Much of my time is now spent staring at a computer screen, and consequently information technology has inexorably put me back in touch with my contemporaries from medical school. I am sorry to report that there appears to be an epidemic of occupational burnout within the group. My Facebook feed is alive with news of retirement adventures, exotic holidays and relocations to sunnier countries. Two of our number have just set off in a sailing boat to circumnavigate the British Isles. Behind the exhilaration of escape, there is a sadness, a cynical collective despair over the state of the NHS. It is almost unbearable to remember the radiant bright-eyed enthusiasm for medicine evident at our party in the medical school bar on the night we qualified, exactly 37 years ago.
I do not believe that the change is simply a consequence of incipient old age. Some contemporaries who emigrated do not seem to feel the same way. Neither do I, but I moved into an academic post in Wales eight years ago, where I am relatively protected from the constant crises that are grinding down so many of my medical and nursing colleagues.
Last week I went to a two-day meeting at the Royal College of Psychiatrists in London. My friend Robert Higgo also attended. Walking back to our hotel at 10 in the evening, we heard the sickening, heart-sinking thud of a nearby road traffic accident. The noise came from behind us, just out of sight. We walked back to see if there was any need for our medical expertise, limited though it is with regard to acute injury.
The car involved stood askew with its lights on and its doors open. A young male cyclist lay semi-conscious, bleeding from his head. The front of the car was badly buckled, suggesting he had been hit quite hard. His twisted bicycle was just down the road. The driver of the car was on his mobile phone, trying to summon an ambulance. A female passer-by was doing a good job of keeping the cyclist calm. All that we could do was to make sure that his vital signs were stable and that no one tried to move him. The accident was blocking a major thoroughfare, and traffic quickly backed up.
A steady stream of off-duty nurses and doctors (plus a medical student) stopped to see if they were needed. The crew of a bin lorry had witnessed the incident, capturing it with their dash cam. They positioned their lorry to prevent cars from attempting to get past the incident, although delivery motorcyclists were undeterred. A wide diversity of passers-by offered their assistance.
The unfortunate driver, sweating and obviously badly shaken by what had happened, was having a difficult time with ambulance control, who were trying to guide him through an assessment of the man’s injuries. This puzzled us until a local GP who happened to be passing explained that they were trying to establish the urgency of this incident compared with others elsewhere, in order to decide which one they should respond to. Evidently this happens routinely in London. Ambulances and crews get backed up at A&E departments, looking after patients who are awaiting assessment. There are not enough of them available to respond to all calls.
Eventually Robert took the phone from the driver and gave ambulance control his assessment, emphasising the urgency of the situation. Very shortly thereafter, an ambulance arrived. 25 minutes had passed since the accident. Once the paramedics had taken over, we left. No police attended whilst we were there.
I work in a district general hospital and sometimes I have to assess patients in A&E. I know what working conditions are like there at present. Nonetheless, I was shocked that it was so hard to get assistance for a man who clearly needed urgent assessment. As time passed, I started to feel quite anxious about his safety because of the combination of a head injury and altered consciousness. This delay and the need to plead the patient’s case are consequences of seven years of austerity in the health service, small but significant indicators of a health and social care system that is being starved to death. The situation will get a good deal worse if the Government elected on 8th June is not committed to a large increase in health and social care funding. The Daily Mail and some other right-wing media present a narrative that the NHS is failing and needs to be replaced, presumably with a US-style system. This would not have helped the injured cyclist who was bleeding in the road in East London. It would compound the problem, not least because it would introduce a new imperative. There would be a need to urgently assess his insurance status alongside his health status.
The response at the scene was typical of what people do when they see a sick or injured stranger. These situations engage the population’s best collectivist instincts. There is no way of monetising these situations without an affront to decency. Something similar is true in the vast majority of situations involving ill-health. The most appropriate insurer is everyone, through general taxation, because we will all become ill in the end, and there is no way of knowing how much treatment any of us will eventually need.
Mrs May is deeply unpopular with a large section of the Parliamentary Conservative Party, and it seems likely that she called the snap election to stabilise and strengthen her position. In contradiction to her tedious incantation, her position is weak and unstable. The health service is not the most prominent issue in the election campaign, but it should be. Many health professionals who work within NHS England believe that it is close to the point of no return. The damage that is being done will be hard to undo in five years’ time, irrespective of whether funding continues to come primarily from the state (which seems increasingly unlikely). Whether you like Mr Corbyn’s beard or not, the value of properly funded, free-at-the-point-of-delivery health and social care is incalculable. This should inform everyone’s voting choice.