The challenges ahead

With little surprise to myself, the government has quietly fudged on the key recommendations of the Francis Report. Despite the detailed report commissioned at no small expense by this government, they have compromised on the recommendation of candour to be shown by any NHS staff who witness ill treatment or neglect of patients. Some would argue this is a betrayal of the very report which they ordered and a betrayal more pertinently of the public who have to brave treatment therein. It is my contention that the government has made an indirect concession that such a requirement is not realistic. They appear to concede that it is not within the basic make up of all employees serving the second largest employer in the world, to actually care. This could be viewed as an indictment on the NHS but I prefer to see it as a realistic view. To care for another person is felt - not taught or demanded. This is why I was so interested to see what would actually happen in the aftermath of the Francis Report.

Let me be abundantly clear. Lord Francis has done a great job in dissecting with forensic detail the chapter and verse of the catalogue of error unearthed at Stafford. We have to be realistic though. Just as Marx and Engels espoused a society in which we would all co-exist in Utopian bliss content with less, with wealth more evenly shared out, Francis is the proponent of a very idealised NHS in which neglect is unacceptable. Of course, in an ideal world, he is quite right to aspire to such an organisation. Sadly, we are in a real world.

I once read a joke book which described a bureaucracy as an enormous cess-pit where the really big bits float to the top. How true. The problem is an old one. Greed and history tell us that protecting a high paid job is often far more important than justifying it. The essence of the problems affecting Stafford and a whole host of hospitals elsewhere is accountability. Many will point to staff shortages resulting in fewer staff being asked to do yet more in their already stretched roles. This rather misses the point though. Caring for another man or woman is not necessarily complicated. Many of the faults identified in the report concerned very basic issues which would have been dealt with had a basic standard of care been in situ. There were of course no shortages of managers. Management is essential of course - in moderation. Management, by definition, is only ever as good as its remit. Introducing so many targets whose main requirement was to save money was always dangerous. Money.

We don't need to enter into the world of complex mathematics to get an idea of the problems besetting the NHS. There is a finite pot of money. More is being taken out of this pot than is being put into it. Therein lies the problem. Ergo, how do you take out less to try and re-dress the balance? Simple. Less people going to hospital means less strain on the system and the much fabled pot of money. In my years thus far as a medical student, certain hospital disciplines are obviously at a dangerous level of strain. Keeping it simple, sugar, alcohol, tobacco and a basic lack of exercise are conspiring to present the health profession with the unenviable task of prolonging life at no small cost. All of these factors to a lesser or greater extent are addictive. It is very difficult to change the ways of a man who goes nightly to his local pub for three pints and a few cigarettes on the way home. It is not so difficult to educate the next generation. Much has been achieved already in this direction but much remains to be done.

As I write, a handful of supermarkets will have just enjoyed another week of massive turnover in respect of a religious festival whose relevance recedes by the year. Mountains of chocolate and obscene quantities of food high in carbohydrate will have been washed down with huge vats of cheap booze and all the while the supermarkets get richer and the NHS poorer. Within the privacy of their own homes, people are only accountable to themselves for their consumption. In the pub, such habits are subject to a lot more scrutiny and no bad thing. Pubs go to the wall at an alarming rate and many become scaled down versions of the large supermarkets. This has been one of the biggest scandals of recent years for which every government since Thatcher has played its part. Pubs once played key roles as community hubs were people got together socially with the aim of inebriation a long way down their list. The pubs though have been competing on an unfair playing field for a long time now. How can a pub hope to compete with the loss leader booze deals of the supermarkets? On many levels, minimum pricing for alcohol is no longer optional from a moral standpoint. Morals though do not seem to attract the attention of this government. Minimum pricing would give a much needed lifeline to a pub sector on its knees after years of supermarket dominance. It would also provide a greater deterrent to those who over-indulge and a greater revenue to the NHS so badly in need of it. Put simply, now is the time to be bringing people closer together rather than driving them further apart.

I took my son to church this morning and was very pleased to see so many other children there too. On this day of all days, there has to be hope for the future and the future is in their hands. First though, it is the moral duty of my generation to put them on a path which has apparently eluded so many since the second world war. If the NHS is indeed to remain free at the point of access according to the founding principles of Bevan, each and every one of us needs to wake up and take stock. I pray we do. Caring is what an army of carers do daily for loved ones the length and breadth of the land. Having been a carer myself, I can assure anyone, you wouldn't do it for the money. If every carer decided tomorrow that they no longer wished to do so, the NHS would be bankrupt within the hour. The debt we owe these people can never be repaid. They are the silent majority without whom we'd all be in trouble. They are also the role models for a new generation who ought to be at the forefront of thinking for the new NHS. Managers they are not. Real people with compassion and feelings they are. It is a great pity that some of the patients in Stafford weren't in the hands of real carers who get on quietly with the job in hand every day in their communities. I would further venture that community holds the key to future healthcare.

The recent spate of closures of community hospitals in North Wales beggars belief. Here, the ethos seems to propose putting even more strain on the general hospitals rather than relieving them. This is utter madness and history will show the folly of this decision. The bigger something gets, the more its essence is lost and we need only peruse the history books to witness it.