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Topics

Why is everything changing in the NHS?

One of the main reasons is because people are expecting a much higher standard of medical care compared with say 20 years ago. People are also living longer, and the extra years  are in old age when people have more illnesses to cope with. All this, plus the ability of modern medicine to prolong the life of people with previously fatal diseases means that the average person will have far more care and treatment from doctors and nurses in their lifetime than ever before.

 The NHS copes with this increasing demand in two ways. Firstly it spends more money on staff and facilities, and secondly it becomes more efficient at treating patients. It is the changes caused by increasing efficiency that people notice most.

 You might ask how treatments can be made more efficient, and you might be surprised by some of the answers.

 One of the efficiency improvers you can see every day at Keyworth. We have nurses to see patients whose complaints do not need a doctor's attention. So the doctors can see more people with more serious problems. We also have a venepuncturist. That is somebody without medical training who simply takes blood specimens, where previously a nurse did it. So now the nurse has more time to see patients she can deal with without a doctor.

 You should perhaps note that the NHS is NOT trying to treat only serious problems and neglect less serious ones. We all realise that big problems start small, and that worry over small thing can lead to illness that we are just as keen to avoid as you are. We think everyone should have access to medical advice, whatever the apparent size of the problem. But what we can no longer do is have a doctor available all the time to deal with them all on demand. A properly trained nurse can deal with many of the problems that crop up from day to day, and if she cannot, she can easily get a doctor.

 We still think that doctors should be available to patients for whatever problem they want to discuss. This is what appointments are for.  It may take a few days to see a doctor in a booked appointment, but you are welcome to discuss any medical problem.

  Home visits are becoming less common as part of the efficiency changes. It stands to reason that doctors can see several patients in the time it takes to do home visit. Not only that, but in today’s world it is less easy to conduct a proper medical examination at home, particularly when everybody expects standards to be uniformly high. There are many circumstances when doctors need to do home visits, because of infirmity for instance. But nowadays many people have access to transport, and it makes much more sense to see an ill person in a properly equipped health centre from the medical point of view.  We realise that it often seems unkind to insist that sick people are brought to the centre rather than have a doctor visit, but please remember that a doctor has a duty to put him/herself  in the best position to make a diagnosis, and this is hardly ever going to be at home if the patient can possibly be brought to the medical centre.

  Another big area of efficiency is the application of what we call 'evidence based medicine'. This is more difficult to explain, but it stems from the fact that many of the treatments that are used in medicine have never been proven to be effective. Sometimes we just “know” things work or we believe they work, without proper evaluation ever having been done. A good example of the general principle is how long people stay in hospital after an operation. People used to stay a long time while they recovered, and it sounds the best thing. But when people actually measured how quickly people got better, they found that you get better faster if you leave hospital sooner. People criticise hospitals sometimes for being uncaring by sending people home to soon! But what is real caring? Is it being kind but have more people die of complications. Or is it doing what makes people healthier?  Many treatments are being tested for evidence of effectiveness, and if no evidence is found then the NHS is unlikely to spend money on it. That is why you hardly ever find doctors prescribing cough medicines or slimming pills. They do no good! These are just two examples. There are many, many more.

Some thing that are seriously questioned might surprise you a lot. Antibiotics for ear infections for example. Physiotherapy for common limb and joint problems is another. Next time you see that some treatment is unavailable or withdrawn, ask yourself if it could be because there is no evidence that the treatment is beneficial, rather than that the NHS is running out of money!