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'Put down the pitchfork – the workers are getting it right'


Don’t you think we all need a holiday? Yes, all of us.

It costs nothing to dream and in our house we like to compile lists of possible holidays before putting all of the ideas into a hat, burning the hat and letting my wife decide.

This is because I once suggested we try to compromise so that everyone got something of what they most wanted. Interacting with wildlife (daughter), spending time in the water (me), and experiencing a different culture (wife) somehow came together to form a holiday that involved swimming with sheep in Wales. Which is more expensive than it sounds unless you smuggle your family into a coastal farm, at night, and harass the already troubled sheep toward the sea. I don’t think it’s as much fun as that sounds and most Welsh farmers agree, so down with compromise.

I was talking to a student the other day who said she had two weeks off and was hoping to get a late booking somewhere warm for a week where she would sleep, get a suntan and write an essay. She had been working in her “spare” (sic) time as a healthcare assistant and had enough self awareness to notice that she was emotionally and physically exhausted. “I have spots,” she said, “and I’m 29!”

I wonder if it becomes dull to notice the amount of effort nursing staff, including the often voiceless army of HCAs, are expending in trying to contain the tidal wave of need that is the everyday NHS? Because the energy required to provide not just the care but the attention that goes into most clinical days is worth noting and admiring.

Why the holiday? Well, apart from the obvious need to rest after such a lot of work, a recent poll of health service chief executives by the NHS Confederation said that 53% of them expected patient care to worsen. Not one said this was because we were on holiday or because nursing staff were not being attentive, focused and professional, but because services would suffer through another reorganisation, public services would be cut and the ideology driving the Health Bill was not focused on good patient outcomes.

Meanwhile new research in the Journal of the Royal Society of Medicine tells us that the UK has among the most efficient health services in the whole world in terms of saving lives per pound spent. Reading this conjured up an image from an old Frankenstein film, where all the angry villagers are charging up the hill with their lit torches and pitchforks, fixed on slaying the out of control monster that is the NHS. And there is someone standing in front of them pointing out that actually they are getting very good value for money and it would be far more expensive for them if they lived in pretty much anywhere else but he is trampled by the angry people and left lying in the street with a pitchfork up his bottom.

It would be interesting to find out what it is that makes the NHS such good value for money. Given the fact it seems to get an organisational makeover every time the government changes the colour of its tie I would guess its strengths lay in delivery.

And what is it about that delivery? Its skill? Your fortitude? Emotional labour? Clinical ability and qualities that go beyond protocol and into the attention staff bring to patients?

These are difficult times but research - as opposed to political rhetoric - suggests staff are getting a lot of the important stuff right. Given that fact, in reality staff deserve more than a holiday - they deserve a pay rise. What are the odds?


Readers' comments (12)

  • Absolutely agree! We don't get anywhere near the thanks, recognition, or status for the fact that the NHS still runs so well DESPITE the slow dismantling of it by government forces outside of our control, because make no bones about it, it is the STAFF that are responsible for the good that the NHS still does, not the NHS itself, or the reorganisation, or the managers (despite what they say) or any crackpot government scheme.

    We need a long holiday and a massive pay rise, I totally agree. But what we DESERVE, are much better career and working conditions, and an NHS that is free from moronic politicians and managers.

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  • "It would be interesting to find out what it is that makes the NHS such good value for money."

    That's an easy one, Mark. It's the people who make the NHS work, in spite of,"....all the angry villagers are charging up the hill with their lit torches and pitchforks,..."!! Where else would you get the skill, fortitude, clinical ability and dedication for so little in return?

    As my wise old granny used to say, " Aye, they'll miss us when we're gone."

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  • hi mark, could you provide a link to that Journal of the Royal Society of Medicine article, please? the only research in the current issue i could find online was about pulmonary embolism. ta.

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  • Adrian Bolt

    The report by the Commonwealth fund, to which I think you refer defines “efficiency” as the percentage of GDP spent on health. The higher the figure the greater the efficiency apparently. The same report goes on to rate Britain as second to last for “long healthy lives” and Britain also came bottom for life expectancy at age 60 with the UK having a much higher death rate in 2003 from treatable conditions amenable to medical care than most of it’s European neighbors.

    We all know that Labour drastically increased spending on health during the last parliament but that increased spending does not appear to have been translated into anything tangible such as increased life expectancy aged 60 or “long healthy lives”. So how does the report square that with its main finding that,

    Increased spending = Increased efficiency?

    If anything the opposite would appear to be the case.

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  • we should be focusing on the provision of good services with adequate treatment to avoid death and deterioration for treatable diseases and disorders for each and every patient and the money should follow and not the other way round!
    human lives are valuable and unique and cannot be replaced and are not to be treated and processed like goods in a factory where the rejects can just be chucked out!

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  • Adrian Bolt

    Anon @ 9:57am

    "the money should follow and not the other way round!"

    Which is exactly why the NHS is so INEFFICIENT. The NHS is a top down bureaucratic nightmare where targets matter more than patients and the whole thing becomes a political football to be kicked back and forth between the government and opposition parties.

    Some form of privatisation coupled with an insurance based system to pay for health care, (such as they have in most of continent), would ensure the money follows the patient while retaining the "free at the point of use" tag fundamental to any system of health care provision.

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  • I strongly agree and I am glad you agreed with my comment which could be perceived as totally daft in today's political climate!

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  • The NHS is not a sweet shop it is a service and cannot be based on sweet shop economics. As far as I'm aware under Labour the NHS effectiveness was increasing. The efficiency factor is something different and will always be uncomfortable to a business driven individual or ideology due to the fact that they want to spend the least possible in all situations.
    Operating a service requires investment, particularly in healthcare.
    However saying that an insurance system will automatically be better as the money will follow the patient is simply not true. The money will follow the business not the clinical appropriateness, and end up in the shareholder coffers.

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  • Adrian Bolt

    Interesting response Anon @ 10:17pm what you are in effect saying is that the NHS is a “service” and so economics (whether of the sweet shop variety or not) has no role to play in its management. That is the sort of naive thinking that will end up bankrupting the entire country including the NHS.

    If the efficiency of the NHS was so good under Labour then how do you explain two WHO reports one in 2001 that ranked the NHS at 24th in the world for efficiency and another from 2000 that rated it at 19th. More recently the Commons Public Accounts committee has just published its 26th report which has found that despite increasing spending by 70% in 2000 - 2001 productivity has actually fallen over the last decade. So much for throwing money at the problem.

    If an insurance based system of healthcare does not deliver a better and more efficient system of healthcare how do you explain the significantly better standard of healthcare enjoyed in France and Germany?

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  • "The U.S. health system spends a higher portion of its gross domestic product than any other country but ranks 37 out of 191 countries according to its performance, the report finds. The United Kingdom, which spends just six percent of GDP on health services, ranks 18 th.....In Europe, health systems in Mediterranean countries such as France, Italy and Spain are rated higher than others in the continent."

    WHO (2000).

    Do you honestly think that the investment from the Labour government manifested itself by 2000 after only four years of Government?

    The principle objective of a private healthcare provider is to make money...never forget that.

    I haven't gone digging about for any more facts and figures but I do know that the Government recently supressed a DoH report for which the data was collected at the end of a sustained period of investment by Labour and it showed that satisfaction with the NHS was at an all time high. There are many more facts and figures available to refute your idea that market based economics are the solution to all of our woes.

    I am not politically aligned by the way!

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