I've been thinking about the NHS again, it is hard not to right now what with it being in the news virtually every day. So right at the start I will set my stall out, I still believe that an independent cross party commission is needed to properly sort out the future of the NHS. I said at the start of my NHS blogging that I didn't believe politics alone could sort out the NHS, and recent events have certainly proved that.
What I've also been thinking about is what I want as a patient and what I've got a right to expect. For that I have an analogy.
At my place of work I am, amongst other things, a product manager. As the product manager I have to make a lot of decisions about my product (a piece of software as it happens) and I'll use a couple of areas to try and make my point. My product has customers, and in order for my product to be successful I have to sell my product to both my existing customers and hopefully some brand new ones too. So I have to understand exactly what the want from 'an ideal product' and try and make my product fit that bill as best I can. However, if I ask my customers what they want and they say "I'd like the moon on a stick" please I have some decisions to make. Primarily:
- Can I afford to provide my customers with "the moon on a stick"?
- Am I best placed to be the provider who gives those customers "the moon on a stick"?
Just to flesh that out a bit, the provision of such an enhanced service may cost me a lot of money to provide, maybe it might cost me more to provide than I make in revenue from the product. Also it could be that actually I may not see my product as being a "moon on a stick" kind of product.....it may better fit a different market. So it is with the NHS.
Now. As a patient I may well want "the moon on a stick" but that doesn't mean that the NHS has to provide it, or indeed that doesn't mean the NHS can in any way afford to provide it. The area's I am thinking about are in particular a "7 day NHS" (in a hospital) and being able to see my GP 7 days a week. Don't worry doctors reading this....I'll go onto qualify "7 day NHS"!! In fact I don't remember the government or the NHS asking me what I want at all, because in fact I really don't want to be able to make an appointment with my regular doctor on a Saturday or Sunday (or bank holiday). I am lucky in that my work entails Monday to Friday working and the weekends are my own. But I am also lucky to be in a position to be able to squeeze doctors appointments into my working week because my employer is flexible enough to allow me. I know not everyone will have this view, and maybe for some people a weekend appointment with their GP would be preferable. Whilst I don't want to be ill and ideally don't want to see my doctor, I see this as a 'normal' weekday event, I don't want to be heading down the surgery at the weekend thank you very much. If I am unusually unwell at a weekend, then I can head to my local pharmacy, phone 111 or god forbid I am THAT unwell off to my local A&E.
This part of my analogy may not be a very comfortable read, but it comes into the "am I best placed to provide this service", in particular with reference to it being the 'same' as a weekday appointment. What if the government/NHS decide they are going to provide this 7 day GP service, but what if it wasn't free? Yes, you can see your GP on a Saturday, but it will cost you £10/£20/£30.....there has to be a consequence of providing a service, giving the service absolutely costs money, and we all pay for the NHS through NI contributions....but what if the payment was more in your face? It is one of the reasons that a cross party commission needs to look into EVERY eventuality and what a suitable answer might be. It might not be a wholly palatable answer, but making these kind of decisions helps patients realise that there is a cost and consequence to the NHS providing a service - it may be free at the point of need, but it certainly isn't "free".
Just quickly about that 7 day NHS in a hospital. On June 22nd 2013 as it says in THIS blog I got admitted to hospital. June 22nd was a Saturday. I had problems brewing all week and I was on a collision course with a weekend admission....it was just one of those things. I had become progressively more ill that my wife ended up phoning up the NHS 111 out of hours service in the early hours of Saturday morning. After speaking to a doctor he knew I was sufficiently unwell to need A&E, he booked me into a bed at the MAU and my wife drove me to hospital. I was having an Addisonian Crisis (Adrenal Insufficiency), it is a life threatening condition and I was hooked up to all sorts of IV drugs in the MAU and a week later I was released in a lot better shape that I started. I was in hospital all weekend, guess what, it was full of nurses and doctors and consultants. If you have an urgent medical condition that means you have to be admitted to hospital, you are going to get seen 24/7 - every single day or night of the year, without fail. So yes of course there is a 7 day NHS already.
But in a different scenario, I refer to when my Dad got admitted to hospital, not on a weekend but on a bank holiday - Boxing Day 2014 it was. Again, an emergency ward full of staff to sort dad out who had a double-stroke....although we didn't know that initially. He spent 3 months in hospital and he was well looked after....the problems he faced were two fold....not enough Physiotherapists and none at the weekend and too much time taken for social services to help us find dad a care home, because again they don't work weekends.
It is this element of care that REALLY DOES need to be 7 day. Because we both work, most of the care homes we visited were at the weekend. So when did we most need to speak to social services to ask questions and give feedback as to the suitability of the homes?....the weekend. Dad's stay in hospital was undoubtedly extended by a week or two because of this, it doesn't sound much, but I know well enough how valuable a hospital bed is.
So on weekend emergency care, the NHS delivered for me and it does for everyone. Do I think that I would have liked to have had my pituitary surgery scheduled for a weekend? (the true 7 day NHS the government is on about) I'm not sure, it was urgent but urgent enough it couldn't wait a couple of days? Actually the operation was originally scheduled for a bank holiday, but although my operation got rescheduled to the Tuesday after the B/H Monday, the reason it got rescheduled is because several other urgent patients had to get operated on by the Neurosurgeon....because guess what, the highly paid surgeon works on bank holidays, who'd of thought! So the government have to think is providing me the patient with my surgery on a Saturday or Sunday, is that "moon on a stick" territory or not. Do I want it and can they afford to provide it and is that a service they even want to provide if they could afford it. Evidence that I've seen suggests that they can't afford it, or even staff it right now.
Incidentally something else that occurred to me recently, MRI scans. I've had 4 of them and every single one of them has been at a weekend, 3 in Portsmouth and one in Southampton. Clearly the department wasn't fully staffed, but it was staffed enough to still photocopy a good many humans in great detail. More evidence of 7 day NHS working.
As for GP appointments on a Saturday/Sunday, I don't want them....I honestly don't. Does the general public, probably some do, but I don't know the answer to that one either. Is there enough GP's to provide the service and can the government/NHS afford to provide that service. Again evidence would seem to suggest not.
The government cannot just go around wanting to provide "moon on a stick" level service if it can't back it up with the staffing and the money and some kind of evidence its customers want or need that service. Yes in some areas 7 day services are needed.
I hope I'm making sense here.....it made sense in my head before I typed it out.
Let's get this cross party commission off the ground now. There seems to be some support building for it, so let's hope someone can make it happen.