Description

Britain is one of few countries in the world with a sophisticated health care system in terms of delivery, comprehensiveness, coverage, and constant innovations advancing health care technology. The National Health Service since its foundation in 1948 and despite endless political interventions proves to be a story of success. The British people are attached to it and its founding principles: comprehensive service, free at time of delivery. Yet, they are not happy. You wake up, literally, every morning and almost certainly there is something in the newspapers or the media about the NHS. A patient died while waiting for a cancer treatment. So many thousands are waiting in long queues for medical or surgical interventions. A general practitioner missed a diagnosis. A junior doctor gave the wrong injection. A consultant did not attend his clinic. And so on. Politicians react rapidly to such news and promise to reform the NHS, break the organisational and professional boundaries and start endless negotiations on new contracts for junior doctors, general practitioners and consultants. Experts, (many of them have never been in a hospital or primary care centre / surgery or worked in any job in the NHS) analyse and give opinions which are nothing to do with reality. None of these incidents reflect what is actually going on inside the NHS. A dedicated workforce exists, trying to meet the ever increasing demands on the service (ageing population, expanding medical advances, and high population expectations). They are practising in unsuitable physical environments (lack of investment in building programmes of hospitals and community premises by successive governments as part of cost control over many years), shrinking resources and continuous complaints (and sometimes physical attacks) from patients as well as criticisms from politicians, but still they carry on working.

What has all this led to? It has left a remarkable dent in doctors morale. Many are willing to leave the service early or indeed the country. Many posts are vacant today and this has led to the vicious circle of longer queues, crowded clinics, training posts without supervision, and of course a political fix. More medical tasks will be delegated to telephone lines, walk-in centres and other un-tested ideas. But the public want to see their general practitioners They want the best consultants in the best settings. They want clean hospitals, and they want to be seen now and not tomorrow. They want the best technology and they hate taxes.

This is a dangerous mix of the possible and the impossible. Doctors need to practice medicine freely without unreasonable political and public pressure. Doctors have condemned sensational reporting of medical controversies and the way politicians respond to it. To apply the science and art of medicine they need the training, equipment, the environment, the support, the teamwork, the partnership with patients and above all the respect which they deserve. For many doctors (and indeed other health professionals) the time has come to say no to those patients who lack the courtesy to respect their healers. This maybe the only option left to protect the integrity of medicine and its value to society and the human race. For society to receive the best care it deserves, it should appreciate the costs of medical advances and the consequences of caring for an ageing population, accept the limitations of medicine, value the free service at the time of delivery and above all care and respect the dedicated workforce. Without such a balanced formula the NHS may not be there in a few years time, medicine may not be delivered by high quality doctors anywhere in the UK, and many citizens will be left without insurance cover to the mercy of the states social protection. A first class service to those few who can afford it and a basic service to the majority in society. A miserable picture to imagine, but society cannot have its cake and eat it.