NHS Reforms

I was planning a post about national service for the near future however current affairs have overtaken me slightly. In the post I was planing on making a case for mandatory national service for school leavers for the dual purpose of developing social awareness and responsibility in young people while providing them with transferable skills. I was then going to say that this need not necessarily be military (although that should certainly be an option); instead it should be of some social benefit and should not necessarily be independent of the individual's career ambitions.

Fortunately the government seem to have beaten me to it (a bit) with proposed NHS reforms that they revealed today. At the moment I am agreeing with less and less of what the government does, despite being broadly Tory. I don't fully agree with the reforms as they have been suggested but they've taken a big step in the right direction.

As a bit of background, these reforms are being proposed as a consequence of widespread mistreatment of patients in a British NHS trust some years ago. Not only did this occur, but it was actively covered up.

One of the main reforms is the creation of a legal duty to disclose mistakes to patients and their families. To my mind, common human decency would dictate that this should happen as routine however those in the NHS seem to think differently. Perhaps they are above admitting they are wrong or don't believe they are capable of it. Seemingly patients dying are exclusively a mistake made by God rather than clinicians.

As a follow on, it has been suggested that a new criminal offence be created of concealing mistakes. Again, this makes perfect sense. In the real world, aiding and abetting is a crime in it's own right. Covering up a catastrophic mistake that has life-altering or life-ending consequences, in my mind, ranks alongside this. It would also strip over-inflated senior medics of their ability to bully junior staff into silence. We just need rigorous enforcement and an anonymous means of reporting errors.

One part of the report is a bit half-cocked is the suggestion that all potential nurses should have to spend a year as a healthcare assistant (a nurse in old money - somebody who has basic care such as hygiene and feeding as their top priority) before they can begin their training. To me this doesn't go far enough. It started as a good idea but I think it should also be extended to aspiring doctors too.

If this seems a bit extreme then let me expand the idea a little. Having started my tertiary education in medical school and spent most of my subsequent adult life surrounded by medics and latterly doctors I have spoken to lots of people who are allegedly at the cutting edge of healthcare. It's surprising how many have gone into it for reasons other than healing the sick. There are many other reasons why they have embarked on this career.High on the list of alternative reasons is the pushy parent who channels their offspring into medical school as a result of their own ambition and prejudice. The worst offenders in this category tend to be parents who are also doctors and seem incapable of understanding that their kids perhaps want to pursue other careers. Following on it's heels are the status seekers and the fragile egos who believe a medical career is a way of assuaging their massive inferiority complexes. I have encountered more of these that I ever want to. Time spent in their company generally serves to make one feel dirty, cheap and generally unpleasant. It's incredible how drunk people can become on their own (perceived) importance. Equal last are those that go into it for the intellectual challenge and those that just see the salaries. In a way I respect the honest of both of these categories but I still don't think their place is with people at their lowest. I believe that a year or so spent doing all the dirty, smelly, unpleasant jobs will quickly separate those with a genuine vocation from the above examples. In addition, it will give some additional maturity to those embarking on med-school and give them a chance to make a bit of money to fund the increasingly expensive business of tertiary education. I'm really struggling to think of any down-sides.

Hopefully, despite their shortcomings, these reforms will come into force soon. It would certainly give me considerably more faith in the health service than I have at the moment.

JR