There is a problem.
Society has taken a topsy-turvy approach to healthcare. It is to a large extent what you might call a mishmash. An inversion.
You see, healthcare is seen, whether rightly or wrongly as hospitals.
They have become a fulcrum; where you go when things go wrong.
It is not as straightforward. Many people when poorly or unwell, sick, vomiting, in pain will stay at home and sit it out. For the most this works – humans being quite resilient; others will self-medicate, that is, purchase paracetamol and wait. Time is a fantastic healer.
Some will visit their GP although this is far from straightforward given constraints of appointment availability, selecting the right doctor (the one you know who knows and understands you) (aka continuity of care) and so on.
The rest, when things go south, will go to A&E. Some will phone an ambulance, which of course costs less that catching the bus and is more convenient. (Some towns and cities in the UK still have sufficiently accessible public transport to make this a possibility.) Don’t try driving; you won’t find a parking space, or it you do, it’ll cost (not in Scotland).
All this preamble hasn’t taken me to my argument which is, hospitals being seen as the place to go when something is wrong, or, rather, perceived as being really wrong. A pain that can’t get fixed, intractable vomiting, immobility, fracture or fever.
Is this OK?
Is it right that hospitals are what happens when you either don’t know where else to go or what to do and are frightened? This could be something serious.
I think as a society we have been led to believe this is the case.
We have created a leviathan. A beast that can’t stay afloat.
Instead of hospitals being places of special attention and care for those who can’t be supported outside its walls, it is seen as all things to all people, particularly in times of need.
Now, are the people daft?
Most have a very good understanding of hospitals and, the majority are keen to avoid visiting if at all possible. They stay away and look after themselves and their own.
Yet, we still have buildings bursting at the seams.
We have a catch-22.
And this is my point.
How do we reverse the fortunes of a topsy-turvy system? How do we stop people opening shoe-shops? (ref – D. Adams)
Well, I’d suggest taking the attention that is focused on hospitals and hospital waiting times and direct it with sense into community services.
Aren’t we already doing that? Is that not the Long-Term Plan?
Well, yes and no.
You see, The Plan says that more will be invested into community care, yet, the cumbersome nature of the NHS, again, the upside-down system of health and social care has resulted in lots or organisation and reorganisation but little transformational thought, little concept of how we can do things differently.
‘What about the pharmacists, physios and paramedics undertaking new or enhanced roles?’
Well, for the most part, they are doing more of the same. Taking much of the old inefficiency and spinning it out.
There is little evolution, more, drift.
Snipping the corners, the low-hanging pathways.
And the point of this preamble?
Here is the thing.
It is personal.
You see, my son, for reasons I cannot explain, is considering a career in medicine.
I have written before about the new breed of medical students and junior doctors walking the campuses of British universities; they are, at least to my sense, very different to my day, possessing a better understanding of science and technology, approximating academic and ethical excellence – much of this because entry to courses is so competitive and challenging.
As central component of the process of application for a medical degree, not only must you have multiple A’s in GCSE and A-level, you have to volunteer, have an interesting pass-time (ideally something competitive or creative), participate in a significant physical challenge – Duke of Edinburgh is entry-level, you have to also have undertaken an internship.
And, it was this that got me.
It also got my son. As he couldn’t get into the local hospital. All places were filled.
He hasn’t given-up and I am sure he will find somewhere, yet, it was this concept that there was no room at the inn that interested me.
And this takes me (or us) back to the start.
What is healthcare?
For many it is hospital.
It is the multi-storey building with an NHS flag outside.
The hospital is care; the hospital is treatment; it is operations, emergencies and clinics. It is where you go if things go wrong.
And, it is where the internships are happening.
I spent my internship in the community, visiting the sick and terminally ill in their homes, will not garner as much kudos as, ‘I held the scalpel whilst the surgeon snipped the artery’ (Not that sixth-form student would be allowed to do this nowadays).
The hospital is full, and the internship is full, seemed to me to reflect another aspect of our perception of health and social care that is wrong.
Are there internships in community care in the UK today for aspiring young doctors?
Where do you go if you require an x-ray, a CT or consultation with a specialist?
Where do you go if you need oxygen, intravenous antibiotics or fluids?
What about hourly observations, drains or other invasive procedures?
Are we really this limited in our sense of what and how to do?
Why are we not utilising the skills of paramedics, community therapists, nurses and doctors to support people in their own homes, or, at the very least, care homes?
Why is ‘do not admit to hospital’ perceived as palliative care, when we can, with a little imagination do everything outside, in the community? Actively treat, support and care?
The hospital is full because all its beds are occupied.
At what point does a person become a patient then a bed?
The inefficiencies of hospitals are huge.
We pour resources into the mouth of the beast.
Most of healthcare is not high-tech operations, observation and intervention.
It is waiting and watching.
Allowing people to recover.
Something frequently slowed down by the unnecessary application of antibiotics when there is no infection or intravenous fluids when a cup of tea would have been better.
Unravelling the mystery, or, rather, complexity that is hospital and community is not straightforward; it is impossible if those who determine the funding and the direction of travel are sitting in hospital boardrooms or even, strategic towers, at which point the possibilities of doing things differently is not a consideration.
A little while ago I called for a revolution in health and social care.
I have been very bad at following-up on this proposal.
You might call me a toothless revolutionary; a Che without cigar, beret or Kalashnikov. (He was a frustrated medic too.)
I know there are many working in hospitals, clinics, ambulance depots, hubs and so on who whilst not necessarily agreeing with my entire thesis, at least get the point, understand that a good shake-up (reorganisation) is not what we need, it is an evolution and transformation; and, this, beyond the hollowness that is, ‘Huzzah, I am the director of transformation!’
Real change, reimagining of what is and what can be done.
Heck, we could even ask those sixth-form students for some ideas and, failing that, talk with patients, district nurses or community therapists. Invite those who have frequently experienced the madness of hospitals and moved-on.
Consultation, co-creation, collaboration?!