As a lot of you already know my wife had to go into hospital for an operation on her back. She both slipped and ruptured a disc (probably during labour) which resulted in massive pressure on one of the main nerves running through her spine. She was gradually losing feeling from the waist down and could barely walk or lift anything (like our baby for instance). An extremely worrying few months getting this sorted out, but now she’s had the operation and seems to be recovering. The relief is tangible, but I thought it important to record my real feelings before they fade. You see, it’s traditional at this point to thank those angels in the hospitals who carry out such a demanding job under such difficult circumstances, but that’s not really the full story.

Don’t get me wrong, we are blessed to have the National Health Service. My family lived in Cape Town for nine years and every illness or trip to the doctors meant tightening of the belts for the rest of us. However, it’s not really “free”, is it? You pay your National Insurance every month and you know full well that another chunk is taken out of your income tax to help cover what that NI can’t. The difference is that everybody pays at the same rate regardless of how much they use the facilities. In a very real way I have been paying for my free health care for 17 years now and have been repeatedly warned that there will be sod all state pension for me when I retire despite part of the NI contributions allegedly being ring-fenced for that very privilege, so in some ways, my generation have been paying even greater contributions to the NHS than those who came before us.

With the War on Waste being started by the Tories and carried on by Labour, a whole raft of managers were drafted into the NHS to improve efficiency and cut out duplication of effort and unnecessary spending. One of the key changes which was picked up on was that a city with five hospitals in it would need the equipment for five casualty departments. If the machine that goes “ping” is only needed very occasionally then it would still need to be bought for each of the five centres if it was considered an essential resource for a casualty ward. Obviously if you could close the casualty departments at four of the hospitals and take a careful check on how often you use the machine that goes “ping” then you might get away with a bigger casualty ward at the only hospital to keep one and possibly two MTG”P” making a saving on staff and equipment that could then be reinvested elsewhere (or, if you are a cynic, simply used to pay the salaries of the managers who pointed this out).

This centralisation of services into centres of excellence has continued through all departments as the various NHS Trusts gradually trim and pare away at all parallel services on their patch as they each struggle towards unifying into a single super-hospital with one specialised department of each type. To the outsider it looks as though the sole exception is the cancer wards since either nobody is prepared to give up the research income they generate or that the problem is so widespread and often incurable that getting people to travel to a centre would be pointless.

The reason for this tangent is to show that I appreciate why the centralisation has come about and that I recognise that it was not instigated by the staff on the wards but was actually imposed on them. The reality remains, however, that my wife had to go to Newcastle General to the Neurosciences department rather than travel five minutes round the corner to the North Tyneside General. The Neurosciences ward she was put on (“ward X”) has 12 beds for male patients, 12 for women and 8 private rooms. All head, neck and back injuries from Wearside to the Scottish border, coast to coast, come to this department, often by helicopter. On the women’s side of the ward they have a surgeon performing in the morning and one in the afternoon. On a perfect day they can each deal with 3 cases, although they never managed more than 2 each while I was there.

They are operating on NHS waiting list bods, private patients and emergencies in reverse order. Therefore, you are placed on the list for a Tuesday, but an emergency is flown in from a car crash and you have your op cancelled. Likewise, if you were first on the list with a private patient on after you and an emergency comes in, it will be your op rather than private one which gets axed. As a result of the wildly fluctuating situation, patients are called in the day before their op is scheduled to ensure the nil by mouth and form-filling is observed. My wife’s particular surgeon operates on Tuesdays and Thursdays (he might do men on other days) so when we had the first call to get ready some 4 weeks back we arranged child minding until the necessary date and for family to come and stay thereafter since I would be visiting in the evenings which would make it impossible to collect the bairn as well.

Predictably we got cancellations for 2 weeks and all the child minding arrangements were thrown out of whack. We called on the council for any help they could offer us since Nicola will be out of action for 3 months after the op and we cannot afford child minders on a single wage. Strangely we didn’t find that their solution of a live-in helper at a very reasonable £247/week was quite the solution we had in mind, but after introducing the local health visitor to the local social services officer (apparently they had written to each other but never thought of talking before) we thrashed out a deal whereby they will give us something towards paying for a child minder (not sure how much this had to do with my offer of going upstairs and abusing my baby if that was what their forms demanded). With all the stress of this to cope with and the repetitive cancellations each Monday and Wednesday, we eventually got a call to get her in that Wednesday as there was a gap. I booked a taxi and took the last of my holiday entitlement (started the new year in April – all holiday gone by August – a new record) to allow me to look after Robert and do some bedside vigils.

