Wednesday, 25 June 2014

Article: The Quest for Excellence – Healthcare

In my last blog I highlighted that by tweaking our way systematically and methodically out of a crisis we can collectively reach greater efficiency and major overhauls. Health and social care is no exception to this principle but when they reach a point of crisis there is undoubtedly extra pressure to do it quicker as lives are at risk.

Historically the NHS and current benefits (formerly National Assistance) came about to alleviate suffering from illness for every man, woman and child here in the UK.  A noble and bold move. Many causes of serious illnesses were identified as having simple solutions by way of basic housing, dental care and the introduction of free milk and meals for children at school. The funding for which was available because our nation was not as sophisticated in its needs and following two world wars were of a mindset to help each other out. Whereas in the 20th century people were grateful for any help at all they received, at the beginning of this century people seem to be more inclined to criticise what it hasn’t the capacity to deliver... yet.

I sometimes think we have become like a truculent child never satisfied with what we have got and unaware of how much it helps to keep us safe and healthy.

It would appear that no one in government or in the NHS or Social Services predicted the effect of a massive growth in population or the rate of technological and medical advances. The result now seems to be that both have a demand from patients that far exceeds the supply of staff or facilities to cope with it at the rate that we, the public demand that it should. There are log jams everywhere for while there are many aids to the disabled and chronic conditions it is very much a lottery as to who will have access to them. In some cases it is down to your postcode, in others it is simply down to a lack of investment to roll it out at all which is incredibly frustrating for the medical science that works so tirelessly to find such solutions. It is also frustrating for doctors who are duty bound to constantly keep up to date with what might be possible but most of all frustrating for sufferers themselves desperate for that solution that has been reported in the media. It can be like placing a meal in front of a starving man but banning them from eating. We are all part of the problem and the solution at the same time.

We, the public, have become very adept at making ourselves unwell and disfigured. Professional dancers and sports people in their quest for excellence actually deform their bodies, people cripple their feet by constantly wearing high heels (occasional use doesn’t have this effect), thrill seekers and speeding drivers often end up in serious accidents as do those who would rather ignore or forget safety measures in the workplace to do things their way. We damage our livers with alcohol, our lungs with smoking, our brains with drugs, we eat too much or too little, do too much or too little exercise and most significantly of all make ourselves anxious and irritable about everything. Some even knock out their immune systems by striving to eradicate all germs which help develop them. Hermetically sealed homes are hardly likely to be a solution.

More people than ever attempt to self diagnose without any training by latching onto one or two symptoms and looking it up only to assume they have something terminal. Most commonly we panic that a simple symptom is an early sign of cancer. Early intervention is vital and yes you should talk to a doctor if you are concerned but the reality is that one incident of constipation is not likely to indicate a serious condition of any kind. Many such symptoms could just as easily indicate something very easy to remedy by tweaking your diet or exercise levels and by not leaping to the worst case scenario in the first place.

Quite a few serious conditions arise from anxiety and worry including heart conditions and mental health problems. In short we can help ourselves by not assuming the worst as an immediate response to one or two isolated symptoms. We can instead talk to a local chemist or phone NHS Direct – it can save many an unnecessary sleepless night.

Your GP is an Operations Manager for your well being

When you consider how many disabilities, ailments, accidents and illnesses the human body could suffer from, aren’t you rather grateful that your GP takes several years to train to learn about as many of them as they can? When you consider how many treatments there now are, aren’t you grateful that it you have a GP has the knowledge to alleviate so many by themselves AND direct you to specialists when required for further tests and treatment? Aren’t you glad that we have consultants that specialise in every area of medicine to get you well?

Your GP is responsible for the whole of your health both mental and physical so when they refer you to someone else, I recommend you go unless you want to get worse instead of better. Given how complex the human body is it is perhaps not surprising that in some cases it can and does take weeks and months to track down the root cause of illness, and likewise to get the treatment right. The important point to remember is that they try their best - if they didn’t there are safeguards in place for them to get suspended or sacked. When a GP does not refer you to specialists they do not so out of malice but most commonly because you do not need it, yet I have come across some who will not accept that. A large percentage of the time the GP is right but of course there are exceptions.

