Monthly Archives: September 2021

Britain, Government, Health, Medical, Society

One of Britain’s top medics says we need an NHS fit for the modern age

NATIONAL HEALTH SERVICE

PROFESSOR Stephen Smith, Dean of Medicine at Imperial College London, has been making his professional views known on the state of the NHS. The leading medic says that the service will never improve until the entire system has had radical surgery. In a brilliantly argued prognosis, Professor Smith has seen first-hand how the rest of the world almost always delivers better health care and says it is not about the money.

As a consultant gynaecologist and professor, he once advocated a change in the appointments system at one of the best hospitals in the country – the Rosie Hospital which is part of Addenbrooke’s in Cambridge.

The existing arrangements saw one batch of women called in at 9am, another at 11.30am. The medic became increasingly tired of seeing these patients sitting in the waiting area, often agitated and fed up.

He cites a woman who comes through the door having been made to wait for more than two hours and who is understandably angry, tired and resentful, especially as she’d been trying to entertain a screaming three-year-old. The clinician says you’re not going to get the best account of someone’s medical history in those circumstances.

He thought individual appointment times would be better: say, one every 15 minutes. Every doctor and patient he spoke to agreed.

You would think it easy to get things done for someone who is a professor in the NHS. Senior doctors are revered: their opinion and judgements count. But try to actually change anything and it’s a different story.

Naively, Professor Smith thought the switch to a 15-minute appointment system would be easy. Instead, he had to argue his case in front of at least six committees who each have a separate chairman and differing agendas.

That instance was just the first of many of his battles with the staggering bureaucracy within the NHS.

Next, his unit pioneered a scheme whereby pregnant women would carry their own medical records to appointments instead of looking up their records on the central database. The opposition to this was ferocious.

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PROFESSOR SMITH’S unit pointed out that 17 per cent of central records could not be found. And once women were trusted with their own notes, only 5 per cent turned up without them.

He also mentions another arduous battle in which post-appointment letters are sent to the patient, with a copy to their GP – instead of the other way round.

At the heart of this chaos, he says, is a system that doesn’t put the patient first. The hurdles placed in the way of reform are designed to shore up the NHS – and are not in the best interests of the people who need it.

After Cambridge, Professor Smith became Dean of Medicine at Imperial College London, then CEO of the Imperial College Healthcare NHS Trust. He has also worked in Singapore and Australia.

Having had a view of our healthcare system from many perspectives, today’s NHS, he says, is simply not fit for purpose.

The additional funds the Government is about to direct to the NHS – some £36 billion over three years thanks to a new “Health and Social Care Levy”, including £5.4 billion to help clear the backlog caused by Covid – is well intentioned. But throwing money at the current system won’t get us anywhere.

We have been furnished with yet more stark reminders of the eye-watering sums the NHS is capable of wasting. It reportedly paid around £400 million a month last summer to block-book private hospital care for non-Covid patients.

A good idea, many might think. But astonishingly two-thirds of that went unused, perhaps for ideological reasons. Many NHS staff have an aversion to private medicine.

Meanwhile, waiting lists have grown. About 5.6 million people are waiting for hospital treatment, and that number looks set to double in the coming years.

Some £9 million of the new money is already earmarked for salaries of up to £270,000 for executives who will be expected to “actively champion diversity, inclusion and equality of opportunity”.

The medic says he has no quarrel with high salaries if they help to attract highly competent people. These are, after all, important jobs. When Professor Smith was chief executive at Imperial College, he was responsible for a £1.2 billion-a-year budget and had people’s lives at stake.

His prognosis says it’s time we had a major review of the way we run our health service. The NHS was born from such a review: the famous 1942 Beveridge Report, which looked at health care, social care and education. It was marvellous and set up an NHS that was suited to life 80 years ago.

We need now to set up a new Beveridge review. A national debate should be had about how to best fund and run our health service for the 21st century.

The review could be a Royal Commission, it could be an inquiry led by a judge. But, he says, any inquiry should typically involve medical personnel, economists, social-care experts, politicians, and patients, while avoiding childish, political squabbles. And we need to ask: what do we want, and how do we pay for it?

Professor Smith’s analysis says there are other, far better ways in which we can pay for healthcare in this country. The best would be the social insurance schemes seen elsewhere in the developed world – which would offer a vastly superior service than the one we have now.

The biggest obstacle to bringing in social insurance is actually the English language. When you mention social insurance, people in Britain almost freeze. They think: “I can’t afford medical insurance!”

