Sunday, 1 April 2012

Challenge or regret? A look to the future

It’s disappointing that in the week following the successful passage of the Health Bill through Parliament, pasties and jerry cans go to the top of the agenda. Is this the calm after the storm, the deflation of defeat, or was this a brilliant piece of distraction from the government? If it was the latter, then they may be their own worst enemies, because they have come through this week looking like rather posh buffoons, completely dissociated from the ordinary lives of the people they are supposed to serve. Their only relief from the media mockery seems to have been handed to them by their biggest enemies, the Labour party, who somehow contrived to lose the safe seat of Bradford West to that political Weeble, George Galloway. One can only imagine the humilation of being defeated by the man who once praised Saddam Hussein for his ‘courage’, his ‘strength’, and his ‘indefatigability.’

If you can make sense of all of that political nonsense going on in one week, then please post your comment below.

But for many of us in the NHS, the passage of the Health Bill is not simply the end of an interesting episode, but rather the start of something big. We need to think about what this means for us both personally, or for us as professionals who are trying to deliver good healthcare to the populations that we serve.

I’m a bit conflicted on this matter. I am not a fan of the health reforms, because of the risks that I have written about before, but who can deny that this is an interesting time to be working in the health sector? We face unprecedented challenges in trying to deal with the inevitability of rising costs in the context of a societal desire to control the escalation of resources needed to feed the health sector. I don’t think that the reforms are the best way to solve the problem, but we are in a position now that means that we have to face the challenges of the future in the context of the organisational landscape laid out in front of us. And that is really interesting. It’s like trying to do front crawl with one arm tied behind your back, or writing with your non-dominant hand. I choose my smiles with some care: these are circumstances of complete artifice, and without rational explanation, to which the simplest solution is to stopping messing around and do it properly. But even so, trying to solve the problem is fascinating.

But this isn’t a game. The price for failure is high, and is counted in human costs. Enough suffering is built into the job of being a hospital doctor, without it being built into the way that we fund and provide healthcare. And this is where the conflict arises: I am excited at the prospect of working through these challenges, of thinking about how to best provide care to my patients over the next 30 odd years. But I am also a little scared of what it means to get it wrong.

Since the inception of the NHS, we have seen health outcomes and access to care improve, and the public have reasonably come to expect that year on year their NHS will get better. Even over the course of my career, I have seen better designed systems for commissioning and delivering care appear, and have watched my own ability to deliver decent medicine take off as both my knowledge and the facilities at my disposal have got better. All of the consultants I know who have retired have left with the knowledge that the care they gave at the end of their career was better than the care they delivered at the beginning. Some of this was knowledge, some of it experience, but a lot of it was technology and organisation.

What will my reflections be in 35 year’s time, when I retire? Will I be able to say that the NHS got better? Will I have to say that it got worse? Or will I say that I liked it when I worked for the NHS, but it’s been very different since it disappeared?

I don’t really mind change, but I’m worried about this one.

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