Re: Oh Danny Boy(le)
I don't know if I count as a "sneering leftie commentard", but I have been in two different hospitals as a patient several times for different complaints over the last few years, and dealt with my GP and outpatient services for those and other conditions. I am also an ex-nurse, and I am currently extremely closely involved with the provision of medical law and ethics education to medical students, practitioners, and management . I therefore feel that I am qualified to comment here.*
Overall, my experience of the NHS is that it is still very, very good, but there are areas that are slipping. In terms of diagnosis and basic treatment, I have nothing to complain about. One recent condition was diagnosed as being something completely different from what was being looked for, and the change from one specialist to another was quick and seamless. It is possible that, under a better system the time from diagnosis to surgery (four months) would have been less, but it was not life-threatening, merely (very) uncomfortable and had some impact on my lifestyle for a while. The most recent hospitalisation in January (as far as I can remember - I was very ill on admission) must have cost thousands of pounds in tests while the doctors stabilised me and tried to work out what the problem was.
The down-side is that levels of communication between staff and patient, and especially with my wife, were extremely poor. As an ex-nurse, I find the amount of time that anyone qualified to speak knowledgeably about my conditions either to me or my nearest relative extremely poor. During the last admission I literally had to say to a doctor (the chances of speaking to a nurse were laughably small - absolutely disgraceful, since that is the primary function of a nurse in my opinion) "Please come and tell us what exactly is happening". They had been great at telling me what tests they were doing, and what results they had got, but not at pulling the story together. Disappointingly, the junior doctor who did come to do the job told a different story than the consultant gave me two days later, and I still don't know if I have had a particular intervention done or not!
The major problems in the NHS are: 1) creeping managerialism, with too many people coming from commercial enterprises and having no clue what the basic ethos of the NHS is, and how to maintain it. For instance, I know of one Trust Chief Exec who feels that all clinical ethics problems are management issues, and therefore that Trust has a Clinical Ethics Committee made up entirely of managers! 2) Poor standards of training for nurses. There was nothing wrong with the old apprenticeship method of training that was phased out on the 1980s, but the RCN insisted that nurses need to be more "professional" to compete with doctors. This was an utter disaster, and leads directly to cases where people are dying in hospital due to dehydration, and (to use a case posted here) people with throat cancer are given oral medications. We need an urgent return to nurses being trained on the wards as members of the team (though who would train them properly now we are infested by nurses trained in universities?) 3) Contracting out leading to a lack of team spirit. When I was on the wards, everyone, from the cleaner to the ward manager, was on the same team and did what was necessary. This is no longer the case, and it impacts badly on the patient.
I could go on, but the NHS is still worth fighting for. Treatment free at the point of care is vital in a civilisation, and the information that is locked in the NHS should be freed somehow in order to improve care (indeed, Beveridge expected that there would be no need for a huge NHS after a while because the information generated would lead to better preventive healthcare). If that makes me a "sneering leftie commentard", I'm proud of it!
*I do not discount the possibility that all of these things affect the way I have been treated, and so accept the possibility of observer bias.