At first we thought we must have come to the wrong place: nobody knew who we were and, more importantly, had no interest in finding out. Eventually somebody was found who claimed to know something and Nicola was allowed to get some rest. She had a terrible night. Mrs C who was in the corner had suffered multiple strokes over the last few years and has been left unable to speak much but able to cry with pain, which she does all the time. Nicola and the others in the ward were all in tears by morning and Nicola asked the staff to move Mrs C into one of the private cubicles because of the distress it was causing. She was told to stop being so heartless as Mrs C needed the company. Now precisely how crying with pain day and night and ringing her buzzer which everybody ignores constitutes companionship is beyond me, and why anyone would think that the fear over an imminent operation will be kept to a minimum by being kept awake all night is distinctly baffling. Nicola mentioned the problem to the consultant when he came round and fleas were put in ears and Mrs C was whisked into a private cubicle before you could say “happiness of the many”. Sadly, the other women who had been kept up all night as distraught as Nicola were all sent home that day so she was left to face the resentment of the reprimanded on her own.

It was a truly dispiriting day. Nil by mouth for Nicola, so the same for me through tact alone and nothing but the cold shoulder and waspish remarks from the nursing staff to help prepare for an operation. To make matters worse, I had to leave by 4.00 to reach the child minder’s in time to collect Robert, and Nicola was due to go down at 3.30. This meant that she would come back to a hostile ward without me there to comfort her. As it was, she was left in surgical gown and anti-thrombosis stockings (not nearly as raunchy as it sounds) until 3.45 when she was told that the op had been cancelled and that she’d have to wait until supper if she wanted anything to eat. They tried to make Nicola come home until Tuesday but we had heard that one before and informed them that the only way they were getting the bed back was by performing the bloody operation and bollocks to their poxy rota, which covered it quite nicely. The consultant who had been supposed to operate was furious as it was someone else overrunning that had prevented him operating on Nicola and he was determined to try to fit her in over the weekend as an emergency case since all the tests were showing that Nicola’s condition was worsening.

The weekend was a disaster with Nicola again waiting all day in preparation before another last minute cancellation, this time because the anaesthetist quite rightly protested that she couldn’t be an emergency case since she had been on the ward for five days. I appreciate his problem: his life would be made Hell if there had been a pile up and emergency cases weren’t treated in time leading to someone being paralysed and it then emerged that Nicola was being operated on as though she were an emergency. Nor would I have liked to explain to anyone else pushed off the list how Nicola had come to take their place. Still, did they have to put us through the full dry-run yet again instead of letting us know at the outset? Also, a 29 year old car crash victim had been placed in a private cubicle but because of the brain damage she had suffered as a result, she is unable to recognise anyone and simply feels pain. She screams all day and night when not asleep and this terrible sound has everyone wound up to breaking point. The relief I felt leaving the ward each night was only matched by the sense of guilt and shame that this caused me.

Of course, by now my holiday was all used up and Nicola was on her own. Fortunately my Mam (bless them, what would we do without them?) had come up to help so that I could visit after work. Tuesday was the now traditional sadistic costume drama with the curtain failing to rise and we resigned ourselves to living this strange half-life for the rest of our days. On Thursday, however, Nic called me to let me know that it was definitely about to happen and my employers generously gave me leave to get myself round there right away. Sadly, they took her down earlier than stated so I missed her being wheeled away and was left to hold a lonely vigil in the Day Room. After a couple of hours I was told she would be up in a few minutes and took myself down the corridor to wait where I could see the lift. From here I was shooed away back to the Day Room and was told that they would call me when she came up. Considering as how it can take upwards of 15 minutes to get one of them to ask what you want when you ring a buzzer, I was not particularly convinced by this and had to be forcibly ushered “out of the way” (an odd expression for someone sat in a chair provided for people waiting outside one of the private cubicles).

She came up and we were reunited, her all blue lipped and shaking from the anaesthetic and needing to be resettled 3 times and me just plain relieved that she seemed to be able to move her legs. Overnight they admitted another poor girl who seems to have been attacked, but whose head injuries are so severe that she hasn’t been able to tell anyone what happened. She spends her time either moaning whilst awake or screaming for someone to get off her when she’s asleep. Despite having this latterday Bedlam to contend with Nicola felt so much improved that we were able to bring her home on Sunday after she had demonstrated an ability to climb stairs and get in and out of the bath with minimum help.

As I said at the outset, relief is already helping these memories to soften, but I want to record this while they are still stark enough to get me angry. When somebody thinks of ways to improve a service by cutting out waste and identifies division of labour and specialisation regionally, I can only hope that they are ignorant of the pain and unnecessary suffering this will cause. I spoke daily to Mrs C’s husband who was having to set out from Sunderland every day to sit with a woman he’s been married to for 35 years waiting for some indication that they can either cure her or are going to have to let her die. What a choice for this poor man: suffering the draining tedium of all those bus trips and yet fearing that when they stop he won’t have a wife anymore. All they needed was the chance for her to be looked after at Sunderland Royal with the Neuroscience specialist set to visit once a week and their lives would have been improved immeasurably, or at least is would, because I absolutely guarantee you that he will end up in one of the wards himself if this keeps up.

When you trim everything back and improve efficiency until you get all your wards running at 100%, you have to recognize that your staff are permanently busy. Value for money you may be getting but at what hidden cost. I’ll tell you what we missed over those 10 days: compassion, caring, explanations, humanity, dignity. Nicola was too afraid to ring for help in the night. I was twice told by nurses that they were “too busy” to help and had to do what I could for Nicola with no idea of whether it was right or wrong. What kind of a way is that to look after people you claim to value? Was this because they were all in the wrong profession? No, they were exactly what they looked like: overworked, overtired and seemingly used to human suffering.