But it’s not at all like private medical insurance – that’s completely misleading.

Under a social insurance scheme, the Government “hypothecates” – that is, promises – the money to go on healthcare. The scheme is then run-on insurance principles, but it’s paid for by the state out of taxation. And the money cannot be used for anything else.

Be wary of the objections from the Department of Health and the Treasury that social insurance is complicated and difficult to manage. We know through international comparisons that it provides a high standard of care – often higher than the NHS.

Many will have been cheered to see that the levy the prime minister announced last week will be hypothecated for health and social care. That’s a small step towards a proper system of social insurance.

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THIS has nothing to do with “privatising” the health service, nor is it a criticism of our health professionals who have shown – especially over the past two years – selfless dedication. It is about dramatically improving healthcare in this country.

The great myth about the NHS is the belief that, because it provides for everyone, it is exceptional. But do people here seriously think the citizens of Belgium, Holland, Germany, New Zealand, Australia, Canada, Sweden, Switzerland, Denmark, Norway, Spain and Italy all go around worrying about whether they will get treatment for any condition they may have? Of course not.

All these countries have slightly different systems, so our NHS review could look at the right mix of options, taking ideas from several countries, perhaps, to get the best for the UK. 

Professor Smith highlights the Dutch system, which has a small number of sickness funds which patients can switch between without penalty.

As a nation, the medic says, we’ve set the bar far too low: grateful to see a GP after several weeks’ wait, grateful to have surgery, if only after the millions ahead of us on the waiting list have had theirs.

The truth is, he insists, is that we can do better.

Explaining that when he was a young doctor, the clinician was filled with fervour for the NHS. He had the fiercest arguments, insisting our system was the best in the world. Then he began travelling to other countries as part of his academic research into menstrual dysfunction.

Much of his early research was done in Sweden. That was his first eye-opener: the Swedish system was outstanding.

One of the first things that impressed him was that consultants went outside their hospitals and held clinics in GP surgeries.

That was enlightening and certainly new to him. In Sweden, the consultant was expected to go to the patient, not the other way round. That is still a feature of Swedish medicine and we should look at it closely.

Right now, too much in healthcare isn’t right for the patient but persists because “we’ve always done it this way”.

And as for privatisation? When people talk of “mixing public with private”, there’s a widespread suspicion that evil American corporations will descend and make huge profits from “our” precious NHS.

But – and here’s the key point – large parts of the NHS are already private.

In the many years of working in hospitals, Professor Smith has never understood why so many people haven’t realised that GPs don’t actually work for the health service. They are small businesses. So are dentists, including those offering NHS care.

The first criticism from the Left is always, “Look at the American system!”

Professor Smith acknowledges that the American system is atrocious – not to mention terrible value for money. Many people live in fear of not being able to pay their medical bills and care costs twice as much as anywhere else in the world. Nobody wants that. What would improve Britain’s healthcare is a system like those of many of our European neighbours.

The biggest challenge for the UK health service now is how to integrate primary care (GPs, dentists and opticians) with secondary care (including hospitals). This comes naturally in a less “top-down” social-insurance system.

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SOCIAL CARE has long been neglected, but it is key to making the whole system work. It’s about getting older and vulnerable people home from hospital, rather than leaving them stuck there when they no longer need to be.

If Mrs Jones, 95, is ready to be discharged but social care can’t ensure she will be looked after at home, she must stay in hospital. Then the bed she would have vacated is not available for the next person needing an operation, and so on…

Lack of integration in the NHS is systemic: most patients are astonished, the professor says, at the difficulty of sharing records between a hospital and general practice.

The clinician says that if you are assessing someone’s health needs, you should be able, with their consent, to access their primary care records, operation notes and anything else that is relevant. But this is very difficult – although technology is slowly improving matters.

Professor Smith poses a final question. Should we now change the role of GPs to focus more on long-term care?

The medic says that if you are a woman with problem periods, say, why shouldn’t you access an app, put in your medical history and refer yourself to a consultant whose team will be able to look at the problem and decide if you need to come and see them? Why should your GP be the only port of call?

This final point brings Professor Smith back to his key point. The NHS as we have it was designed for life 80 years ago, when your GP was the person – invariably a man, in those days – who acted as a gatekeeper.

That was then, he says. What we need now is an NHS for the current and modern era.