Sadly there are instances of malpractice, of abuse and of misdiagnoses but they are exceptions and what I fear is happening is that overall there is a mindset that takes these examples as being the norm when they are not. Statistics back this up. In all cases it is better to not cross bridges until you come to them. Better to find someone you feel you trust for your health care than to trust no one at all. The majority of health care professionals are safe and trustworthy. They entered the profession precisely because they want to help alleviate and cure suffering.

The reality is that not everything is curable, but where there is no cure the medical profession as a whole work to help manage symptoms and help us to adjust to that reality. The truth is there can never be a cure for everything as we inadvertently create new conditions and nature itself comes up with new things too. However, when we consider what astounding things are possible today compared to 100 years ago, I think we’re keeping pace rather well.

The Government’s part

Successive UK governments, just like the medical profession mean well but over the decades government invention often has had a detrimental effect. Just at that critical point when a patient is about to make significant progress a local facility gets closed, or there is less funding for tests as the priority from government is to deal with the increased instances of a different disease which is deemed to be more life threatening or on the increase.

It is an extremely difficult equation to get right as without early intervention people’s health conditions tend to have a habit of deteriorating. Economy drives in the form of services which are cut depletes morale in health care professionals which in turn can lead to increased stress which can lead to an increase in mistakes. Even managers get confused by edicts from government;  access for funding for one area of medicine gets switched back and forth all the time in reaction to demand. Procedures get changed, priorities get changed particularly when it comes to administration necessary for record keeping. The effect is that staff often have to adapt instantaneously to radical changes in both finding information and recording it. This leads to delays and further confusion and sometimes missed elements vital for diagnosis and treatment. In effect the changes insisted upon by government can and have added to stress levels, confusion and errors in my opinion. This is not unique to this parliament/government. This is a recurring pattern no matter which party is in office.

I believe this to be avoidable by the simple expedient of analysing what works first and why in as much detail as we do when there is a fault. In my opinion the best place to start to look for trends in ailments is from those who have the greatest level of objectivity in the medical profession, i.e. those who co-ordinate access to all treatments – our GPs. I can think of no other position in the health profession that is more aware of the most common ailments, and of what is likely to become more common either. If we want to stop being reactive and start being proactive to anticipate future demands it’s best to get the most relevant information we can as a starting point isn’t it?

Change is necessary

With increased awareness of illness come increased demands upon health care. With the mandate to prevent illness demand increases as it does with an increase in population; all come with added need for funding, more administration, more staff and higher levels of training requirements. Most of all it results in a greater need for more facilities – not less.

Like the government the NHS is responsible for just under 60 million people’s health in the UK regardless of those who can afford private health care, because it will mostly likely be an NHS A&E department you will be taken to first in an emergency and most commonly in an NHS ambulance. Even if you have private health care the standard of excellence in some areas of the NHS is such that it is their professionals that you will get referred to for treatment in their facilities. I think it only right that it is the NHS itself that dictates to government what its priorities are, but it can only stand a chance of properly assessing that if it has a chance gain the head space to enter into that process of diagnosing its shortages itself first.

In my opinion it desperately needs to stabilise what is already working first for the sake of its hard working staff and their health, but more crucially for the sake of the health of its patients. No private health care provider in the UK has the remit of looking after the health of 60 million people other than the NHS. Therefore no private health care provider could possibly have experience on how to do it. That is not to say there are not brilliant ideas to learn from private health care though. 

It is nothing short of a miracle that the NHS has and continues to cover so much. It puts me in mind of scientists trying to work out why a bee can fly as for years they were baffled by it. Bees seemed to defy all known laws of aerodynamics and yet they flew. So perhaps it is to science and mathematics that we should turn to find out how the NHS manages as if we understood that it would help to build upon its already marvellous achievements.

Do not stop seeking help when ill from the NHS, but do try to be (pardon the pun) patient. When any of us are ill it is often the hardest thing to do, but hard never means impossible. I’ve never worked for the NHS, but I doubt I would be alive today without it. When seriously ill, I have made matters worse sometimes, been demanding, angry and frustrated. It is very much the nature of us all to do so when we are at our most vulnerable, but by working with my medical team instead of against them my health improved. We can always help each other to improve everything we value and nothing on this Earth is as valuable as our own health. Cherish it, and above all take good care of it. 

"Keep calm and carry on caring!"

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