And what suffering we are talking about. The horrific condition of the patients in the cubicles and those pitiful cries all day and night would mean you either had to develop a stone shell against it all or go mad. The horror for me came in having to pass the “High Dependency Ward” on the floor below: what kind of nightmare passes for normality in there?

The mental torture of having to ready yourself three times for operations that were cancelled at the last minute. You wouldn’t do that to your worst enemy. That’s what centralisation brings you, every emergency case and regular case coming to the same ward. Why the Hell can’t they have a separate emergency ward?!? Why do people have to actually end up in gowns and stockings prepared to face paralysis only to have the suspense tightened up another few notches as you settle down to another night of screaming to take your mind off it.

The cherry on the top, though, was right at our lowest point after the second cancellation. Having some slimy shitehawk tell you that if you can get hold of 2.5k they can sort it out in 2 days. Now I know it must be difficult to run private and public medicine side by side, but the time to extort money from people in the shit is at the outset. A plain, open, frank, honest discussion at the start as to how you are likely to be pissed about from pillar to post unless you insure yourself with some filthy lucre would have been just about acceptable. However, to approach people at breaking point is simply money with menaces and ranks right up there with all that was sleaziest about Thatcherite Britain. Have you any idea how desperate you feel at that point?! Can anyone possibly comprehend how badly you wished you had 2.5k to make it all go away?!? How easy it would have been to borrow 2.5k against the mortgage and then spend the next 3 years slipping further and further into the red. A rise in interest payments later and they’d have had another family looking for a council house. What the f**k has this got to do with the health of the nation?

Private healthcare should be treated like private education: a constant reminder to the state sector of what can be achieved with the right resources and as a target to aim at. Not some twisted system whereby you give no education to children of non-paying families or decide that they should get sub-standard treatment unless they can improve their economic status.

Perhaps saddest of all was that at no time were we made to feel that we had experienced anything unusual. Clearly it is the norm for folk to have their operations continuously cancelled, for the staff to be too busy to help, for the imposition of rules but not of compassion, for families to suffer the dislocation of long journeys instead of the specialists moving about the region on a rota. All I can say is that I am profoundly grateful that Nicola is home and on the mend, but that I also understand why the ward has no flowers or thank you cards from appreciative patients. Not their fault. Institutionalised cruelty. This government needs to deliver on some promises or they’ll be hearing a lot more from me.

-- Anonymous, August 13, 2001

Answers

Why wait to let them hear from you Softie? We have a Health Secretary from the North East - send him a copy of this immediately. Send a copy to the Ronnie Gill as well. This needs a wider audience than your friends on this BBS. (PS, it may need a bit of editing in places!)

Best wishes to Nicola. Hope she is continuing to improve.

-- Anonymous, August 13, 2001

Brought a tear to my eye, what a wrenching tale of dispair, sounds like you and Nicola had a torrid time. I know people that work in the "health care" system that have left because of the substandard quality these "managers". Like Jacko said post this to as many people/agnecies/newspapers/websites you can think of.

Glad to hear you're both doing better, good luck with your future battles.

-- Anonymous, August 13, 2001

It is well known that a person's psychological state is all important in aiding recovery. So the most shocking element of this for me was the "Russian Roulette" that was played on Mrs S during the time. This was NOT a trivial operation by any means (I believe Nicola told me there was a 20% chance of disablement) so you can imagine a patient might be extremely worried just prior to the op. So to have the op cancelled at the last minute several times I find quite appalling. I visited Nicola on her first Saturday there and fortunately found her quite stoical in the face of what can only be described as psychological torture - completely barbarous.

Glad to hear she's home Softie - I hope her recovery proceeds well. All The Best.

-- Anonymous, August 13, 2001

Use your anger now before it wanes. As suggested you MUST send this to a poltician and any rag interested, and let each know who's also receiving.

Bets wishes to Nicola, makes my sore neck feel very trivial :0)

-- Anonymous, August 13, 2001

Softie After reading your posting I felt fatigued, frustrated, angered, helpless, emotionally drained, in any order you prefer. I guess that the only way we can "cope" with these situations is,day-by-day,to believe that the problems will "all be solved tomorrow". If we don't then we're in deep sh*t. I agree with Jacko...your posting..just "as is" needs much wider circulation, including a copy to the office of Tony Blair. I sincerely hope that there are much better days ahead for you and your spouse and wee bairn. -phoenix

-- Anonymous, August 13, 2001

Sad state of affairs, Soft one, here's hoping Nicola makes a rapid and full recovery.

I had a knee operation, here in Singapore, 3 years ago @8k quid. They decided to 'lateral release' my kneecap after forcing me to sign my consent to full surgery; if the arthroscopy suggested the need.

I still can't walk properly / run to this day - money grabbing b@$t@rds, where's the compromise - NHS / private???