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Arts, History, Philosophy

(Philosophy): Georg Wilhelm Friedrich Hegel

1770–1831

GEORG HEGEL was born on 27 August 1770, in Stuttgart, Germany. He studied philosophy and classics at Tübingen, and, after graduation, he became a tutor and explored theology. Hegel taught at Heidelberg and Berlin, where he wrote and explored philosophical and theological concepts.

Hegel was a major figure in German idealism. His historicist and idealist account of reality was revolutionary at the time and a major factor in the development of some radical threads of left-wing political thought. His major work, The Phenomenology of Spirit (or mind), was published in 1807. Many of his ideas were developed in other deeply complex works until his death, from cholera, in 1831.

Almost everything that Hegel was to develop over the rest of his life is prefigured in the Phenomenology. The book and text is far from systematic and is generally accepted as difficult to read. The Phenomenology attempts to present human history, with all its revolutions, wars, and scientific discoveries, as an objective and idealistic self-developing Spirit or Mind.  

Hegel is a notoriously difficult philosopher to understand. For a beginner with next to no grounding in the Greek logic of Aristotle and the later works of Descartes, Hume and Locke it is probably a forlorn task best left until the fundamentals of philosophy are mastered. Being able to comprehend what he writes requires a grasp of at least the basics. Hegel still causes frustration among academics and one of the philosophers that give the discipline its forbidding reputation.

For example, in his book Hegel, Edward Caird writes: “But the height of audacity in serving up pure nonsense, in stringing together senseless and extravagant mazes of words, such as had previously been known only in madhouses, was finally reached in Hegel… and became the instrument of the most bare-faced general mystification that has ever taken place, with a result which will appear fabulous to posterity, and will remain as a monument to German stupidity.”

To have any chance of understanding Hegel one must first come to terms with the principle of the dialectic method. This is a type of argument or discussion between two or more opposing viewpoints whereupon the outcome or truth can be distilled. As the mechanism for this process Hegel proposed variations on the three “classical laws of thought” – that is, the law of identity (essentially “truths” that are taken to be self-evident), and the laws of [non]contradiction and the law of the excluded middle. Paraphrasing these last two suggests respectively that contradictory statements cannot both be true but that either proposition must be true. This is the kind of difficulty that any student of philosophy will be faced with.

Hegelian dialectics is based upon four concepts:

. Everything is transient and finite, existing in the medium of time.

. Everything is composed of contradictions (opposing forces).

. Gradual changes lead to crisis or turning points when one force overcomes its opposing force (quantitative change leads to qualitative change).

. Change is helical (spiral), not circular.

In summary, Hegel believed that when our minds become fully conscious, awakened, or enlightened, we will have a perfect understanding of reality. In short, our thoughts about reality, and reality itself, will be the same. He argues this by showing that the mind goes through an evolution on its way to what he calls “absolute spirit”.

Because Hegel’s philosophy requires a journey it can be seen that it is the process and not just the result that is important. A struggle exists between one viewpoint (or thesis) to which there might exist one or more opposing viewpoints (or antithesis). A process of debate or connected dispute such as revolution or war might lead to a higher level of understanding (or synthesis) to which another antithesis might emerge and thus the process towards truth will continue. This is a Hegelian description of all history as an inevitable progression towards truth. It is complex and a difficult area of study.

Hegel’s mark on history has been profound, in that his influence has spread throughout both left- and right-wing political thought. Marx drew influence from Hegel by developing the idea that history and reality should be viewed dialectically and that the process of change – the struggle – should be seen as a transition from the fragmentary towards the complete. Yet, this is a skewed development of what Hegel tried to suggest in Phenomenology. However, in practical terms it is likely that Hegel may have approved of Marx’s revolutionary interpretation, as he was witness at close hand to revolutionary Europe towards the end of the eighteenth century.

. Hegel on Reason and Experience

“Truth in philosophy means that concept and external reality correspond.

Genuine tragedies in the world are not conflicts between right and wrong. They are conflicts between two rights.”

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Government, Policing, Scotland, Society

View of policing is ‘old-fashioned’

POLICE SCOTLAND

A POLICE watchdog has said the idea that policing is solely about law enforcement is “old-fashioned”.

HM Chief Inspector of Constabulary in Scotland Gill Imery said maintaining the view that the job of police officers was confined to catching criminals was a “stunted” belief.

She has spoken out amid concern over the expanding range of duties officers have beyond enforcing the law, such as administering naloxone to save overdosing drug addicts.

However, the comments come following an explosion in rape cases and an increase in violent offending, with prosecutors admitting there is “absolutely no sign” of a sustained fall in serious crime.

