secretary wants to uncharm his way to a revolution.

To galvanize support for a seven-day National Health Service (NHS), which the NHS was before Jeremy Hunt’s radical plans, and still is, he asserted that thousands die because there is a shortage of senior doctors during weekends. This is an expedient interpretation of a study which showed that mortality was higher in patients admitted on weekends. Hunt ignored the fact that patients admitted on Friday night are actually sicker than those admitted on Wednesday morning.

When logos failed, and after briefly dabbling with pathos, Hunt resorted to ethos. He insinuated that doctors were clock watchers (“service that cranks up on a Monday morning and starts to wind down after lunch on a Friday”). This led to a hashtag on Twitter: #ImInWorkJeremy.

Hunt wants to modernize the NHS. Leaving aside whether modernization is modernization, post-modernization or pre-post-pre-modernization, presumably this endeavor benefits from having doctors on board. How has Hunt enticed the doctors? He prophesized that GP’s diagnostic skills could be obsolete in twenty years. He wanted to replace doctor’s clinical judgment with computers, sooner rather than later (he’d just returned from Silicon Valley).

Karl Marx rallied workers to fight machines and capitalists. Hunt’s approach is of a middle manager with a touch of Mahatma Gandhi. “You suck. The computer will replace you. Do you mind hastening your replacement by embracing the machine, preferably without breaking the screen? Thank you, kindly.”

Junior doctors are leaving the NHS in droves. Many serve Australia’s areas of need, such as Mount Isa in Queensland. This allows homegrown Aussie doctors to stay in Melbourne, and intrepid Aussie doctors to move to Sydney. Britain’s tax payers are subsidizing the Australian healthcare, just as the tax payers from the Indian sub-continent once sustained the NHS.

Hunt, tackling the issue with Kissinger’s diplomacy, offered junior doctors a stick with no sight of a carrot. He wants them to work harder for less pay. In return? There are certain things money can’t buy….

History will unlikely judge Jeremy Hunt as the heir to Machiavelli. To be fair, neither is he the heir to Slytherin. He is Ebenezer Scrooge’s fastidious accountant. He wants the NHS to deliver as much as possible with little investing. He’d be a handy companion if backpacking in Thailand on a shoe string budget. Until he embarrasses you at the Hilton by refusing to pay for the premium scotch.

Hunt is in awe of Virginia Mason hospital, Seattle although I am uncertain he will import their entire business model to the NHS. He wants American healthcare at NHS prices. He dreams globally and pays locally.

Hunt suffers from austeritis – he wants the political gains of austerity without the political losses of austerity. He wants his austerity and not have to eat it. His method, uniquely British Conservative – pay less and demonize the workers – once worked in Stalin’s Soviet Union.

There is a chasm between doctors and Jeremy Hunt. Doctors think Hunt is a pantomime villain. This is unfortunate, not only for pantomime villains. The NHS has different issues today. Britain has changed. When the NHS was born, Brits were resilient, and the Daily Mail did not have an online comment box to vent. There were fewer permutations by which death could be deferred marginally. There was tuberculosis. People were grappling with the harms of smoking. And people were told to eat an apple, not a statin, a day.

Furthermore, the emergency department (ED), or whatever it was called then, wasn’t a one stop shop after Saturday night partying. NHS’s crisis is an ED crisis. The ED crisis is a societal crisis. The crisis has been caused, partly, by four-hour targets, which forced the ED to see patients, regardless of the chronicity or absurdity of their symptoms, as soon as possible.

I once worked in an inner city ED with nurses so good that they gave doctors a run for their money in clinical acumen. The nurses triaged and triaged liberally, making some with long-standing symptoms wait eight hours to be seen, all the while ensuring that streppable myocardial infarction was seen instantly.

The eight-hour wait time persuaded the thirty year old with vague belly pain for six months to see his GP. Everyone in the UK has a GP. Everyone. It is their right. The “right to a GP” has become a “right to a GP at my beck and call”. Hunt wants this right guaranteed at no surcharge.

