Saturday, March 28, 2015

Unity past the rhetoric

Unity. Or lack of it in any shape of form. Pretty much defines what doctors are all about. Maybe it was ever thus, perhaps the world of social media has made it ever so more visible. A lack of unity when there was need above all..not for their own self preservation but purely to keep the NHS afloat. Elections are coming and without any surprise, the rhetoric is flowing thick and fast..depending on your political leaning, it gives you abundance of glee or despair while the majority who try to see things beyond political rhetoric simply shake their head at yet another sound byte aimed at the public, ramping up expectations. 

The Reds say they will guarantee 48 hour GP access, have 8 (or is it 10?) thousand more GPs. They will also give extra cash raised via the mansion tax. Key flaw? The mansion tax, even if it comes into being, won't be so till 2017 at the earliest, while the NHS gasps for money now. More GPs? Yet another sound byte perhaps in an era where recruitment is tough, jobs are tough, Antipodean adventures are on the up- so unless there is a secret door to a Narnia like place where there are GPs available on a shelf, well, you get the picture. A 5% cap on private providers sounds good...only the competition rules of EU may frown upon that, not to say why doesn't that involve all? If Trusts make profit, reinvestment should be in system, not just their own hospital, right? Then again, how many providers do you know who have a 5% surplus? 

The Blues say they will guarantee 24/7 NHS a service among many other things..a laudable view -in fact Sir Bruce has been working on that for a number of years...but recently his frustration with lack of progression was clear to all. NHS IQ continue to hold events, the reality is that it's stalled and present drivers ain't working. How would the extra time from Consultants be funded? Well no one is really sure not to mention,attempting to squeeze contracts by driving pay down will risk alienating people from taking up the role ( Hello New Zealand!) thereby a lack of staff and we have a Catch 22. Then there is the little matter of trying to enforce contracts..middle managers up and down the country probably have just had a cold sweat at the very thought. Sack the uncaring bastards..errmm..who does their job then? Good sound principle and no debate about the need but folks, what about the plan?

Doctors, actually let me change that, healthcare professionals need a sense of unity..a voice which will engage with the politicians and ask them to stop - irrespective of colour- at their attempts at meddling. I don't believe in the rhetoric that politicians, in the main, are corrupt..I do actually believe they want to serve,so something inherent in them must believe that we as healthcare
professionals cant do this properly..maybe the onus is on us to work as a team and show that given the budget, we actually can. Free from restrictions of our own little financial restrictions, genuinely believing their is only one pot and realising that to make a "profit", someone else has to take a loss. If you have only £10, there's only 1 way I can make £ nicking £1 of you..right?

A bit of unity would be nice...enough has been written about the recent Resilient blog and enough blogs written in would be nice to actually have a sense of solidarity, perhaps disagree with the method if it isn't your cup of tea, but at least agree as a group that things are that bad that committed professionals, who have gone on to do this work with as much love for patients as anyone else, have had to publish a list to generate debate.  You may not like it but have a look at Facebook ...its teeming with support too...the heat is on so much that we actually are having camps such as patients vs doctors. Try and move away from the concept of being either the one who knows all,by all means, but don't swing the pendulum and say we are servants. Say that enough, you will get treated as one. I am neither a demigod nor a a trained individual, well paid by the system, trying to do the best job I can, to the best of my ability...that's pretty much it. A bit of unity again on this front would be nice, wouldn't it? 

So ladies and gentlemen, a bit of stock taking, a bit of calm..all here to do the job..and the last thing we need is infighting amongst ourselves and certainly not chasm with patients. Stand together, irrespective of your political beliefs and ask the politicians that they don't need to do the rhetoric. We talk about finances and as has been mentioned by Roy Lilly a number of times, what has swept under the carpet is the 22 billion efficiency drive on its way. Did you say what it is? Well, you know that Nicholson Challenge? Well this is mark 2..but with all the low lying fruit gone.

Tough times, ladies and gentlemen...a bit of unity could go a long way. Divided we actually don't fall as doctors...that's the irony. As doctors, we will always find a place to work..such is the world economy. Divided the NHS falls...and if that does, so goes with it equitable healthcare. Unite, make the case and a plan what extra investment would show, perhaps stop asking for more of your own ilk all the time...everyone needs more from the prism of their own profession.

