NHS - The death throes of a sacred cow

"Old Sawbones" is an established consultant
surgeon with many years experience working both
inside the NHS and private practice who cares
passionately about his vocation

An insider's view by "Old Sawbones" - our man in the know inside the NHS

I admit to being an anti-establishment critic. I have written about 100 letters to broadsheets and medical journals over the past 10 years, but there has been little public reaction.

Off the record, many apparently agree with what I write, but they daren't put their head above the parapet for medico-political reasons such as conflict with their work on committees or private practice. Basically, the motivations are money, power and prestige -the self interest factor.

In it's present form, our NHS was unsustainable even before the credit crunch, but as a country in collective denial and with politicians of all shades terrified to say the unsayable, we muddle along. Cancer cure rates and other indicators of success in medical treatment are already near the bottom of the European league.

No other country has a Healthcare system funded purely from taxation alone. Our NHS is not free, and there are financial restrictions on what care we receive. Whilst emergency care remains free, dental care certainly does not, and many people still pay for prescriptions. There is a post code lottery, and "NICE" admits that it's recommendations over cancer drugs have to be influenced by the cost. Thus we don't necessarily receive the life prolonging treatments available in some other European countries.

We have been graded as low as 18th by the OECD in the European league, and while health care systems throughout Europe (and indeed the world) struggle to contain costs, the most successful ones had mixed funding. Sources include "top up" patient's private medical insurance (in some cases compulsory), "Social Insurance" paid by the employer as in France and Germany, and voluntary contributions. So, with rising costs from expensive new treatments for an ageing population, I see no alternative to some form of direct payment such as charging to see a GP - as in Eire.

Perhaps we should turn a blind eye to the European Working Time Directive, as already happens in many, mainly Southern, European countries which don't slavishly follow it in every detail. This may be politically unacceptable, but there is no reason why today's doctors cannot work a reasonable amount out of hours, as still is the case in many parts of the world.

How can doctors bear to simply shut up shop at the end of the day?

There is some truth in the aphorism that from being a vocation or profession, medicine is now just a job. It is no longer a way of life, and a privilege to practice. I fail to see why today's GPs cannot work out of hours on a reasonable rota or with acceptable cover. With regret, I suspect it may simply be that they haven't got the resilience, stamina and staying power to do so. The "new" GP contract must be rescinded. If motivation were a patient, it would surely be on its last legs!

Another controversial measure would be to allow direct patient referral to specialists as occurs in many countries world wide. Patients know or can find out with help from the internet what specialist they need to see. But the GP as the gatekeeper to secondary care has to validate this. Often this is a waste of GP time and, of course, money. Unfortunately, there are too many vested establishment interests at heart here and the BMA trade union exists to preserve them.

And then of course there is immigration with its attendant costs to the NHS, the myriads of managers and jobsworths, "health and safety", and the compensation culture to consider...

I don't see our health service surviving in the long run, it's time expired, but the public and politicians have a blind spot - and our devious deluded dissembling PM wants to "protect" it!