How to repair the NHS? Sack slackers and take an axe to managers

Dear Wes Streeting, 

Last week, in the pages of this newspaper, you wrote about the crisis consuming the NHS. You repeated what you said on the day you were appointed Health Secretary — that the NHS was ‘broken’. ‘Sunlight is the best disinfectant,’ you wrote, asking for frontline staff and patients to diagnose problems so you could ‘write the correct prescription’.

Well, I have worked full-time in the NHS for more than 20 years and I can certainly lift the curtain for you. I am truly shocked by the state of the health service.

The most important thing is that people are scared — of getting ill, of going to A&E, of needing to see a GP or an operation. They’re scared because they fear they won’t get the treatment they need, when they need it.

There is enormous will among staff to turn this around, but you will need to take some very bold decisions. In the long-term, we might need to change the NHS fundamentally — how it operates and how it’s funded. In the meantime, here is what needs attention now!

More beds to solve corridor crisis

In recent years we’ve tried to save money by cutting the number of hospital beds and moving services into the community. It doesn’t work. The UK now has shockingly low numbers of beds: 2.43 per 1,000 population versus 5.73 in France and 7.82 in Germany. 

Don’t listen to the management consultants who tell you it’s the answer. You said you wanted to know if patients ‘are being left unattended, unsafely on trolleys in corridors for hours’. Just go to any A&E anywhere and see for yourself. It’s happening now.

Scrap university fees

There simply aren’t enough frontline staff. We need to encourage the best to train and to keep them when they graduate. Scrap university fees for nursing and medical students and reinstate a full grant. In return, they have to commit to working in the NHS for a minimum of, say, seven years. 

This will help restore the sense of loyalty and duty present in my generation of doctors (who didn’t pay fees and got grants) but is often lacking in the younger generation (who did pay). Resist the temptation to plug gaps with physician associates — it takes years to train a doctor for a reason and I worry about patient safety with PAs taking the brunt.

Take an axe to management

There are many layers of management that do very little for patient care, and we doctors spend far too long filling out pointless forms for them.

A consultant friend says the hour and a half of NHS paperwork after a patient assessment takes just 20 minutes in the private sector. When he works privately all he has to do is write a letter to the patient’s GP.

It’s interesting that when time is money, all these forms become obsolete and unnecessary.

You need to axe entire layers. There’s no excuse for having managers who just manage managers. Those who survive should spend the equivalent of one day a week on the frontline. This already happens in some trusts — where I work, for example, the medical director spends one day a week in the dementia service assessing patients. It should be mandatory across the NHS.

Make waiting lists your top priority

These are out of control. There’s no magic answer — but increasing beds, staff numbers and efficiency will all help. Use the private sector in the short-term, but be wary of relying on it for long because it will push up costs.

Root out slackers

Matrons have been reintroduced, but we need them on the wards, pushing up care, not in management offices where they spend too much of their time.

It should be much easier to fire staff who aren’t pulling their weight or who don’t care. And we need cast-iron protection for whistleblowers.

In some areas, there has been a real deterioration in attitude and productivity since the pandemic, with some staff having got used to doing less. It’s a painful truth to acknowledge, especially when so many are working their fingers to the bone, but we do need to root out slackers.

Tougher A&E targets

It’s often pandemonium in A&E. Various policies have tried to improve this and the ‘four-hour rule’, stating 95 per cent of patients should be seen and dealt with within four hours, certainly focuses minds.

I think it’s more than reasonable to ensure that, from the moment someone registers at reception, they wait no longer than an hour before they are seen and, if they need more complex care, they are admitted or referred elsewhere within those four hours.

Put other specialists into GP surgeries

GPs are the whipping boys —everyone blames them for the problems in the NHS, yet most are working very hard. Is it any wonder so many are quitting?

Yes, sometimes it’s near-impossible to get an appointment. We need to encourage more young doctors to enter primary care as a career and we need to think creatively about keeping them.

In my trust, psychiatrists have been placed in GP surgeries to see patients with mental health problems and to offer support with less acute psychological diagnoses. It’s a genius idea and means fewer referrals to secondary mental health services. Surely something like this can be introduced nationwide — and with other disciplines?

Those suggestions are just for starters, Wes. I’m sure there will be readers who will be able to tell you their own stories, and many who will have smart and clever solutions.

I trained as a doctor because I wanted to work in the NHS. I hate to see it on its knees. Please, do your best. We might not agree on everything politically, but from the bottom of my heart, I wish you success.

Max

Strictly pits Celebs against Pros 

The Strictly saga comes to a head today with the release of the BBC’s verdict on the row between professional dancer Giovanni Pernice and actress Amanda Abbington. Whatever it finds, the mental health of both has suffered and the Corporation needs urgently to protect future contestants.

Perhaps the problem lies in the culture clash at the heart of the show. Professional dancers require very different personality traits to celebrities. Discipline is all. Dedication to their skill consumes their lives. The professional dancers I know tolerate training and a lifestyle that few would be able to endure. To some, it might even feel sadistic, but for the dancers, it’s a means to an end — a necessary sacrifice for their art.

Celebrities are motivated by different things – adulation, adoration, the limelight.

I wonder how many understand the difference before they sign up to the show. And whether the BBC prepares them for it.

One in ten people have problems with continence. But how often do you hear anyone talking about it? 

Now the estimated eight million Britons living with an overactive bladder (a cause of incontinence) could be given a new lease of life after officials approved the drug vibegron. 

We need to lose the shame around this problem and come forward to be treated.

Dr Max prescribes… Blood donation

The NHS has issued an alert saying it has just days’ worth of blood left following the recent cyber-attack which led to thousands of operations being postponed. Stocks of O negative stand at 1.6 days, while across all blood types it is 4.3 days. 

Those with O negative and O positive blood — the most common types — have been urged to donate.

Register and book an appointment on the GiveBloodNHS app or at www.blood.co.uk.