Your call whether your political preference tops your desire to keep the healthcare system this country has. Clocks ticking....
Or is that all a bit too much for us all?


  1. Do you think it's possible to have unity/ solidarity? I think not.

    Anne-Marie was attacked quite viciously by one of the Reslient GPs online and it's clear from my discussion (published on their blog) that they didn't think about the likely impact or consider the considerable research already published on the subject. You're no stranger to insult having called your colleagues 'champagne socialists' on Twitter.

    The values between GPs who work with vulnerable populations and are concerned with the social determinants and political economy of health and err on the side of more welfare and protection and those who are more right wing and err on the side of less welfare and more individual responsibility, cannot be bridged.

    This is not new: when the NHS was founded there were strong rifts along the same lines with the right-wing, conservative BMA extremely hostile to the idea of the NHS. Now the BMA is more divided with heated and divided opinions for and against a public socialised health-service which is probably why it failed to halt the NHS Act and is seen as vacillating.

    In his work on Values Based Practice, Professor Ed Peile suggests that where values are concerned you will likely come up with a dissensus, a range of irreconcilable values, but it is always better to know what they are, than to ignore them. Evidence on the other-hand (about why patients consult or how to support resilience) can be debated rationally and eventually you can come to a working consensus.

    How this can help is to make conversations more honest and more respectful by being explicit about what our values are about.

    The challenge is to accept that there is a dissensus of values among the profession, that there are things which we believe deeply that cannot be reconciled. How we see this dissensus as a strength that can benefit patients now and in the future is what matters.

  2. Hi JT

    I agree there will always be difference of opinions and thought processes- as well as ideas- but the point is whether all are more influenced by their political leanings rather than the need for equitable health care.

    If there is, rightly, criticism of 7 day NHS service ideas without provision, then similarly there should be criticism of 48 hour GP access - individuals tend to pick and choose what they criticise based on their politics and for sake of patients, that ain't quite fair.

    The reality is that all parties, irrespective of their colour, are moving us to a non sustainable NHS which needs to be challenged uniformly and the "how" asked for- albeit with respect.

    I haven't picked up the vitriol you mention aimed at Anne-Marie- if so, thats unfortunate- but if you see my TL, I have tried to personally have a more balanced view- there must be enough heat in the system to make caring individuals do that- sometimes do we forget about the HCP too? Perhaps

    Finally, the insult you refer to I made was in younger days and one always appreciates trying to lecture others on healthcare when we are all in the same boat may tend to get them labelled as quote unquote as a "patronising" something...Having worked in areas of deprivation the UK sees only in pockets thankfully as a first world country- I fully appreciate the different beliefs and idealogies - it's the pick and choose methods of discussing issues in healthcare which we could probably do without.

    But then again, as you say, it may all just be wishful thinking.

    Thank you for your comments- as ever insightful and helpful.

  3. Andy Burnham's office asked me to give them a call after I criticised their 48 hour access policy. There's a decent evidence-base about safe, equitable access which I was able to quote to them. Their policy is designed to appeal to voters, if Labour guarantee that everyone will be able to see their GP within 48 hours it sounds great, but it bears no relation to clinical need in relation to acute illness or ongoing management of chronic illness.
    Likewise there is pretty robust evidence about higher death-rates at weekends, but to my knowledge, no evidence that shifting around the already over-stretched workforce will reduce the death-rates or just push it up a bit in the middle of the week and down at the weekend, so making no overall difference.
    My comments on the Resilient GP blog (if you haven't seen them) were directed at what we can do to support each-other because compassionate patient care is a reflection of the way we treat our one-another:


  4. Without any hesitation, that in my view is commendable and I acknowlege that. However that makes you a rarity and perhaps others could indeed take a leaf out of your book on that. I understand the frustrations too of other colleagues as beyond a lot of the social media glossiness, on the ground, in some areas things are pretty close to the bone.
    It's now in a situation where compassion and the desire to improve care is thwarted by sheer finances which engenders frustration for all quarters.
    Thanks for the discussion...always good to have sound opinions on blogs!