I have been retired from the NHS for 11 years but I have remained a keen observer of events, and think I have been around a little longer than the ‘in-house doctor‘. I became a medical student in 1967, qualified in 1973 and was brought up prior to that by parents who were both GPs – so my exposure to primary care medicine started when I was five and first went out on house calls with my mother.
It’s not a question of whether the NHS will accept reform. It has. Frequently. As I outline in my book Mad Medicine: Myths, Maxims and Mayhem in the National Health Service, I have seen many ‘reforms’. None of them have worked. Over 70 years have passed since the NHS was established; if the best minds in medical and organisational thinking have been unable to come up with solutions in that time, perhaps there are none. I find the suggestion that doctors are to blame for inertia in promoting change is unfair – at least so far as hospital medicine goes. I spent the last three years of my professional life fighting managers who wanted me to do less work (i.e. see fewer patients) based on ideology developed by non-specialists. I was not supposed to overbook clinics, but did so regularly, as well as accommodating patients with an emergency problem. I wanted to prioritise appointments by need (by looking at referral letters); with the advent of computerised booking that became impossible. The brilliant diary appointment system of one of my obstetric colleagues was destroyed by the same system. I adopted the ‘treat early and treat aggressively’ mantra for rheumatoid arthritis a full 25 years before it became generally accepted in rheumatology circles. My surgical colleagues were constrained by the rigid application of operating theatre opening and closing times; thus, if an operation at the end of the list would be likely to be long, and therefore overrun, it would be cancelled. Was this the surgeons’ fault? Certainly not.
We must ask ourselves not what the problems are, but why they are there. One recurring issue, though, is the loss of NHS institutional memory. While people may dismiss aged, retired people like me as yesterday’s men, they carry such memory. Managers (and politicians) are here today and gone tomorrow. In my career I have lost count of the number of times that a new proposal was brought forward and I had to say, “We have been there and done that – and it didn’t work”.
For hospitals, primarily there is a lack of capacity. Some of that is because it is expensive to run a system where for much of the time there is spare capacity, with bed occupancy less than or up to 85% and therefore room for increased need at peak periods such as winter. Empty beds are still maintained and staffed, which costs a lot. Cutting beds, closing wards and running at over 95% occupancy saves a lot, which is why it has been done, but you get into trouble in winter (as the NHS has done for 20 years or more). The old overspill network of cottage hospitals closed because they were too expensive to maintain – small units are less cost-effective so are first to go when money is tight.
And the rest? People who 50 years ago would have died because there was no treatment for their conditions now have expensive investigations, even more expensive treatments and as a result live longer with multiple pathologies. When I became a hospital consultant, the biggest pharmacy spend in my hospital was on oncology drugs; with the advent of biologic therapies for inflammatory arthritis my departmental budget overtook it, and increased from an annual cost in the low thousands to over seven figures. Complex cardiac or neurosurgery and interventional radiology are time-consuming, labour-intensive and very expensive. There has been a recent resurgence of the idea that preventive medicine is the answer. That was what Aneurin Bevan thought in 1948; disease prevention would cut the costs. But he failed to foresee the enormous expansion in techniques, drugs etc. that make that a pipedream. When I qualified there were no CT or MRI scans, almost no ultrasound, no coronary artery surgery, no organ transplantation, no genomic investigation, no thrombolytic therapy for stroke and very limited drugs for cancer. Now we have all these things any savings made by shortening hospital stays is matched by the spend on them. Of course, if the current epidemic of obesity and consequent diabetes could be stemmed by education then a lot of medical work would vanish.
The strike issue is less relevant than an ongoing, year-round problem in the NHS – that of sick leave and maternity leave. Neither is predictable and both require locum cover at great expense. When I was a clinical director I had, at one point, three physiotherapists on maternity leave, all of who were being paid, and to cover their workload I needed to employ three agency staff, which more than doubled the cost. My budget was horribly overspent. Management was more concerned with the overspend than the clinical consequences of leaving the posts vacant. As for sick leave the sudden absence of a doctor required a major re-jig of rotas – or an expensive, short-term, at-no-notice locum which was often hard to find. If there is no slack in any system then a sudden problem will catch you out.
