Happy New Year!
It is amazing how time passes faster the older you get. It seems like yesterday that we were celebrating New Year’s Eve 2016. It was a quiet one as we were not sure what the following year would bring in terms of my personal health and whether I would be able to return to the job I love, working as a Surgeon in the NHS. We had just told the children of my diagnosis, fearful of their reaction and with the optimism of youth, they were not worried at all!
The appreciation for life also becomes more profound. Family and friends have passed last year and many new ones were born. The grief is intense on losing those who are close, and although people always tell you that time will heal, this is not understandable until you go through it yourself. The grief fades into the background but the memories become more striking with time. They become triggered by the most odd things: scents, foods, colours, words amongst so many things and the menories make you laugh or cry at the most insane moments.
And there are so many memories. I remember celebrating New Year’s Eve with my parents, brother and sister. We would all stay up until Big Ben chimed and then my parents would send us all to bed. As the years passed, we would have to try to keep our parents up until midnight with increasing difficulty. We have done the same with our children. Watching the London fireworks has become a tradition as has phoning our nearest and dearest. Communication has enabled connections across the world in seconds compared to the old airmails that Mummy would send to India that would take several weeks. These are the times when I really miss Mummy and Daddy. They both continue to give me a drive for life and enable the success and health of others.
I cannot thank the NHS enough for my care last year. I would not be here, back to working, without the excellence of the team at Croydon University Hospital who diagnosed my acoustic neuroma or the skill of my neurosurgeon at the John Radcliffe in Oxford. The care I received was without reference to my background, wealth or culture. How many countries can boast such an altruistic system. It never crossed my mind to seek private healthcare as I knew I would get the best within the NHS.
I am proud to be working in the NHS. I see my colleagues, in all aspects of healthcare, working so hard with the scant resource, trying to ensure that patient care is delivered to the highest standard possible. Time is precious and there is no doubt that there is waste and inefficiency in the system but most of us spend our time firefighting, trying to manage the crisis caused by targets which do not allow longer term planning. Change is being forced centrally at pace and there is no time to evaluate whether this really will be to the benefit of the NHS and the patients it cares for.
The junior doctor dispute was bitter as was the decision to withdraw bursaries for those who wish to pursue roles within the NHS, often as a second career. It sent a clear message to the workers: those who manage the NHS do not value their staff, they are not thought to be integral to the NHS, as people who invest their careers in one company for a lifetime but rather as expendable workers. No wonder so many have left the NHS or changed their allegiance to a different country or even to Scotland or Wales. Brexit has added to these pressures as we have already sent out the message that we do not value our EU colleagues although they are the backbone of our NHS.
These decisions have culminated in a system where there are gaps at so many levels within the NHS. In an effort to make the money go further, there is a cap on locum and bank pay and spend for medical and administrative staff. The NHS needs to cap the salaries of non medical NHS staff in the same way to ensure parity. Those who are still working in the NHS are covering these gaps by working innovatively to ensure patient safety but this cover has now become a struggle.
Consultants are being asked to cover registrar shifts, trainees are missing training opportunities and the NHS has lost the ‘firm’ structure that ensured that we all worked in teams, allowing emotional support, debriefing and rapid feedback. Nurses are staying beyond their shift times to help support colleagues with sick patients and all staff within the NHS are contributing free hours as many of us are altruists and cannot see patient care being compromised.
There are limits to what can be achieved within the cash envelope which is NHS funding. The winter crisis of 2017/8 has been and continues to be difficult to cope with. The NHS does not do Christmas or New Year holidays, everyone keeps the ship running, with relentless targets for cancer and elective care needing to be met. There have been surges of emergencies for many Trusts, due to increasingly sick and frail people as well as those who have self-inflicted the need for NHS care. Mental Health provision is extremely challenged and ambulance services ensure these people find a safe provision of care which is often the acute sector, often at a time of crisis rather than semi elective care. GPs are on their knees and there are reasons that trainees are not choosing to follow this profession and decide on portfolio careers to allow a pressure valve when the NHS becomes too hard. The extra winter funding is a start but without funding for community care, this does not improve the flow through the acute sector. Most Trusts are in deficit and will not achieve the impossible financial control targets and even the John Radcliffe Hospital, a world-renowned centre of clinical excellence, is struggling financially. The NHS is spending millions on turnaround teams and consultancy firms, perhaps we should pay the internal staff better and allow them to get on with running the NHS well.
I am proud to be back in my job, working as a clinician and a manager. I see the skill of colleagues in clinical and managerial practice, trying to balance excellence with finance. We need to make a decision soon as to what we want. The NHS achievements over the last 70 years have been astounding but are costing more and we are all living longer and expecting more.
From an aspiration of care delivered without cost at the patient face in 1948, the only cost implemented is that of prescription charges but even this has exceptions for those in need factored in. Do we now need to think about charging? Or just changing the way we respect the care that the NHS gives? The NHS gives freely, Grenfell, the Bridge attacks, Manchester. Each time the NHS has to deliver excellence, it does. Perhaps the public need to give excellence too.
Why do people fail to attend hospital appointments, even dates for surgery. Each of these episodes costs all of us already but we just don’t see it. Recently, I have witnessed bookers trying to persuade patients to take dates offered for surgery, to be told that these are not convenient as they have social plans. Really?
Each NHS user should be asking how they can do their bit to use the NHS resource as well as they can. Trainees sent out to accompany ambulance crews were shocked at the number of calls for inappropriate reasons but also as to the number of frail, elderly people or those with mental health problems, just about coping at home until that final straw breaks the unstable status quo. Have we stopped being a compassionate society where we looked in and knew the neighbour next door?
I am looking forward to working in an NHS to the end of my career and will continue to invest in it as it has in me. I have loyalty to the NHS as in the past it had loyalty to me. Our younger trainees and staff need to feel valued now as do the Senior Staff who are the memory and innovators of the NHS.
To allow it to succeed, the NHS needs to be unshackled from many of its targets that have become beasts that need to be fed. The fines that are applied for missing targets need to be reviewed: we should be learning not being penalised for processes that need improvement. The question of finance must be addressed this year and a cross party working group may enable how we can continue to deliver a NHS that we are all proud of.
I am looking forward to this year, looking forward to getting my strength and health back to normal. Learning to cope with my hearing loss and ensuring that I develop a new work life balance. I am looking forward to my 50 (again) birthday this year as well as the 70th birthday of the NHS on the 5th July.
I have had another chance at enjoying my family, my work and continuing to chase my dreams. Let’s work together to give the NHS that chance.
This is a series of blogs starting from the day I was diagnosed with an acoustic neuroma. If you want to start at the beginning then please follow this link: