Health – the insider’s view

Earlier this month I woke up to the 6am news briefing to hear that my proposals for the health service would be announced later that day as Government policy! Hospital ‘targets’ would be scrapped and the costs of operations would be calculated and standardised across the UK. This was exactly what I had discussed with the Medical Staff Committee at Salisbury District Hospital the night before.

Just as each one of us is an armchair expert on roads and traffic, so we all have solutions to health care problems. The trouble is, it all depends on your point of view. The way it looks to us from our GP’s waiting room is very different from how it looks from Whitehall. So it was no surprise to me after an hour in the Postgraduate Education Centre at our District Hospital that our clinical Consultants and Specialists, sitting at the apex of the NHS as we know it, had important concerns we’ve probably never thought of.

For example, the EU Working Time Directive. Of course there is merit in protecting employees from exploitation. But in our NHS the Directive will force changes to traditional clinical practices which may sound good, but which will have unintended consequences (as usual!).

Take junior hospital doctors, whose long hours on call have caused concern for years. Shorten their hours and you need more of them. Where will they come from – and what else will be cut to pay the new wage bills? And if the junior medical staff aren’t there, how will the senior clinicians function?

Well, this is all supposed to be regulated by the Royal Colleges. What is the point, they argue, of training people if the posts cannot be funded and the support staff aren’t there? But from the patients’ point of view, where will all the Registrars and GPs come from – and the anaesthetists and surgeons, the A & E Consultants, spinal specialists, plastics experts and all the rest?

And what, I was asked, would happen to routine pathology as well as specialist cancer research if the Human Tissues Bill, currently before Parliament (and designed originally to prevent unauthorised removal of organs from the deceased) ended up imposing such draconian restrictions on the use of DNA and the whole system shudders to a halt?

In Salisbury we are privileged to be served by twice as many hospital specialists and consultants as a decade ago. They are attracted by the good reputation of our hospital and the 400 staff who make it what it is. They stay here because of our quality of life in South Wiltshire and because the health community is dynamic and valued.

But we must never take our hospital for granted. Believe you me, there are envious eyes and hungry health planners – not just in Whitehall but also in our strategic regional health bureaucracy and in Southampton and Bristol who think we have too much resource, too successful a service, and not enough people to justify it. I don’t think so. Especially when our dedicated mental health services are stretched to the absolute limit.

So my messages to Health and Treasury Ministers as they reveal their latest wheezes to Parliament is, keep it coming, think before you act – and don’t even dream abut removing or reducing NHS provision in our community, if you know what’s good for you!

Robert Key
19th February 2004