On that glorious NHS

“What we have also exposed in this review is a range of far wider, fundamental problems with care for the dying – a lack of care and compassion, unavailability of suitably trained staff, no access to proper palliative care advice outside of nine to five Monday to Friday,” the report said.

Lady Neuberger said patients were being left “in considerable pain” and suffering distress and hallucinations without getting the help they needed because in most parts of the country, expert teams “shut up shop” at 5pm on a Friday.

What we might call the rise of the producer interest, eh? People don\’t die M-F, 9 to 5. Nor do they begin to suffer pain or distress nor even do they start to become ill in those times.

But the health service is organised so that the producers of the remedies to these things get their weekends.

Hmm. A Wonder Of The World indeed.

The review frequently uncovered accounts in which families were shouted at by nurses for trying to give water to desperately thirsty relatives, she said. Too many staff had misinterpreted guidance which in fact says that nutrition and hydration should be given for as long as possible.

Hmm.

The Neuberger review heard evidence from relatives who had been forced to soak paper towels from bathroom dispensers in order to provide comfort to desperately thirsty patients who had been placed on the pathway.

Oh aye

The approach was supposed to mean that treatment could be stopped, if it would mean a more comfortable death, while food and drink could be withdrawn if dying patients did not want them. But the panel of experts said the pathway had been misused, which had distressed too many patients and their relatives.

The implication here seems to be that the original of the pathway was to not officiously strive to keep alive. Fair enough really. But when rolled out by 1.4 million people as part of a State plan it became deliberately denying hydration to dying people in order that they might die faster.

All hail State plans, eh?

17 thoughts on “On that glorious NHS”

  1. This is THE message we need to keep reminding people of. The state kills deliberately when it grows large. We should also ask ourselves why people are not going to jail for this

    (Now we are od course waiting for the lost nurse to come along and say that this is all the “market’s” fault and that all we need is more central planning

  2. “But when rolled out by 1.4 million people as part of a State plan it became deliberately denying hydration to dying people in order that they might die faster.”

    Let’s call it what it is—murder on an industrial scale.

    DK

  3. Its not murder, its just ‘failing to adhere to the guidelines’ and no-one in the NHS is guilty of anything, PaulB said so.

  4. On the matter of services not being available outside Monday to Friday, 9 to 5, this is actually a wider issue. Most professionals complain vociferously if they have to work evenings or weekends. Your lawyer or accountant shuts up shop at 5pm; at your GP surgery there’ll be a foreign locum covering the Saturday morning shift. High street banks have only in recent years opened on Saturdays, and I’d argue that that was enabled by the rise of computers and thus the de-skilling of the role of bank manager. Even getting your car serviced at the weekend is a lot harder than it ought to be.
    I’m not sure what the solution is; perhaps we as customers need to be more demanding, or perhaps we should expect to pay more for out-of-hours services. But this particular problem certainly isn’t unique to the NHS.

  5. RE – producer interest, Its noteworthy that the one service that all tax payers are most likely to use, even if they only use the NHS that they are paying for just once, A&E is the worst manned. Is it because there is no career in A&E

  6. @Andrew M…

    That’s very true, but nobody is going to suddenly need a Conveyance drafting in the early hours of a Sunday morning, or a set of accounts preparing on Saturday evening. If you desperately need cash there are some 6,500 ATMs spread around the country. Even I, a radical petrolhead, wouldn’t be too incommoded by having the leave getting my car serviced until Monday…

    The same doesn’t, unfortunately, apply to our ailments…

    Having been, via my unwell wife, at the mercy of the NHS rather a lot lately I’m bloody horrified by the truly dreadful facilities available outside “normal office hours”, the appalling lack of care and compassion shown by nursing staff, doctors more difficult to find than Yetis. Even during 9-5 things aren’t much better. Add to that the fact that hospitals appear to be run for the benefit of the staff not the patients and you have a totally disfunctional system.

  7. AndrewM,

    Most professionals complain vociferously if they have to work evenings or weekends. Your lawyer or accountant shuts up shop at 5pm.

    Hardly the same thing though, is it? No-one’s going to die if they can’t get their company accounts finalised at 3am on Sunday, or even see their finances and business suffer much. And it’s not like anything was unexpected and at very short notice.

  8. “Most professionals complain vociferously if they have to work evenings or weekends.”

    Really? None that I’ve known have a particular issue with it.. assuming that there is good reason (and appropriate remuneration.)

    Tim A is right.. nobody will die if accounts cannot be finalised on a Sunday.. but if there is a pressing urgency to have them sorted out then the accountant who refuses to make the time available will find that his time isn’t needed so much in the future.