Managers and doctors will always be in conflict because the role of managers is to save money in a constrained budgetary system and the role of doctors is to spend it. So on the one hand you could reduce the constraint by increasing funding (which has been the way the NHS has sort of coped), and on the other you could get the doctors to spend less. But there is one major sticking point on that approach: doctors are programmed to treat, not to abandon hope. One could address this latter by not indulging in what I term futility medicine, where for example elderly patients have heroic surgery, require long ITU care and are then discharged back to their care home with their dementia probably worsened by the disruptive experience. Should we spend tens of thousands of pounds on cancer therapy that extends life by three months? Just because we can does not mean we should. Regrettably it is not just the health professionals who are averse to defining constituents of futility medicine, but a public who have been conditioned to expect that if a treatment is available then it must be employed.
An example. Take a 94 year-old lady in a care home who is very deaf, has lost some of her sight to macular degeneration, has lost half of what’s left to a minor stroke, who has a stiff hip, a chronic and resistant to antibiotics urinary infection and double incontinence and intermittently does not recognise her family. She becomes confused because she develops sepsis, and falls, breaking her shoulder. Admitted, her family has a meeting with the orthopaedic team who suggest they could pin the shoulder and replace the stiff hip in one operation. For what purpose? And before you say that I am callous, this is my ex-GP mother who I am talking about, and she is lucid enough to say she doesn’t want any more treatment and has already signed an advance directive. She occupied a hospital bed for 11 days before she died; it would have been three times that to get her fit enough after major surgery. Treatment would, in my eyes, have been a classic example of futility medicine. Just because we can does not mean we should. We must have a rational debate about what parts of medicine will be abandoned, either completely or to the private sector.
The pressure on A&E departments is heightened by patients’ perceived inability to get a GP appointment. In my parents’ day, in the 1950s and 60s, there were no booked appointments; you turned up at the surgery and sat and waited. If the wait was not justified by the severity (or lack of it) of the medical problem you went away. Indeed people were attuned to the system and it inhibited their demand. No-one in real need missed out. Why not abolish appointment systems? I concede that GPs might rebel at such a suggestion. Alternatively, or as well, introduce a charge for appointments. It won’t be the doctors that kick up, but patients will!
The cost-benefit of some interventions needs to be re-examined. For instance, statins are cheap but prescribed in vast quantities, so all in they are not cheap at all. Monitoring takes up GPs’ time. Re-evaluation of the evidence in their favour suggests that they have little absolute benefit, and anyway probably don’t work by lowering cholesterol. Such evidence – and there is a lot of it – is ignored by those with vested interests and conflicts of interest, and there is too much tramline thinking for an independent assessment to be easy, and acceptable – not for want of trying. But the money (and time) that would be saved by abandoning them is very large.
Elective surgery units are only a partial answer to the routine waiting list issue. You cannot safely operate on patients in such a unit if post-operative care requires an ITU, which elective units don’t have (too expensive). So complex surgery cannot be done there. Furthermore, if such units are contracted out to the private sector, experience has shown that contract over-ordering is common, so NHS money is being spent on work that is not being done. Using hotels as pre-discharge overflows is an idea that has been proposed before. I doubt it’s a safe option. Just before I left the NHS my hospital, as part of a group, became what was known as a step-down unit. A significant number of admissions had been rushed out of their acute bed too fast, were not well enough to be in the step-down unit and had to be returned. But everyone has forgotten this. Who will monitor patients in hotels? The nurses we don’t have? (Will ‘guests’ pay for their food? Probably not, although as everyone eats every day I don’t see why they should be fed for nothing, even in hospital.) This week’s news suggests that care homes may have spare capacity. Is delayed discharge the fault of the doctors? Certainly not; the assessment processes by social workers and therapists act as a gigantic drag anchor.
The idea that there is some sort of fast track for senior apparatchiks to access NHS care seems ridiculous. The reason that senior staff might be able to pull strings is that they have the knowledge of what strings to pull. They may be better placed to judge what needs more urgent attention and communicate this in a way that speeds up access.
The in-house doctor says: “The British medical establishment will die in a ditch before allowing remuneration to be linked to measurable productivity of individual doctors.” I would like to know how one might measure productivity. What a doctor does, and how he or she does it, will differ between specialties and grades. Comparing a neurosurgeon to a dermatologist is like comparing apples and pears. Outcome measures, perhaps, like surgical success rates? That will encourage all surgeons to stick to the simple, no risk stuff. Been there, done that. Outpatient numbers? As I have pointed out, it was managers who attempted to reduce my numbers, not clinicians with any knowledge of why I could not. I suggest that anyone trying to introduce a remuneration system linked to productivity will be the one dying in the ditch.