-- Anonymous, August 13, 2001

Softie, I had no idea things were so serious. Very glad Nicola is home and recovering. My best wishes to all of you.

I'm horrified at what you described, but sadly not terrible surprised at most of it. The only surprise to me is how surgery seems routinely cancelled. Animals get better treatment. By all means, you must send your post to all politicians, hospital chiefs, etc concerned with these issues. Also to the papers. If people don't speak out, nothing will ever change.

-- Anonymous, August 13, 2001

Oh, AND I AGREE WITH OUR FRIENDS ABOVE, CIRCULATE YOUR POSTING TO AS MANY AS POSSIBLE, IT MIGHT JUST END UP ON THE RIGHT PERSON'S DESK.

-- Anonymous, August 13, 2001

We have it easy here in OZ. I think that the Private health funds here are affordable. If Mrs gus and I had not had private health cover I shudder to think what would have happenned. With Her parents recently, Mrs gus herself and the gusette having $4000 worth of orthodontics, of which $2,500 was claimed back from the private fund, We would have had more money, but probably not everyone alive.

This is endemic. Anyone on here living in whatever country NOT had the same experience?

-- Anonymous, August 13, 2001

Complete sympathy my friend. And best wishes to the family in the coming months

-- Anonymous, August 13, 2001

I heard they were 'closing the gap'. It's on all the adverts...

-- Anonymous, August 13, 2001

Best wishes for recovery John, guess any thoughts of Nicola in the British pole vault team may be a little premature then??;-)

What has been said about further action rests with you of course, to get something out of it will be a long road ahead, best of luck.

-- Anonymous, August 13, 2001

Softie, First of all, best wishes to Nicola & I hope you are ALL on the road to recovery. I hope you will not be offended when I tell you that your experience did not shock me in the slightest...I have been nursing now for 11 years, 10 of them in London in the largest health authority in England,the infamous City & Hackney. Your account of Nicola's nightmare is spot on....I'm not sure if you forgot to mention that it was nearly always one of the nurses who broke the news of yet another cancellation to the patient & ,therefore, nearly always the nurse who copped the abuse first hand? Of course, for me to read your story brings back those pangs of guilt when you know that at the end of a shift, yet again, you barely spoke to some of the patients let alone sat down & talked to them. I will say, however, that the ward Nicola was on sounds particularly dangerous & for buzzers to be left for that long is definately unacceptable.....as advocate for the patient ( as we are constantly reminded) it is the responsibility of the nurse in charge of that ward to kick arse & stick up for his/her staff & patients & get beds closed....contraversial you may think, but safer for sure. I have been working in Sydney now for 10 months & am constantly telling them that they don't even know the meaning of the word 'understaffed.' What is happening in Sydney has already happened in the UK.....the other point I feel very strongly about is that private care doesn't mean better care...Nicola would have still been in the same ward next to 'Mrs C' because a private room is NEVER guaranteed, don't ever believe it! How the hell am I ever going to convince anyone that most of the time I love my job??!! Towards the end of my time in London, I had a wad of complaint forms in my pocket to give out all the time....it's people like you who have worded it just as it is who MUST keep plugging.....to what avail I really don't know. My God, my first posting on the BBS & I haven't mentioned NUFC once!!!!! Sue.

-- Anonymous, August 13, 2001

see what happens if you turn yer back just once..

-- Anonymous, August 13, 2001

I'm so sorry to hear of your ordeal and so happy that things seem to be on the mend. I agree with the thoughts of everyone on here. Send it to your MP, the health secretary, Blair and every Labour MP in the region. It's all of their constituents who suffer - the more people you contact the merrier.

Is there a watchdog for the NHS? kind of like Offwat? You should try and contact them as well.

It's an absolute disgrace and things just seemed to get worse - I've had problems at hospitals in Durham before and I hoped that things would get better - obviously not.

-- Anonymous, August 14, 2001

Softie, I'm sorry you and Nic have had this horror. As you know, I have had some experience of the local NHS (although for far less serious matters than Nic's) and was fairly impressed with the care I received so I'm gutted to learn that my experience was the exception rather than the norm.

-- Anonymous, August 14, 2001

PS. Softie, if anyone can write an articulate, persuasive argument, it's you so I agree with the others that you should bombard everyone with letters about this outrage.

-- Anonymous, August 14, 2001

I know this is tuff softie, but you have a valid case for a malpractice or abuse of power lawsuit. You should check with a local barrister about it. If even one of the staff members would back you, you could be looking at a precedent setting thing here. Mrs. S should definitely be awarded some damages here.

The bottom line here is Public or not, this does not excuse them from mistreatment. Check it out Softie, I think you'll be surprised.

-- Anonymous, August 14, 2001

Totally and absolutely shocked.

-- Anonymous, August 14, 2001

Not trying to be a martyr, just recognising the bbs as the true forum for all topics of discussion too uncomfortable for the media to investigate objectively (after all, people will change the channel if it's bad news but not ghoulishly horrible: ie. Shipman trial good TV, everyday overcrowding and depression bad TV). Thanks for all the kind words, particularly Lady Tynedale for sneaking an NUFC reference into her first posting :-) And yes, you are quite right, it was the long- suffering nursing staff who were left to break the news of cancellations and very unhappy about it they were too.

