SAVING OUR NHS THAT HAS SERVED US FOR SEVEN DECADES

Our National Health Service is fast approaching a crossroads that may alter its trajectory from what was originally planned as a noble objective: “health care available at the point of need, regardless of the ability to pay for it”. Like the late Prof Stephen Hawking, many of us who have benefited from the NHS share his common sentiment: “The NHS has saved me and I must help it to be saved”.    by Buddhdev Pandya MBE   23 March 2018

The ongoing political struggle between socialism and capitalism has distorted the commitment to the healthcare needs of the population since the formation of the NHS seven decades ago.

From the Conservatism of Thatcher to the New Labour approach of the Blair–Brown leadership, considerable momentum has been provided to the Public–Private Partnership (PPP) acolytes to impose privatisation to the NHS over the past three decades at a much faster pace.  

From professionals to voters, most of us have conveniently bought into the idea, while many have indeed jumped on the bandwagon without realising that increased integration of the private sector would eventually dominate and shape the future of healthcare provision. 

Instead of introducing ‘added value’ to the NHS, the private sector appears to be draining public funds in a subtle but sure-fire manner to line its own pockets!

I would agree in general with the late Professor that the crisis in the health service has been created by politicians who want to privatise it when public opinion, and the evidence, point in the opposite direction. But, it would be naïve to pin all the blame on privatisation for the state in which we find our NHS today.   

In addition, I would urge our leadership cadres to seek fundamental reforms to the way in which our service’s regulatory and monitoring institutions are shaped. And while their performance raises serious questions, their structures seem to be outdated and poorly executed – unfit for purpose in the modern era.   

The recent case of Dr Bawa-Garba is a classic example of systemic failures that exhibit neglect of the due care and attention that should be ensured by institutions and their leaders. 

In a letter written by Hannah Quirk from University of Manchester’s School of Law, she highlighted that “there were many mitigating factors which are well known to you and some of which I listed in my last letter. Since neither Bawa-Garba’s consultant nor her NHS Trust was on trial, their roles largely slipped into the shadows. To put it bluntly, she was abandoned by her consultant, shafted by her employer and then tormented by the courts and finally persecuted and made unemployable by you. I wonder if you looked behind the court decision at the staffing levels and the workload on that fateful day – an absent consultant, a woeful shortage of trained nurses, no rest break and so on – and whether you would consider them to be prudent and acceptable. If so, perhaps you would be kind enough to publish them so that we can all see what the GMC regards as a safe working environment” (BMJ 2018;360:k481).

I would add to this the question of what happened to the CQC inspection reports of the Trust failing for the past few years, which should have sought redress for such appalling conditions. We must acknowledge that many international medical graduates have suffered from a distasteful experience with the GMC. 

More often than not, the leadership and their voluntary sector organisations consistently raise (in good faith) issues that have adversely affected these professionals and eventually impacted on the quality of ‘patient care’. And, in the case of many NHS Trusts, there have been failures to provide a conducive environment that is fair and supportive to the workforce, while sustaining conditions that are putting the safety of patients at serious risk.

Despite all the rhetoric of modernisation, both qualities in monitoring and redress are missing in the governance structure; all we receive are generic institutional apologies, which sound patronising. During the past few months I have noticed an emerging opinion among politicians that the Government should consider establishing a Royal Commission that can conduct a comprehensive and thorough review encompassing the past seven decades of service, reflecting on the service delivery structures, as well as the regulatory and monitoring regimes, in order to suggest opportunities for the improvement of management structures and creation of enhancement of  implementation processes with accountability and transparency across the NHS. 

The GMC is in desperate need of reform to replace outdated and cumbersome legislation with processes that can help improve confidence in the medical profession. The future demands a model of regulations that is flexible and fit for the needs of a modern workforce, which is now being advocated by the Chief Operating Officer of the GMC and endorsed by the Bow Group in response to their research. 

The Government would be well advised to introduce an independent watchdog, an observatory body with the power to investigate and report. 

Finally, while we continue to lose valuable medical professionals and front-line workers, most of the NHS Trusts remain busy chasing their tails. Invariably we remain fixated with ‘pampering’ the heads of institutions and jockeying for positions that are often tantamount to nothing more than ‘tinkering at the edges’ of the challenges that we face in the NHS today.

We hope that both of these proposals – a Royal Commission and independent watchdog – are supported. 

Feedback welcome: buddhdev.pandya@gmail.com