A few years ago I spent some time comparing the NHS with health services in Canada and Australia, and concluded that each had different advantages and drawbacks; overall, none was better than the others. The French system works reasonably well, but patients pay (not a lot). I believe that today a service that is free at the point of delivery is an unaffordable luxury. We pay prescription charges, so why not appointment charges? Usual exceptions of course, but the one principle that is truly outdated is that ‘Our NHS’ must be free. Dispose of that and we might make some progress. Identify and ditch futility medicine and we will make more. Streamline the discharge process. More still. If politicians were ready to listen to those who hold the institutional memory, and thus avoid introducing already tried and proven-to-fail ideas, we could be flying.
Dr. Andrew Bamji is a retired consultant rheumatologist.
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Tear it down and start again!
1948 it was born, (sounds very Yoda!) time for a great reset!
Never thought I’d here myself saying that!
Agree, but do not try and build back one megalithic health service, the institutional inertia in an organisation the size of the NHS makes it almost impossible to manage. I work in conservation and the wildlife trusts operate on a County basis, the Devon Wildlife Trust may at times be quirky and tricky but it is small enough that people know each other and change and adaptation do happen and good results are achieved. The county wildlife trusts do have an overarching national group for discussion of ideas and conducting surveys but in themselves they are independent and autonomous. Possibly this model may offer a pointer for running health care?
Of course your point is right but I fear you have let the cat out of the bag.
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Now there will be a failed politician or a retired covil servant gagging to impose national standards and policies on all County Trusts. It happened in the Red Cross, CofE, Art Society and many many other organisations.
The Conservative and Labour Parties are fully centralised and local associations exist only to rubber stamp candidates imposed on them and to raise money.
The People’s Health Alliance is building an alternative system to the NHS based around local hubs to provide for the local need.
We have to build the alternative otherwise we’ll get a top down imposed ‘solution’ modelled along the lines of the WHO one size fits all approach.
Get your point Steve, but it can and must be better than this black hole that not even money can escape
Thank god,and Toby, for this platform!
I would have gone doolally long before now without it! Keep up this good work all you amazing people!
Some insights from a retired experienced doctor but he does not address the issues and yes, I find his disregard for palliative care extremely callous and immoral. He is not God. He does not decide who lives and dies – especially with my tax money. He seems to forget that I the peasant pay for all this and he is not God.
So my problem is this: I give £15K every year to the NHS from my income in tax; and we don’t use it. Why is there no capacity, no GPs, no technology and no real direct line bypassing a GP to a private system? Why did he (assuming) and the quacks fully support the Rona fascism, the stabs and the tik tok videos in empty hospitals?
If I paid £15 K for a car, and most of the time it does not work, it is usually missing a wheel, and is unusable, I would look pretty damn stupid and question why the purchase. Why am I funding something that does not work and if applied to any other market would lead to bankruptcy or a return of the product ?
Someone institutionalised in a failed institution isn’t capable of and objective assessment.
Ain’t that the truth
Choices regarding treatment are made on a daily basis.
Take transplants for instance. A decision as to who gets the organ may take into account QALYs left.
The example you find callous is actually humane. Why put this person through procedures, reducing her quality of life, for limited to no benefit whatsoever?
I am not quite clear where you found something to suggest I had disregarded palliative care, except perhaps that I hadn’t mentioned it. I should clarify that the palliative care nurse who helped manage my mother’s last days was wonderful, but regardless of the suffering, or lack of it, it was care for the patient and not for the family, who were forced to endure an agonising wait for the inevitable without any endpoint. Furthermore, wearing another hat, I looked after a rehabilitation unit for over 20 years, dealing with patients with long-term conditions such as multiple sclerosis, severe brain injury and motor neurone disease – a patient population of around 300 at any one time. It was very common for the team to believe that with some deteriorating patients resuscitation was not in their best interests. This was pragmatic rather than callous, but we had a special way of dealing with the issue, which was to discuss the status quo with patient and relatives (and as we cared for the patients on and off over many years, we all knew them very well) and posed the question directly – if you get very sick and have a cardiac arrest, do we call the resuscitation team down? We would then do what the patient wanted, and did not impose what we thought was the “right” thing. So I am not God. Also it’s my tax money too.