The worry is that this really isn't a horror story, but a perfectly ordinary operation undertaken with the expected level of stress and disorganisation. Can you imagine only working with people in constant agony from a bad back or suffering some personal nightmare from massive head injuries? All family and visitors will have the extra tension associated with the seriousness of the condition of their loved ones. When I said that nurses told me they were too busy they weren't making it up. Every patient was constantly asking for pain killers - nerves, you know, all they do is transmit pain - and the staff were worn out.

Typically there were two people who made it better, a nurse who was 25 weeks pregnant and took a real shine to little Robert and one of the domestics who came round with a permanent smile distributing hot drinks and specially brought a packet of biscuits in for Nicola as she was due some time off and the other girl always started distributing from the other side of the ward so there were never any left. Little things like that can make all the difference to someone whose day consists of pain and hopelessness.

Likewise sparxx I'm afraid you could be right about malpractice, the fact that everyone is made to suffer equally doesn't make it alright, but I have a deep-seated aversion to the practice of suing people as though money makes up for pain. Nicola is infinitely better physically than she was before her operation, and that is the only grounds upon which I would have even considered legal action if it impacted on our ability to care for Robert. I couldn't very well bemoan the pitiful state the NHS has been run down to and then appropriated some of that much-needed funding in the courts: too much like the Save our Seats campaign for my liking - "I love NUFC so I'm going to sue their a*se". It's a personal bugbear but thankyou for the advice.

The real problem is where some time and motion study will ring up a perfect score because everyone is so busy all the time, whilst the most cursory glance around the ward will show nothing but unhappiness. Human contact is surely part of the healing process. You take people out of their homes and circle of aquaintances when they go into hospital, and in this case there were folk coming down from Whitehaven and Alnwick, and then expect them to flourish with little more human contact than "What's your date of birth? Do you have any allergies?" 3 times a day. Not enough is it? Part of the nursing staff's job has always been to care about people and they aren't being granted the time to do it.

-- Anonymous, August 14, 2001

Not granted the time is just it. :-( My mom was a RN her entire working life and saw the changes from the 50's to now. Nurses got piled with more and more responsibilities, more and more paperwork and got nowhere near the pay and respect they deserved. So many capable people left the nursing profession because of the conditions that she was often left with undertrained or plain incompetent temporaries to try to staff her wards..increasing the stress on the few good nurses even further. She was so happy to retire 2 years ago because she only saw things getting worse. She's convinced alot of it has to do with hospitals moving away from caring for human beings to a bottom-line money based way of operating. :-(

-- Anonymous, August 14, 2001

I am very sorry for what happened to you and Nicola. I am glad that that the operation itself went well, but the anguish, tension, disappointment and botched communication that surrounded it are indefensible. I’m not going to try and pass the buck, because as I’m sure you know, I am responsible for clinical quality and performance around here – the letter didn’t have to go too far before it landed on the right desk, eh? If you want to write to me in an official capacity, I will for what it is worth apologise formally and unreservedly on behalf of the NHS.

Whilst I’m still not sure about responding in this forum, you support it for topics too uncomfortable for the media, and I certainly don’t wish to duck my responsibilities. You have told us what happened – in characteristically powerful fashion – and it is a horrendous account, no less shocking for being all too common an experience. But I believe that your assessment of the causes – uncharacteristically – misses its target in several respects.

Your first target is specialisation and the attendant centralisation of services. This has been a worldwide trend for the last 30 years or more. It is driven by a greater focus on outcome. Clinical teams develop and maintain their expertise by carrying out procedures regularly, and get better results than those who dabble occasionally. Part of the criticism of the Bristol children’s heart team was that they were not doing enough of the rarer stuff to maintain their skills, and that they were unable to audit their results consistently because of small numbers. This doesn’t seem to me to be all that unexpected, and there are plenty of familiar examples in other walks of life: Schumacher doesn’t take his Ferrari down to the local Quickfit, etc ad nauseam. There is no evidence that centralisation of health services saves any money, by the way, and apart from a brief vogue in the 1980s it hasn’t been done for that reason. Neurosurgery has always been a highly specialised service ever since it was invented about 1900: there has simply never been a unit in Sunderland or North Tyneside (the unit for the whole north-east used to be in Shotley Bridge for historical reasons to do with the WW2 Emergency Medical Service, but it was still a single regional centre). Health care has for some time been the province of teams (“multidisciplinary” in the jargon), so the idea of the visiting specialist falls down badly – during the 167 hours a week when the visiting specialist is not around, things can go significantly out of kilter and not even be recognised because of unfamiliarity. Neurosurgery requires some very complex care for some badly damaged people – as you found out at all too first hand – from expert teams that are used to working together, but the conditions that they are dealing with are fortunately not common.