Breeding unfettered consumerism and social justice creates disingenuous public policies. The public wants 24/7 concierge doctors without forking out the dosh. Who would say no to that? Hunt, instead of confronting this arithmetic delusion with honesty, is fanning it.

NHS is the art of the impossible. If Jeremy Hunt was less patronizing, and gave doctors due credit that they can add and subtract, they will deliver more than the impossible.

Instead he, like those before him, has gone for the jugular. Bringing doctors down a notch won’t modernize the NHS. Hunt’s strategy is penny foolish and pound retarded. If doctors abandon the clinical judgment that Hunt so belittles, austerity will be an imaginary number.

Saurabh Jha is skeptical by nature not because he hates you. He can be reached on Twitter @RogueRad

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12 replies »

  1. Well the problem is obvious. England’s minor public schools like Charterhouse are adept at turning out arty Rock bands like Genesis, but the real job of governing should be left to Old Etonians & Whykemists.

  2. You are right lawyerdoctor. Having worked in both healthcare systems, I see advantages and disadvantages in both. Interestingly, politicians on both sides want to emulate the other, without incurring any pain – i.e. both want the access of American healthcare at NHS prices.

    Basically, what they’re saying is: the grass is greener on my side, but please give me your lawnmower.

  3. Thanks Dr. Jha for pointing out something I have maintained for a long while, that is, Americans tend to have a much greater “consumerist” approach toward healthcare than the Brits do, at least historically.

    I practice (I’m the ER Director) in a relatively small town. Likewise, our semi-rural hospital is also small. However, our ER sees almost a THOUSAND PATIENTS per month! Not only are we the main portal for admission (like all hospitals), but we have to deal with the failed chronic care issues, the runny noses, the folks who want an MRI for their sprained ankle, the family that wants granny admitted “to get some rest” (shit I thought that went out in the 1960s??) etc.

    Tunbridge Wells is eleven times my town’s population. I’m betting they do not see 121,000 patients in their “accident ward” or “emergency” annually? (our annual volume is 11,000)Lewes in Sussex is 4 times our size. Wonder how many ER visits they have in their local hospital? GSW’s? MVC’s? Kids with flu? Nursing home pt’s sent because they weren’t “looking very good” in the eyes of the LPN in charge of their care?

    Why? Because the Brits do not have the expectation that an orthopedic surgeon, a plastic surgeon, a pediatric allergist, etc. are all sitting in the ER awaiting their presentation. The British, with their stiff upper lips, apparently do not pour into ER’s 24/7 demanding refills for oxycodone.

    Yet, our political leaders (and occasionally medical “leaders”) insist that the U.S. adopt the British system. I’m personally fine with it, but I think these folks grossly under-estimate the torches and pitchforks that would ensue when Americans have to experience a healthcare system that is not avail 24/7 to their “needs” (“demands”).

  4. Presently, there is a suspended service on weekends, much like academic centers here. JH wants a seven day work week.

    Suspended service means a service which treats emergencies not electives. You can still get a CT for pulmonary embolism in a suspended service. But not p-ANCA or a CT to rule out malignancy.

    JH is not a physician by training. Unlike here, in the NHS there are very few physician leaders. This is unfortunate for the NHS.

    The public is increasingly harboring ill will for doctors. This is because Whitehall (equivalent of beltway) doesn’t have the courage to confront unreasonable demands, unreasonable relative to investment. The easy thing to do is to blame greedy doctors.

  5. Saurabh
    Seeing as our system has challenges to go 24/7 (and I am familiar with the paper you cite re weekend deaths) can you help me understand the NHS particulars a bit more.

    1) docs are being asked to go from what kind of schedule to what kind of schedule?
    2) does the public harbor resentment towards the docs, i.e., majority?
    3) Is Hunt a doc or a health lifer/administrator?


  6. “Breeding unfettered consumerism and social justice…” Here’s a parental combination guaranteed to produce birth defects! Enjoy reading you, Rogue, as always.