My unit worked by maintaining regular review admissions, which kept the clientele out of acute hospital beds. I stopped its closure (usually proposed on financial grounds -we had lots of staff to deal with totally dependent people) at least four times. Our specialised care prolonged happy and active life often for decades. If we were unable to admit someone and they ended up on an acute ward they would often end up with serious pressure sores or die, so we “rescued” them as soon as we could.
Callous? Never. Immoral – yes – but not our team; the managers waited six months after my retirement and closed the unit down, throwing all our patients on the mercy of often inadequate home care and enabling acute emergency admissions were they were treated by doctors who did not understand the nuances of chronic disease.
But returning to my point I can suggest what might fall into the category of futility medicine from long experience, but it’s not up to me to implement what I think; it’s up to the public to decide. Heroic but futile surgery? Dealing with repeated drug overdoses in addicts (I am repeating a suggestion made by a friend here)? Etc. We should have the discussion.
So, in other words, the problem is that we just won’t let people die.
Good point! People do and always will die, its the most common thing in life.
The human race seems insistent on saving lives at any cost,this just disrupts the balance, do what we can by all means but instead of asking “could we?” maybe we ought to ask “should we?”
And then on the other hand, the National “Health” Service jabs the young and healthy with untested, unnecessary concoctions.
What a queer state of affairs.
You cannot save a life, merely delay death. When that delay is measured in weeks, and the treatment is traumatic, I can understand his outlook.
For a 20yr old in similar straits, there’s a lot to gain and that traumatic experience may well be worthwhile.
Back to QALY again.
I can report a similar experience to the author’s comments about his mother’s treatment. My own 92 year old mother had a serious fall at home (it was her third over a period of just 2 weeks) and both she and the immediate family, which included an eminent retired consultant surgeon, recognised that there was little chance of her resuming a “normal life”.
She had no wish to occupy a hospital bed, and the family was well positioned to provide her with round the clock care. The problem was the rules-based approach of the medics overseeing her treatment and, in particular, the medication available to her. My mother was lucid but uncomfortable but, as GP visits were unavailable, the closest she got to a proper consultation was a Whatapp chat with her GP, followed up by a visit from a District Nurse.
During her final days, she remained on the lowest recommended dose of pain relief medicine and, although the GP agreed to increase this, the District Nurses who were managing her medication claimed that the GP’s proposed increase in dose exceeded their own guidelines, and they refused to implement it. Eventually, just 3 weeks after her fall, she stopped breathing.
As a family, we had saved the NHS having to provide a hospital bed (and we’d saved my mother the trauma of spending her final days away from her own bed) but her experience could and should have been made much better.
“the closest she got to a proper consultation was a Whatapp chat with her GP, followed up by a visit from a District Nurse”
Oh, very familiar with this scenario with my mother in law. She was dying and we and she knew it. She was in pain via an oedema in her leg. The GP surgery would not offer GP home visits. What did they offer instead?
A mobile phone appointment with a GP and a request that we film the infected leg.
District nurses were attending in person twice daily.
I would be banned if I detailed my contempt for GP’s.
Interesting article and some good practical points in the final paragraph. If I were in charge the first thing that I would do is to stop paying GPs for doing nothing.
Pay them on a piece work basis for the work they actually do and not on a capitation basis with extra money on top. Also give them back responsibility for out of hours patient care. Being able to work part time for £100K a year is taking the pi55
An Australian perspective.
Through my career, I have seen a significant reduction in lifestyle modification as a method of keeping people out of the medical system, and a concurrent increase in the use of medications.
In the case of statins, as you point out, there is no real data suggesting benefit in primary prevention, and only a small benefit in secondary prevention, yet the cost to the system is huge.
The Covid public policy world wide was to worsen all lifestyle factors (exercise, diet, alcohol, weight control), then wonder why the system is failing.
Inevitably, this is what happens when a system is controlled by bureaucrats under the heavy influence of Big Pharma.
And the British Heart Foundation, advocating them for all without any quantification whatsoever.
The BHF are wholly signed up to the depopulation agenda. I wrote early in the Scamdemic questioning their unstinting support for masks even for people with heart disease and received a boiler plate reply.
I dare say the BHF are absolutely loving all the attention generated by the heart attack inducing “vaccines.”
A fake charity which should be shut down immediately and its senior staff sent to court to answer charges of malfeasance at least.