    All the professionals I know work the days/hours needed to get the job done. The difference between us and Doctors is that these unschedulable emergencies are the exception and not the norm.

    As a society we’re still fairly wedded to defined core working hours. The NHS is probably the organisation most weakened by that… but moving away is a cultural thing which will take time. Younger people seem more at ease with the idea that it doesn’t matter which 40 hours you work in any given week than the older people who make all the rules.

    I’d like to think we could get to a true 24-7 working window.. but that seems a stretch. 12-7, however, is well on the way.

  9. Most professionals complain vociferously if they have to work evenings or weekends.

    The guys who run the electricity grid however take 24-7 operations in their stride.

  10. Less than a year ago, we were treated to the spectacular extravaganza of NHS staff celebrating their own glorious compassionate brilliance at the Olympics. While everyone from the staff on the wards, all the way up to the Care Quality Commission, were busily stifling all the awful stuff.

  11. Presumably the guys running the electricity grid at 4AM on Sunday are persuaded to get out of bed to do so by adequate remuneration. Thus, yea verily, is the shutting of the surgery door at 5pm on Friday merely the market at work.

    The question is, therefore, are doctors underpaid or have they formed a cartel?

  12. @ JamesV

    It could be neither. Well.. we have a cartel, for sure, but maybe the system is as much to blame as the doctors themselves.

    A friend has got a health problem and is having serious difficulty getting his doctor to give a fuck. I suggested he investigate whether he can get an appointment with a private doctor. He cannot afford private treatment… but a consultation might be useful.

    It stuck me, however, that we had no idea whether that service would be available anywhere, or what it would cost, or how to go about finding out (other than Google). The NHS restricts competition, and restricts knowledge of whatever alternatives are out there.. as well as costing people like my friend so much money that even half an hour with a doctor from a different world would (we expect) be a serious financial commitment.

    The very idea of going private hadn’t crossed his mind, or that of anyone else he knows before today. Is there any other ‘service’ that could cause someone months of pain and frustration without having him think ‘hey, maybe I should try elsewhere?’. It’s terrifying.

    So doctors don’t need to club together to ensure we all get a lousy service (if that’s what we get.. other opinions are available).. they just have to join an organisation that does things that way and has no competition.

  13. Most professionals complain vociferously if they have to work evenings or weekends. Your lawyer or accountant shuts up shop at 5pm

    So the professionals I’ve dealt with in the early hours of the morning (admittedly on corporate deals) were apparitions. Client pays – they work whatever hours it takes.

    And that’s why private (medical) consultants hand out their mobile phone numbers to their patients.

  14. Clearly what the NHS needs is a whole lot of competition,
    outsourcing and private finance. Some kind of internal market to bring the wonders of private sector management to bear. So urgent the problem, there’s no need for a pilot study in one region to quiet BMA , just get on with rolling back the State. Also pay business consultants a packet and introduce the total computerisation of patient records.
    Oh but is n’t this exactly what’s happened under National Saviour of Everything Margaret Thatcher and Thatcherite enterist Blair?See Wikipedia History of the National Health Service (England ) final sorry paragraphs.

  15. The same doesn’t, unfortunately, apply to our ailments…

    Of course, if the government didn’t require you to get a doctor’s signature to buy the drugs you need, you wouldn’t have to go hunting for one when you get sick at weekends with a non-critical illness.

    The last few times we’ve visited a doctor we already knew what the problem was from a quick Internet search, and just needed them to sign the piece of paper allowing us to buy the drugs to cure it.

    Why not cut out the middle-man?

  16. @TheThoughtGang: My Father has found the very same thing, in trying to go private. Its not the cost, he can afford it no problem, its that its hard to get an NHS doctor to refer him to a private one. And the private ones won’t take you on unless your GP refers you (I assume this is a some sort of unspoken doctors non competition rule). Some of the NHS doctors have said they will never refer a patient to a private one because they don’t agree with private medicine.

    I have nothing but contempt for the NHS and doctors. They’re all cunts, the lot of them.

  17. > Some of the NHS doctors have said they will never refer a patient to a private one because they don’t agree with private medicine.

    Yup, we had that. An NHS consultant refused to refer my wife on those grounds. This was when she was getting utterly shit treatment that damn near killed her on the NHS. We suggested going private, he told us it couldn’t be done without a referral, he wouldn’t refer her but he could put her on a waiting list to see a different NHS doctor who would consider it, and it would just be much quicker if we turned up to see him at the hospital the next morning. Which we did. He, however, bloody didn’t. So my wife had to sit in A&E for thirteen hours.

    He strenuously denied all this in the investigation that was carried out in response to our official complaint. And if only that incident had been the only thing in the complaint. If only.

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