Medical War Zone

In 2000, I retired from the Royal Army Medical Corps. However, reading through this week’s medical journals, I had the distinct impression that I should be taking my uniform out of the mothballs; for it appears that a war is even now taking place; one that I am firmly embroiled in, whether I like it or not. The battle ground is the National Health Service, and it currently has several open fronts.

The most important issue is the saga of the Health and Social Care Bill, which at the time of writing has just entered the Lords for its final stage there. As readers of this column know, I originally voiced serious concerns at the content and intention of this Bill in one of my earliest columns back in 2010. At the time, I was one of the few who dared to break ranks and speak out against the Government’s plans. Many of my immediate colleagues were muttering behind closed doors, but few would pin their colours to the public mast of disquiet and dissent. However, I thought the public had a right to know what was going on. After all, the NHS is your service as well as mine and, if there are to be major changes which will adversely affect the way health services are made available and delivered to patients, then the public has a right to understand.

However, in recent months, the map of those organisations expressing foreboding and alarm at the content of the Bill has altered considerably. Despite a continued rhetoric from the Government that the medical profession is behind the plans, there is now clear evidence that the majority of the health care professions are against the Bill. Such organisations include the British Medical Association (BMA), Royal College of Nursing (RCN), Royal College of General Practitioners (RCGP), Royal College of Midwives, Royal College of Radiologists, UK Faculty of Public Health, Academy of Medical Royal Colleges, Royal College of Physicians, Royal College of Anaesthetists, and the Royal College of Surgeons. Many are calling for the Bill to be withdrawn completely, on the grounds that it will do irreparable damage to the NHS.

Of course, there has already been damage inflicted, despite the fact that the Bill has not been enacted. Even before the Bill had gone through the first stages, the Department of Health was re-organising the local Primary Care Trusts, with widespread redundancies taking place in anticipation of the Bill being passed by Parliament. These changes cannot be reversed even if the Bill now fails, as important people have been lost to the service; people with a vast experience of running the NHS. In my opinion, that in itself deserves a judicial review. It is a gross misuse of a government’s power when it brings about widespread fundamental changes well ahead of a Bill’s debate and enactment in law. It is political arrogance beyond belief.

As a distraction to the above, there is the less well-known roll out of a service called NHS 111. At its core, this is a good idea; a national number to ring when health assistance is required at times other than in an emergency (when telephoning 999 is appropriate). However, the pilots have raised serious concerns for patient safety. In all, there have been nine serious untoward incidents across four of the seven pilots, wherein potentially life-threatening delay has occurred in patients getting assistance. The view of the medical profession is that the service should not be rolled-out until it is safe. The Department of Health is, as usual, playing deaf.

Other battle-fronts include the intended abolition of practice boundaries, thereby increasing the pressure on over-stretched GP practices that already feel under siege. Then there is the significant reduction in funding for practices, a GP recruitment crisis with unfilled vacancies, the imminent GP Revalidation process, and the need to register practices with the Care Quality Commission. That is all before we mention the subject of pension fund changes.

A recent study found that four in ten GPs have emotional exhaustion, a sense of depersonalisation, negativity, and a reduced sense of accomplishment; in effect they are burnt-out. Sadly, that finding is not a surprise, but it should raise significant public concern.

(First published in the Scunthorpe Telegraph, Thursday, 16th February 2012)