“The Covid public policy world wide was to worsen all lifestyle factors (exercise, diet, alcohol, weight control), then wonder why the system is failing.”
Given that I am absolutely convinced of the depopulation agenda I consider the above measures were deliberately instituted. It is inconceivable that those pushing these measures were unaware of the negative consequences they would produce.
many useful insights in the article. The NHS is third rate and is not capable of being meaningfully reformed. It’s flaws are fundamental.
Healthcare would be improved by allowing opt out from the NHS. The opted out citizen would receive a tax rebate based on the actuarial value of the NHS to the citizen. Funding healthcare would be the citizen’s responsibility including paying full cost for any NHS emergency treatment.
Opt out would be taken up by sufficient numbers to enable a pluralistic system to develop with real choice and incentives for innovation and productivity. The individual would take responsibility for self (and dependants) and make choices about healthcare based on costs, benefits and risks as with other areas of life.
As a paraplegic of 30+ years, over that period I’ve had outstanding care – I genuinely can’t fault it, receiving personalised specialised care in the behemoth that is the NHS system (I was a patient in the spinal unit in Hexham which served me incredibly well being relatively close to home. It’s now closed and incorporated within a much bigger complex in Middlesbrough, much further away).
Of course I understand a specialised spinal unit can’t be provided in every city but I fear a similar agenda on just our rural surgeries – essentially doing the same combining them within much bigger city hospitals. Granted this article is focusing more on the hospitals but this inevitable pursuit to cut costs, it’s the same old ever increasing creep of centralisation because it’s apparently.. ‘more efficient’. Having to continuously argue for our local surgery to exist is frustrating, and not an effective method of cutting costs at the expense of some patients.
I’m sure others are having similar battles since we don’t all happen to live in or even near a town or city, why a genuine National Health Service should surely provide a level of care within relative distance to one’s home – what use is a doctor on call if it takes him 45+ mins in travel time to save you, let alone being able to see a doctor you’re familiar with and who’s familiar with you. Perhaps us rural types have got it really good, I’ll accept that but these rural surgeries, though not as cost efficient per person are a vital component of providing any level of care for those that live more remote, one I hope we can all continue to benefit from despite the increased cost per patient and the ever increasing spiral of NHS expense in general.
Of course once we’re all on NHS-X with our digital profile and social wallet, there won’t be many services at all, local or otherwise, just a convenient zoom call with a random doctor, nothing but on-call services.
“just a convenient zoom call with a random doctor, nothing but on-call services.”
That’s all you will need when you are moved to a 15 minute city.
Haha indeed, though being intermixed with everything you [supposedly] need within a 15-min city is hardly going to save you either. I doubt it’s even possible in the real world, but details, details.
If the recent experience of the £15-an-arm jab rollout was anything to go by, paying for a GP appointment, with a same day surcharge, would increase the rate of consultations if the patient paid the practice directly. Make that GP’s primary source of income.
An excellent article, I agree about charging everyone for appointments (the first one at least) and all prescriptions.
The social workers and therapists are a big problem. A disabled friend of mine had a small op’ and was kept in hospital for two weeks longer than the doctors thought necessary because a social worker had not assessed his home. Which turned out to have everything a disabled person would need.
It’s not rocket science to work out that a scheduled 2 day event turned out to be 16 days effecting a removal of a potential 7 such op’s from the listings.
You’re exactly right about social workers. I have experience of them with my father and, more recently, with my mother. It’s seemed to me more than once that the state kidnapped my parents and neither their nor the family’s wishes and needs counted for anything. And not even the hospital’s either. Try getting them to do an assessment on a Friday afternoon when the consultant decides someone is fit to be discharged! Forget it.
This ‘democratic’ socialist fascist government knows what reforms are required but, just like every other socialist fascist government in this country over the last thirty years, prefers to keep control of the NHS in its own hands:
‘Despite some relative improvements in the last fifteen years, the National Health Service remains an international laggard in terms of those health outcomes that can be attributed to the healthcare system. In international comparisons of health system performance, the NHS almost always ranks in the bottom third, on a par with the Czech Republic and Slovenia…………In more sophisticated estimates of health system efficiency, the NHS ranks, once again, in the bottom third. The NHS is poorly prepared to deal with the financial challenges of an ageing society. This is because, like virtually all health systems in the developed world, it is financed on a pay-as-you-go basis: healthcare costs rise systematically with age, which is why most healthcare spending represents a transfer from the working-age generation to the retired generation. It would be far more insightful to benchmark the NHS against social health insurance (SHI) systems, the model of healthcare adopted by Switzerland, Belgium, the Netherlands, Germany and Israel. Like the NHS, SHI systems also achieve universal access to healthcare, albeit in a different way, namely through a combination of means-tested insurance premium subsidies, community rating and risk structure compensation.’
