I was not surprised to see the article in yesterday’s Telegraph entitled “Patients facing eight-hour waits in ambulances outside A&E”. I thank Dr Alf for re-blogging this article and giving me the opportunity to make some practical suggestions how to improve UK public healthcare. I recognize that some of my suggestions are extreme but they are now necessary because of the extreme crisis.
The Telegraph’s latest research demonstrates the truth of what I have been saying for some time now, which is that the NHS is not fit for purpose, is badly managed and is in need of complete reform.
This also applies to Adult Social Care, and the need to tackle the causes of dementia, diabetes and obesity head-on and with preventative measures.
Piecemeal solutions and ducking important issues, because the politicians fear a political backlash, are no longer an option.
RESOURCES MISMATCH IN THE NHS
Since Tony Blair and Margaret Thatcher came to power and left the number of NHS managers increased by 225% and 189% respectively, and a look at the NHS Trusts indicates that there are far too many of them, resulting in far too many management layers, and far too many CEOs and overmanned and overpaid Trust Boards.
The number of Trusts needs to be reduced to perhaps 100 for the entire country, with half the eventual savings put into more doctors and more nurses after extraordinary costs.
A look at A & E (Accident & Emergency Departments) on Friday and Saturday nights shows a mismatch between vast numbers of drunks, night-clubbers and drug addicts who have been fighting and tiny numbers of nurses and doctors. On weekdays, hospitals have too many doctors and nurses and because of the failure of the Government to get doctors to work at weekends and the public’s inability to distinguish between minor ailments and serious problems, we have too many malingerers cluttering up A & E unnecessarily.
The drunks and night-clubbers, and others of working age engaged in violence, should be made to pay by garnishing wages or benefits; people, such as the man who demanded an ambulance because he needed aspirin, should be made to pay and named and shamed and Manplan scheduling software needs to come in to smooth peaks and troughs in medical staffing and new contracts of employment need to be applied to allow for flexible rostering.
The BMA contract should be renegotiated and if the BMA makes trouble they should be de-recognized and replaced with other doctors who are equally and better qualified than our own, expert systems and more “nurse practitioners” for simple ailments.
ADULT SOCIAL CARE/NHS INTEGRATION
The ultimate cause of many of the NHS’s problems, and local authority care systems costing 50% of County /Unitary Authority budgets, is down to 25% of old people and some younger ones, becoming obese, diabetic and demented.
Those older Adult Social Care recipients without relatives should be removed from the equation straightaway by transferring them to Goa and Thailand, where they can be looked after for a fraction of the cost as is already the case with elderly Germans whose Government has done deals with these Governments to enable this to happen.
Those who are at the early stages of requiring Adult Social Care need to be made to diet, exercise and be aggressively “re-enabled” so that they do not require Adult Social Care or need to take up beds in hospital.
This is already happening under Serco in Hertfordshire and Peterborough City Council but needs to be made universal practice Nationwide but not necessarily via Serco or other outsourcers (companies to whom services are outsourced) on similar contracts, whereby most of the benefit accrues to the outsourcer because the local authorities’ lawyers were not sharp enough to out-think the lawyers representing the outsourcers.
Local Authority Adult Social Care should be abolished and transferred to the NHS, along with those social workers needed to undertake the pre-assessments and the assessments and that portion of the Local Authority budget attributable to Adult Social Care.
The Local Authority should then be required to put their Directors of Adult Social Care and everyone else other than these social workers to the sword.
GP SURGERIES-REDUCING THE NUMBER OF MALINGERERS AND WORK AVOIDERS
About half the people in GP surgeries are whingeing malingerers, who are deliberately wasting the time of the doctors in the practice by wanting someone to talk to or seeking “fit notes” so that they can extend their holidays, take time-off work or go on holiday early or during term time.
This phenomenon can be observed by trying to get into a GP surgery car park on a Monday, a Friday, just before a Bank Holiday, just after a Bank Holiday or before Christmas, Easter and half terms.
Such people and those who break appointments should be charged and given a severe talking to. At all other times the surgery car park anywhere in the country is like the Gobi desert. The presence of these whingeing patients and malingerers, often of pensionable age, does not allow GPs to spend enough time on the genuinely sick which results in misdiagnosis through rushing and in really sick people having to wait at A & E in ambulances.
PREVENTION/VARIABLE TAXES ON FOODS
With the present obesity, dementia and diabetes crisis, we have to take action by introducing variable taxes on foods so as to encourage healthy eating and eventually diet and exercise.
Secondly, we need to eliminate harmful chemicals such as Bisphenol A, Fluoride, pesticide residues, salt, sugar, Aspartame and E numbers from the food chain as these cause cancer, are often gender bending, make people fat, depress people, make people ill and hasten their demise.
Doctors in the UK are paid by the size of their patient lists not by the proportion of people they keep well.
The way we pay doctors needs to change to the system used in China which emphasizes whole person treatment not magic bullet, drug led treatment.
The public abuse their bodies by drinking on empty stomachs, eating rubbish, not knowing how to cook, smoking, failing to use vitamin supplementation and failing to get enough sleep and exercise. They fail to control their mental states by not having a well thought out philosophy, not understanding risk and by not having the necessary personal discipline to be able to cope with the vicissitudes of life.
Both of these need to change if we are to ever get to a situation where good health is the norm and our A & E Departments are not cluttered up with patients and ambulances.
To effect change in the next generation, schools must teach Stoic philosophy, diet, nutrition and how to cook and playing fields must be retained so that sport can take place.
Then we need the reintroduction of National Service to toughen people up.
For present day adults, we need to operate the practice developed in Hertfordshire which is to insist that recipients of major treatments and surgery lose weight before they can have it, and stop smoking and reduce their alchohol intake to the minimum required.
NHS PROCUREMENT/CURTAILING WASTE
Billions are wasted through poor procurement practices of the kind identified by Sir Philip Green in his 2010 report to the Prime Minister.
NHS Supplies needs to be made to implement his recommendations in full along with JIT warehousing and distribution using Lean principles and the savings used to promote preventative medicine and education on the proper use of A & E.
Individual hospital procurement needs to come under a rotating panel of outsourced providers with a draw-down facility to limit anomalies.
WORK AND MARRIAGE
People who work and are married happily generally live longer, more prosperous and illness free lives than those who are unemployed, single or prone to engage in bizarre and unusual lifestyles. They are also less accident prone and less likely to end up in A & E.
The tax system needs to recognize and favor traditional marriage and not try to say that all lifestyles are equally valid.
Our major industrial competitors in the Far East all do this and as a result have a stronger sense of family, social cohesion and looking after their own.
Everyone doing their “own thing” is fine but it carries a heavy price-tag which as a bankrupt country we can no longer afford.