Your next target is managers. Well, blaming the managers has been fashionable for some time now. If only the doctors and nurses could just get on with their jobs without these folks sticking their oar in (no doubt for a fat salary), and there are clearly far too many of them. All recent British governments have jumped on this bandwagon, and it’s a cliché in TV series set everywhere from Holby to Cook County. In fact, the NHS is by any yardstick under-managed. Management costs run at less than 5%, and that includes all of the clerical and admin support that tries to organise admissions, clinics, operating lists, and so on. That’s less than any comparable (ie not developing country) health service anywhere, and about a quarter of what you would find in any other line of work. And the NHS is not any other line of work, it’s an organisation that is both rather large (£50bn turnover, 1m staff) and extremely complicated (more types of procedure than anyone else has product lines by an order of magnitude). Why would we expect it to run itself? Are the senior management team of – oh, say IBM – regarded as useless parasitical wastes of space that stop decent computer-makers from plying their trade how they want to? Does anybody care that they don’t actually build the things any more (and probably never have)? Without management, what you get is a lot of individual clinicians beavering away uncoordinatedly, doing the things that interest them rather than what’s actually needed. With NHS-style under-management, what you get is a lot of individual clinicians beavering away almost as uncoordinatedly, doing a bit more of what’s actually needed – but they sure as hell all know who to blame for anything that goes wrong. I guess that whatever walk of life we are in, everybody blames the management when they have a gripe, but in most other spheres that is taken with a pinch of salt. In the health service, such is the public standing of nurses and doctors (even now) that the managers turn into everybody’s favourite pantomime villain. Getting rid of more (and the numbers have been cut consistently for almost a decade now) would I believe make many of the problems that you describe worse, not better.

So what is going on? The problems you describe are real and distressing, and frustrate everybody in the NHS as well as causing the misery that you describe. An important point that everybody’s heath service is suffering from the same problems. That actually comes across from the other posts on here. The last twenty years or so has seen such as explosion of new treatments – drugs, anaesthetics, surgical techniques, equipment – that no country on earth is capable of providing everything possible on demand to all of its citizens without delay. The operation in question wasn’t even possible experimentally when I qualified in 1974, nor was almost the whole of cardiothoracic surgery, all of minimal access surgery, most joint replacement surgery (we could do hips, but that was about it). The notion that there was some sort of golden age when everybody had all of these things done without a wait is just a fantasy – sad to say, people just continued to suffer. In this country, the way that the service coped with demand until recently was to impose long waits for treatment. Unpleasant, but fair, in that lack of the right kind of insurance or lack of wealth didn’t penalise anyone – everybody waited their turn. However, we now don’t tolerate waiting for treatment (and we still place a high premium on fairness). The inevitable consequence is pressure to use every theatre slot, every bed, and every bit of equipment to its utmost. In a system being used that intensively, it only takes a small peak of emergency demand to create a huge logjam, resulting in cancelled operations and admissions. In systems terms it’s exactly analogous to an over- utilised motorway: one driver touches the brakes momentarily, and the resulting tailback lasts for hours.

If we want guaranteed admissions without cancellations – and I absolutely accept that the effect of cancellations is every bit as awful as you have graphically described – then we have to either all slow down or provide more motorways. Slowing down means longer waits, and people simply won’t accept that. I guess that you would not have liked to be asked to trade off let’s say a six-month wait against a guarantee of no cancellation? Not a very attractive proposition. So why not fund more capacity? Well, many other countries manage to fund their health services to a higher level than ours (although less than you might think when you allow for the higher wages that their staff attract). However, despite what we all say when considering the NHS (of course we want to put more money into it) we seem as an electorate strangely reluctant to back this at the ballot box. Anyway, rightly or wrongly, politicians of both main parties seem convinced that more taxes for the NHS is a loser. Feel free to convince them they’re wrong, I’d be delighted. However, we should be aware that – just like motorways again – increasing the capacity only makes things better temporarily. Pretty soon, expectations become readjusted, more pledges are made about access and waiting, and the system is operating at maximum capacity again. Over the past two years, the NHS has received greater increases in funding than at any time since the early 1990s, but these have been accompanied by so many extra targets and must-be-dones that things seem worse than ever at the sharp end.

Of course, I’m well aware that even given the explosion of demand worldwide and the inability of any country to match the expectations of its population in full, there is a lot more that could be done. Basic courtesy, caring and humanity don’t depend on funding (and if you look at the figures, individual doctors have the same workload as 30 years ago, because their numbers have increased proportionately). There are some major difficulties around professional domination and resistance to change. The balance of power still lies almost entirely with consultants, who only really become accountable if they do something like assaulting a patient (it happens). I could go on about the way that we select and train clinicians, and about the relationship between NHS practice and private practice, but this is already rather long for the forum. However, I know that we have not done enough to address these problems, and that slow progress is no consolation whatsoever to yourselves.

