Pissing into the tent

"It's probably better to have him inside the tent pissing out, than outside the tent pissing in." Lyndon B. Johnson

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It is always easy to criticise the status quo and to be destructive rather than constructive. I am aware that over the last year many of the Dr Crippen articles have been highly critical of the government’s management of the NHS.

In 1997, I voted for Tony Blair. I really believed he would improve health care (and education). I expected taxes to increase and was ready for that. On a personal level, I am earning more money now than I was in 1997, and I am earning that money by a great deal of hard work as I, and many of my colleagues, are hitting all the government targets.

We have done what was asked.

And yet, for all that, the medical profession is demoralised. Older doctors are counting the days to retirement. Younger doctors are on the dole, many considering leaving the country. The wards are denuded of trained nurses, and the ones that remain are at their wit's end.

Not a day goes by at work without several complaints about poor care from the hospitals. Some of the complaints are minor. Many are not. See Martin's story, last week. I am genuinely frightened as to what would happen if I, or a member of my family, had an acute serious illness requiring hospital admission. For all the health care problems that existed in 1997, and there were lots, the NHS was by and large delivering for acute illness.

The government is now so desperate about failing health care that it has resorted to lying. I am not talking about political spin, nuance, media-management and all the normal strategies one expects from politicians of any party. I am talking about bare-faced, brazen dishonesty.

The Minister of Health, whilst sacking nurses and closing hospitals, talks of the NHS having its “best year ever.”

The Prime Minister lies to the the House of Commons when he states that the the NHS is the "pride of the country".

After years of cutbacks under the Tories the NHS was getting better under Labour. (BBC )

I hold no brief for the Tory management of the NHS, but in 1997 I was not frightened about the prospects of hospital admission. But whatever the Tories may or may not have done, that was ten years ago. Tony Blair has had ten years to get it right, ten years to make improvements, and he has failed. Margaret Thatcher is long gone. Whatever your views on her, she is not responsible for what the NHS has become.

If you do not have the staff, you cannot provide the care.

Joint RCOG/RCM Statement
Senior obstetricians and midwives are needed to avoid future tragedies in NHS maternity services.

The recent Healthcare Commission investigation into the safety of the maternity unit at Northwick Park identified lack of clinical leadership in the Labour Ward from consultant obstetricians and senior midwives at the trust. This lack of supervision in the labour ward led to the diminished quality of care and poor management.

It is acknowledged that inadequate training and supervision of clinical staff, and the employment of temporary staff are likely to occur when there are insufficient supervision by experienced obstetricians and midwives to ensure a minimum standard of care. (Full report)

Let us now flesh out that statement with a patient’s experience:

The pain was so unbearable I begged for drugs, so Andrew went searching for the midwife. He was told she was "on a break". When she reappeared 10 minutes later, she refused to give me pethidine, but agreed to gas and air, which was useless but at least stopped me howling. The pain was relentless and I felt as though I might black out – I kept waiting for it to pass as a contraction does, but there was no respite.

Twice more he approached her, pleading for help. Twice she categorically refused to give me an epidural, claiming I wasn't even in labour, and, again, didn't lift the sheet. Had she done so, she would have seen that I had dilated from one to 10 centimetres in just over an hour and a half – a process that naturally takes place over 12-14 hours in first-time mothers – and that the baby was crowning and the sheets beneath me were soaked in blood.

Later, after the babies birth, the midwife continues to do as she pleases:

She was holding a bottle of milk. I implored her not to feed my daughter, but she ignored me, and proceeded to push the teat into my baby's mouth as tears streamed down my face. I returned to the ward shortly before midnight and held my precious baby all night. After two days, and barely able to walk, I asked to be discharged as the filthy bathrooms and rude staff had become too awful to endure any longer. (Full story in the Daily Telegraph here.)

Hard cases make bad law. Just an anecdote, you may say. You cannot generalise on one experience. The trouble is, family doctors around the country are hearing stories like this all the time.

Back to the Daily Telegraph, where a junior hospital doctor, still in training, describes what is really going on.

"I sit in the lecture hall and stare at the presentation being flashed up. Photographs of smiley faces projected on to the screen look down at me, benignly. Key words appear in bright colours. The lecturer drones on. Fewer doctors, he explains, will be employed by the trust this time next year. He smiles. This, he concludes, will improve patient care. Now he's saying something about delivering a modernised and focused career structure. Streamlining. Flagships. Supporting real patient choice."

"Hospital closures will save lives, says Blair"

"War is Peace. Freedom is Slavery. Ignorance is Strength". Jobs aren't lost; instead services are "streamlined" and "restructured".

Resources are "redistributed" and "modernised" rather than reduced; and valuable services are improved by being axed. Bad things are renamed and rebranded as being good; their "benefits" repeated again and again in the hope that we will begin to believe it. (Full story in the Daily Telegraph here)

Theirs is a shiny, happy world of smiling faces, looking down benignly while the NHS is slowly destroyed."

This is “getting a picture of the night with Sue and Dave”; this is the “essence of nursing care”. This is why Dr Crippen has been pissing into the tent. This is why doctors and nurses are demoralised.