Speaking at a recent meeting of the Scottish Police Authority (SPA), Mrs Imery said: “It’s an old-fashioned and a stunted view of policing to think that it is limited to law enforcement.

“Police Scotland have done a huge amount to demonstrate a much wider responsibility of policing – a much wider desire to impact in a positive way on people’s life chances and life choices.”

Backing the use of naloxone by officers to treat overdosing addicts, Mrs Imery said: “I think it is hugely positive on the part of Police Scotland to take that step to prevent harm and ultimately loss of life, which I think is absolutely integral to the purpose of police constables.”

In July it emerged that police administered an anti-overdose treatment to one person a week on average during the first three months of carrying the therapy. Officers in Falkirk, Dundee and Glasgow East had been equipped with naloxone since March 1 as part of a six-month pilot project.

The move came amid a rise in drug deaths to record levels, with Scotland having the worst drug-related facilities in the EU.

Police Scotland said earlier this year that drug related crime is to be considered a public health problem as the force vowed to “drive national improvements in health and wellbeing”.

It announced a partnership with government health quango Public Health Scotland (PHS) in a bid to prevent offending by working with the NHS and others to tackle poor health, “health inequality” and other issues.

Police in Scotland are also keen to adopt a “trauma-informed” approach – taking into account the welfare of suspects and criminals.

Some police officers have criticised this approach, with one officer saying the “hypothesis that reducing trauma prevents crime isn’t backed up by credible evidence” – and condemned the strategy as “motherhood and apple pie”.

Last month, figures showed the number of rapes reported to police had risen by nearly 35 per cent in a year, as sex crime soared to the highest level for six years.

Violent offending overall shot up by nearly 13 per cent in the past year, according to Police Scotland.

Prosecutors have admitted there is “absolutely no sign” of a sustained fall in serious crime. The Scottish Government claims Scotland is becoming safer.

David Hamilton, chairman of the Scottish Police Federation, representing rank and file officers, said: “I don’t think anyone disagrees with Gill Imery that policing is and should be about more than just law enforcement, but it remains our primary function.

“As the service of last resort, we are increasingly having to pick up where others have failed, and the danger is that we commit or overstretch ourselves filling those gaps.

“Officers are concerned that we are already having to fulfil additional roles such as educators, paramedics, social workers and mental health nurses.”

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. Half of police officers in Scotland want to be issued with a firearm whilst on duty

MORE than half of Scotland’s police officers want to be issued with a handgun as part of their safety equipment, a survey has indicated.

In the past three months, 22 per cent of officers have been the victim of assault while on duty, prompting calls for extra measures to ensure their protection.

A survey carried out by the Scottish Police Federation has found that 53 per cent of Police Scotland rank and file would like access to a handgun.

A further 7 per cent of officers said they would like to be trained to use the weapon in case it was necessary.

Of the nearly 1,700 questioned, 47 per cent said they did not want to carry handguns and 37 per cent indicated they would not like to be trained in their use.

However, 84 per cent said they would be happy to carry Tasers.

Scottish Police Federation chairman David Hamilton said: “This demonstrates not just the frequency of attacks but the gravity of them, too.

“Officers consider knives to be the greatest risk to them and firearms are the appropriate last defence to being attacked by such lethal weapons.”

A spokesperson for Gun Control Network said that unless there was a change in (policing) culture society would become too much like America where guns are drawn for any reason – and that is not the way policing has been conducted in the UK. Insisting that it certainly wouldn’t protect the public any more, the Network says that the implications are much wider than what it means to an individual officer on duty.

In 2018, the Police Investigations and Review Commissioner (Pirc) condemned an action by Police Scotland which saw officers point guns at 11 people during an “unwarranted” operation.

The force later apologised to eight people – including two women who were strip-searched. In 2016, shoppers in Dingwall, Ross-shire, spoke of their shock when they saw four officers armed with handguns sitting down to breakfast in a café.

The force’s Assistant Chief Constable Mark Williams said: “There are no plans to move away from being an unarmed service which has an armed capability.

“Being assaulted should never be part of the job and tackling the concerning trend of increasing assaults on officers and staff is a priority. The Chief Constable has underlined his commitment to achieving this goal by providing people with the tools they need to do their jobs.

“Recently, we have improved our infrastructure to support an enhanced roll-out of Taser and work is under way to uplift the number of Taser-trained officers by 1,500 over the next three years.”

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