I’m sure you know that this is a difficult missive to write. Whenever somebody that I know as a friend or a colleague has to use the health service, I dread this happening, all too often with good cause. I hope you know that I am not trying to excuse the experience that you had. My only point is that if we jump to the wrong conclusions about what the problems are – and most do – we stand no chance of understanding what the solutions might be. A better balance between expectation and funding, proper professional accountability and strong management might just help. Thinking that we can provide universal access without waiting for every possible treatment at present funding levels (or anything like them) while clinicians have all of the power and almost none of the responsibility, by getting rid of managers and distributing services, is in my view unlikely to be constructive. Nor was there a “golden age” when anybody got all of this right that is just waiting to be rediscovered.

My analysis will doubtless prove unpopular to commentators on here, but it’s an honest one. Maybe I had better go out now. I may be some time.

Sorry.

-- Anonymous, August 15, 2001

Bill, I’m really sorry for putting you on the spot there, I certainly don’t hold you responsible for everything that happens in the NHS but realise that one of the reasons you are so good at your job is that you assume that responsibility even when it’s not being thrust at you. “I was only following orders”, doesn’t work for me and I no more hold you responsible for any unpleasantness from members of staff than I would thank you for acts of unsolicited kindness on their part. What I do thank you for is giving us such an open, thorough and insightful explanation of what it’s like from the other side.

I hardly need tell you that I hold the British media in utter contempt for its unceasing distortion and oversimplification of complex issues. I bet I’m not the only one who has just been informed for the very first time that NHS management comes to 5% of the budget but has spent the last 15 years being assured that the number of managers is growing in inverse proportions to the numbers of beds available. I couldn’t be anything but grateful for having inaccuracies in my understanding of a situation brought to my attention since the people whose job it is to disseminate information don’t feel inclined to offer me the full story. A miserable collection of liars who bleat about freedom of the press when anyone tries to make them accountable for the way they twist the truth and yet willingly sell their integrity to the richest advertiser and endorse whatever set of values they represent.

I do appreciate what you say about teams being brought together for more reasons than the saving of money (although that’s the one that gets the headlines), I do however think that an entirely results- driven policy is what causes the sort of unpleasantness we’ve just been through. I will reiterate again that I am utterly delighted with the actual surgery and am overjoyed to see Nicola getting stronger and more mobile by the day, it is the “care” part of “Healthcare Trust” that seems to be missing. I accept the argument that a team which works exclusively on neurosurgery will get to be pretty good at it and not make the sort of cockups that a group of enthusiastic theorists might make, but I do not accept that this should tie them to a specific geographical location.

Nicola didn’t go to hospital and blunder into the Neuroscience Department by a stroke of fortune where a dedicated and knowledgeable Neuroscientist was fortuitously on hand to correctly diagnose a problem that would have gone undetected elsewhere. She went through the regular and typically highly efficient system of telling her GP about the pain in her back and shooting pains down the legs and was referred to a consultant who got her an MRI scan which in turn showed up the operation she needed and she was referred to the relevant department. There is still no Earthly reason why she has to go to the Neuroscience Department at the General Hospital other than that is where we have based all the staff permanently. To borrow your example of Michael Schumacher not going to Quickfit, nor is he expected to make a pit-stop at Marinello when he’s driving at the Hungaroring. Surely a dedicated neuroscience casualty ward could be established at Newcastle General and a travelling group of specialists be set up to visit each of the district hospitals in rotation to treat waiting list patients near their homes. The easing of unnecessary suffering would be immense (though obviously impossible to quantify the way that results in a permanently busy ward would be) through such simple things as husbands not having to take time off work to be able to visit, mothers seeing their babies more than 3 times in 10 days, the ability of circles of friends to provide the sort of day-to-day human contact that the ward staff are too busy to provide. It has elements of the “That’s the way it’s always been done” mentality which we all have a duty to reconsider at every possible opportunity rather than “If it ain’t broke then don’t fix it.” The fact was that Nicola’s operation was routine (to the team in question) and she only had to suffer the cancellations and traumatic condition of the desperately urgent cases because everyone has to go to that ward regardless.

Obviously this would cost more and without extra funding to be spent as is needed, as opposed to being spent to target the latest political cause celebre, it would mean the impossible job of choosing between being able to replace hips or mend backs. However, since the only way to prove that things are better is in terms of results and that argument will probably be won by whichever operation costs less and boosts the statistics to shut the shadow minister up.

What I sincerely hope is that articulate accounts of seemingly unnecessary suffering and suggestions as to how this might be combated would be of benefit when the need arises to argue for greater funding. Facts and figures may make the easiest method to win arguments, but the power of words should not be overlooked as the Member for Sedgefield discovered to his cost when facing the public. I would be delighted to submit something like this officially if it actually helps: I certainly don’t require an apology – my wife has been relieved of intense physical pain, nothing to be sorry about there. As it is, I am perfectly happy to have discussed something like this publicly, and feel wiser and better informed for the experience.

No need to go out for a while unless it’s to have a jar with me somewhere :-)

-- Anonymous, August 15, 2001

An excellent and extremely interesting read Dr Bill. Unfortunately your missive won't fit on a T-shirt and thus has little chance of gaining any political currency. I'm very interested to hear you blast away the notion of over-management. This shibboleth is widely touted from tabloid to broadsheet so it's a surprise to hear your informed view. The bit about specialisation was no surprise - it's sheer common sense really.

