Every day in the UK, we hear stories of ambulances waiting in queues at hospitals. Patients waiting hours to receive attention. Patients waiting hours on trolleys in hospital corridors.
What’s the problem?
Much of the media coverage focuses on the “demand”, by which they mean the sheer numbers of people coming to hospital for health care.
Let me return to the issue of demand in a minute, but let’s start with waiting times. Let’s set targets aside for a moment as well, because targets can be arbitrary and unhelpful.
Why are there queues of ambulances at hospitals?
Part of the answer is there aren’t enough doctors and nurses to attend to the patients’ needs.
There aren’t enough, because if there were, they would be able to devote all the time necessary to each patient but there wouldn’t be a huge queue.
Part of the answer is the staff can’t move patients through from A&E for inpatient care because there aren’t enough inpatient beds.
There aren’t enough inpatient beds.
There are more patients needing inpatient care than there are beds to put them in.
Beds aren’t enough.
Once a patient is in a bed, they need to be cared for….by staff to keep the ward clean, staff to make food for them and feed them, staff to care for their daily needs and staff to manage their diseases and get them well enough again to go home.
So can we fix that first?
- Increase the numbers of beds available in the NHS to cater for the needs of sick people.
- Increase the numbers of NHS staff to the level where there are enough of them to meet the needs of sick people.
Wasn’t that the whole point of the NHS in the first place?
To meet the needs of the sick in society.
Let’s turn to demand.
It’s going up.
And there’s absolutely not a shred of evidence to suggest it’s going to do anything other than continue to go up.
The proportions of the population over 60, over 70, over 80, and, yes, over 90 are all rising. All the evidence shows that older people have greater health needs. The demographics of the country tell us that demand will increase.
Life expectancy might be going up, but disease isn’t going down. There are more people suffering from a chronic illness every year. There are more people suffering from two or more chronic illnesses every year. This is what doctors are referring to when they talk about increases in “complex problems and needs”.
All those patients waiting on trolleys for a hospital bed have been assessed as needing the complex care of a hospital to cater for their complex needs.
Not all those patients already in the hospital need the complex care of the hospital. Some of them are elderly, and/or disabled people who are not able to look after themselves at home. They need to be looked after somewhere else.
Here’s the next item on the list.
There are not enough places available in care facilities which are not hospitals.
Places in care facilities, (nursing homes, residential homes etc), need sufficient numbers of trained and support staff to provide the care for their residents. We don’t have enough care facilities.
Let’s think about another aspect of demand. Time and again we hear that many people pitch up at A&E because they can’t get to see their local GP. They are told they have to wait several days, or even weeks, for an appointment so they go to the local hospital instead – with problems which could be, and should be, managed by GPs in the community.
Why can’t people get to see a GP in a more timely manner?
There aren’t enough GPs.
There never have been.
The scourge of General Practice is not having enough time to treat each patient as well as the doctors would like to. Were five minute appointments ever adequate? Are ten minute appointments adequate? Do they give the patient enough time to say what they want to say? Do they give the doctor enough time to listen, to examine, to diagnose, to offer treatment, to give the patient enough information to give informed consent to the treatment, to allow enough time to discuss options and alternatives?
You’ll have a hard time finding someone who can answer yes to that.
There aren’t enough GPs.
And there aren’t enough staff in the GPs’ teams either.
A healthier society
The biggest delusion suffered by those who created the NHS was that the NHS would make the population so much more healthy that eventually demand for it would shrink. That’s never happened. And it’s not likely to happen.
Health care isn’t the biggest contributor to the health of the population.
We need to address the causes of illness if we want to reduce demand. The causes of illness are primarily social, economic and environmental.
- We need to tackle the isolation of people in our society.
- We need to tackle poverty.
- We need to tackle the constant stress of the “precariat” – all those without secure incomes, those on zero hour contracts, short term contracts, those employed for insufficient hours at insufficient levels of pay to meet their daily needs.
- We need to tackle the food industry, from farming methods, to factory production of foodstuffs, to marketing and sales of food.
- We need to tackle the chemical industry, to reduce the amount of CO2 in the atmosphere, the amount of plastic in the sea, the number of chemicals found in the blood of every newborn child, the number of chemicals found in drinking water, the number of chemicals in every household.
- We need to tackle inequality which is rising fast and has been shown time and time again to inflict pain and suffering on millions.
- We need to tackle conflict, to be able to direct resources towards healthy lives instead of war.
- We need to tackle our political systems which leave so many feeling disempowered and forgotten. Democracy might be a great idea. Maybe we should try it. Not the pretend democracy of a vote every few years for someone to work in government, but real, relevant, responsive democracy which increases the engagement and autonomy of citizens.
- We need to find different ways to live together.
- We also need to tackle the Pharmaceutical industry. That industry which doesn’t exist to produce cures, but profits. There isn’t a drug on the market which increases health. At the very best a drug will support the body’s natural systems of repair and recovery. At worst drugs diminish symptoms without making any impact on the underlying disease.
We need a different philosophy of health care, one focused on health not taking drugs.
That’s an awful lot. Daunting perhaps. But are there better answers?
In summary
This is a toe in the water. There is no way to cover the complexity and extent of the issues in one short article. But can we make a start?
- We need more hospital beds, more care facilities, more GPs, more doctors, more nurses and more support and care staff.
- At the same time, we need to tackle the causes of the increase in demand – the social, economic and environmental causes.
Heroes Not Zombies 