Universal Healthcare Without the NHS: Towards a Patient-Centred Health System
Institute of Economic Affairs
An excellent article and much to commend.
In the years I worked in the Civil Service, and thankfully I did spend years in private companies, I lost count of the number of times a new manager would be inflicted on the staff, charge in with a raft of ‘new working measures’ and be told ‘been there, done that’ and it doesn’t work. Not that said manager would take any notice. Nor too would the same here today gone tomorrow managers take any notice of ideas from experienced staff – know your place.
Change for changes sake was a biennial event even if it only amounted to moving desks. Changes rarely produced any positive outcomes and frequently made productivity worse. The idea of leaving good teams alone and allowing them just to get on with the job was anathema to greasy pole managers.
Before completely dismantling the NHS perhaps some of Dr Bamji’s suggestions could be introduced. Why for example are not GP appointments and concurrently A & E not charged for? It might at least stop the ‘day out merchants’ who daily clog A & E departments – the ones turning up pre-prepared with a carrier bag containing a two litre bottle of Coke, a six pack of Walkers and half a dozen bars of chocolate.
And why are the suggestions of experienced staff routinely ignored by managers as will certainly be the case here?
So true. Many years ago I was a Regional Manager with a pharma company, in the days when they were respectable. I covered SE England and my job was to accompany my 10 reps on visits to GPs. Naturally this meant that I began to remember and recognise the doctors. Scarily, I also began to recognise some of the the patients in the waiting rooms.
‘We must ask ourselves not what the problems are, but why they are there.’
The same answers both questions: it is a State-run, non-contestable monopoly with a self-serving workforce. structured and operated to meet socialist ideological and political aims.
The way to change it is to remove that monopoly, allow people to buy private insurance instead of paying into the National Insurance scam, so that a competitive private market in insurance and provision can develop.
There… solved it for you.
How to save tte NHS.
I was rather expecting a remedy, but after a lot of waffle there came none.
Whilst I agree with some aspects of this article, it troubles me to read so much reference to drugs and medicine as being the answer. Cancer is more common now than it ever has been despite the billions given to Cancer Research. Hasn’t a cure for cancer been found yet???? They found a ‘vaccine’ for Covid unless then a year. Maybe we should prescribe more statins to reduce heart disease even though there is no proof that high cholesterol causes heart disease. And there is the problem – eat rubbish, don’t look after yourself and expect the NHS and its relationship with big pharma to come to the rescue. There is no profit in well people who live healthy lifestyles.
I didn’t say drugs and medicine were the answer, merely pointed out that these have developed, alongside investigative techniques, at enormous expense. These are all now there, so they are used. Watch any of the programmes on the TV such as 24 hours in A&E and you will see (at least I do) a very cursory clinical examination before the patients are put in a scanner. Bevan would be flabbergasted to see how medicine has changed. However you are right in implying that lifestyle change may reduce cardiac risk. Remember also that John Yudkin, decades ago, proposed that carbohydrates were the problem, only to be rubbished by the cholesterol brigade – an early NHS example of the Galileo syndrome.
I don’t care any more about the internal challenges of the NHS than I cared about the labour challenges of British Leyland. I’m a customer, I pay a huge amount of tax and get very little in return. Give me a 50% tax rebate for private health insurance and you’ll never hear from me again.
Precisely so. Why should the NHS be the only organisation that has not fundamentally changed over the 70+ years of its existence? It needs to be treated as the dinosaur it is
This seemed to me a good practical article. Sadly I doubt that any of Dr Bamji’s suggestions will ever be implemented!
Excellent piece.
NHS cannot be everything for everyone for free.
The way experience and acquired knowledge are dismissed in the working environment has always been an annoying problem; reducing the performance and frustrating the individuals involved. It is effectively ignored wisdom.
This brilliant article should be sent by all readers, and as many friends and relatives as they can share it with, to their MP.