Excellent analogies about the motorways and log jams. And yes - if we build more they'll fill up too. You can liken the private practice to toll roads, I suppose. Your point about very intensive use of the resources is well made.

Let's hope, amidst all this, that Nicola is well on her way to a full recovery.

-- Anonymous, August 15, 2001

Are you watching? are you watching? are you watching RTG?

-- Anonymous, August 15, 2001

First of all I would like to wish Nicola a full recovery and Softie to surmount the obvious stress he has been through . The main contributors on here are to be congratulated on their very thoughtful and interesting views. It is only in the last three years that I have experienced the full NHS system , I have my own views but would not set them against those on here who I freely admit have more brain cells than Buff will ever manage, anyone who washes down his pills with a dram of Glen Grant or a beer is obviously a suitable case for treatment. I read on here quite a while ago about Dr Bill in the bunker , now this IS up my street, ie Emergency Responce Training etc, I bet my last squid when Dr Bill comes out of that bunker and has a debrief with all involved the one word , the one thing that will be uppermost is communication or in most cases lack of.

In this electronic age the link between the patient, the one of 4 GP`s , the one of 6 Consultants , other various departments within the organisation of the NHS is very very tenious . I can only speak for myself but I feel once you can get on the ward the back up is excellent, cleaners/auxilliaries, doctors the lot, People are now more aware rather in days of yore when calling out the doctor thro the night was considered a mortal sin, my grannie slips on the ice at 75 breaks her arm, sits up all night bathing it, doctors surgery is 9am next day, not bothering him now. It goes without saying that lists will rise due to `people awareness`. I began a new drug under test approx 2years ago , monthly visit to the hospital 40 miles , to test re-action , if none increase the dosage. When asked how I was,said brilliant, the usual, just once I mentioned a wee problem and then boom , stop at that level,appt with vallescular guy, six months later at my appointment with said consult I honestly said that my ambition was to get 18 holes played without pain, then I said Doc there`s a lot more people worse off than me eh? He agreed, told him to forget it, I have no hang up, but after the initial enthusiasm , the back up , the home calls, the dept who were overseeing me on the super drug have never ever been in touch . I am wary of lack of communication, that you may be taking pills you do not need, there appears to be no mechanism to get you off the damm things , its all geared up to taking them, I personally never complain about any symptons now , cos that will be another pill . A brief physical check, nothing fancy , and to hear those words, much better young man , we can get you off rat poision now or decrease the dosage would really act as a pick me up. Why Why Why.??

-- Anonymous, August 15, 2001

Working in the Oz Civil Service, we see the good and the bad that Dr Bill has explained. I would like to point out though Dr B that IBM made their worst loss when they appointed a "manager" who had no technical expertise and steered "Big Blue" in a hardware only direction. But by God he was a great manager!

How much of the management is done by the "Senior Managers" are they too busy and delegate? Then they only have to manage the department heads.

We are seeing in our areas where each department is hiring "managers" and "Fast track" graduates. The graduates only need a degree, could be in dressmaking for all they care. Sorry dressmakers, yours is a valuable art, however, when I am trying to arrest a Hells Angel, I do not want you next to me taking his inside leg measurements.

A manager in some areas cannot always transfer to a second area and run it as effectively with out some technical ability. Technicians also do not always make good managers.

We have had managers come in and take people from duty that was vital to continuing success in our field. Despite all the warnings of the long term effects of the experienced people. Two years later shortly after the person was promoted the results were seen.

Is there no one with foresight and vision to try some thing different, or even the guts to say we got it wrong. Some of the old ways were best?

The original post and subsequent reply is some of the best discussion I have been party to. I stand back in awe of you two gentleman.

I agree with jonno, bottom line is that this did not result in tradgedy. That is the only way that this would have gone "Public".

Regards to Nik Softie!

-- Anonymous, August 15, 2001

Thanks folks - as a fully paid up member of the Strawberry clique I'm sure glad I won't be having to keep too low a profile, the strain might be too much.

Softie, I do agree with your point about teams not being tied to their bricks and mortar. Getting away from that mindset and others like it is called "modernisation" in the ghastly-speak of the NHS, but the constraining factor is generally professional resistance. However, if you will give me permission, I will use your words (powerful indeed and compelling evidence) whenever I get the chance, with everybody from medical staff committees up to the man himself. In the hope you will agree, I'm already cutting and pasting into a .ppt file.

And I am right behind Jonno's most important thought of all: get well soon Nicola.

-- Anonymous, August 15, 2001

made it to the end..... thought provoking stuff.

Let's hope for a full recovery ASAP under the careful attention of care-in-the-community nurse Softie :)

-- Anonymous, August 15, 2001

Softie - I'm so sad that your partner had to suffer this terrible ordeal. At least she seems to be on the mend now. Please pass on my best wishes to her.

Dr Bill - Thanks for your posting which gives one of the best insights I've ever read into the issues faced by the NHS.

-- Anonymous, August 15, 2001