16 December 2022

Not in the Best of Health

Dr Charles Godden, a recently retired Consultant Paediatrician and former Non-Executive Director of an NHS Trust, thinks the NHS is at great risk of fragmentation.

Here he suggests a raft of changes to rescue and preserve the NHS drawing on his many years in health services here and abroad.

Donna Ockenden’s March 2022 review of maternity services highlighted appalling flaws in healthcare, exposing a culture with a failure to investigate, a failure to learn, a failure to improve and a failure to safeguard mothers and babies. Three months later, in the summer of 2022, the knife was twisted further when General Sir Gordon Messenger’s independent report into health and social care leadership exposed a culture of senior management bullying and blame. This happened in the same year that over half of the advertised consultant physician posts in England and Wales went unfilled, and nurses voted, for the first time in over 100 years, on taking part in a nationwide strike.

Why has it come to this and what can be done? Both of these questions will provoke strong and differing opinions, and nobody has all the answers.

At the inception of the NHS in 1948, Health Minister Aneurin Bevan expressed three essential values: services would help everyone, would be free and care would be based upon need. In my opinion this “triad of inconsistency” is no longer achievable. Other countries, aware of this problem, manage healthcare in different ways. For example: in the US, it is of high quality but not available to all; in New Zealand, it is available to all and high quality but doesn’t cover all health demands. We, in the UK, stand alone in failing to address this impossibility. Instead, we try to keep every plate spinning, accompanied by the frequent sound of smashing crockery.

Do you believe the NHS can provide the best care possible for every condition and for everyone in our nation, free? Really? As a doctor working in the 1980s, I believed it could; but, with the advances in medicine and surgery, and an ever increasing and elderly population, combined with woeful provision of social care, I now believe this ideal is unachievable.

The NHS is trying to do everything for everyone and failing on every level. Something must change. So, to try to save the NHS, I’d suggest a 7 step plan; the 7Rs:

  1. Return
    Return community midwives, nurses, physiotherapists and health visitors to their pre-efficiency-savings roles and responsibilities; it makes sense to treat patients within the community whenever possible.
  2. Replace
    Replace chief executives who have no clinical experience with those who do. Those who deal with patients understand hospitals best. I include — not exclusively, and in alphabetical order — doctors, nurses, pharmacists, physiotherapists, porters, receptionists, secretaries — indeed anyone with hands-on experience of handling patients. Replace the current financial model of running the NHS as a business with the reality that it is a service, like education. That way it would no longer be run by accountants focused on savings, but as a service investing in the country’s future.
  3. Reduce
    Reduce protocols and legislation; you can’t cover every eventuality. Reduce litigation. It’s madness to encourage a business of sticky-fingered self-promoters, hell-bent on squeezing the life-blood out of the NHS. No-fault compensation works in Denmark, Sweden, Finland and New Zealand. Why not in the UK?
  4. Ration
    Ration healthcare; the elephant in the room. Design a cross-party, apolitical body to debate whether it is right to fund certain procedures and practices within the NHS. No longer can everything be provided for everyone free. Make a list. Be brave. Be realistic. Be open. Be honest.
  5. Reverse
    Reverse bed closures; the UK currently has approximately 2.5 beds per 1,000 of the population. France has over double, and Germany over treble that number per capita.
  6. Remove
    Remove external consultants; they aren’t worth their fees, and they undermine health care. Remove the concept of revalidation; it has been tried and proven to be a waste of valuable resources. It won’t stop another Shipman.
  7. Respect
    Respect the public and the staff; neither are stupid. They shouldn’t be at loggerheads. Respect the different needs of older clinical staff; and allow them the opportunity to come off onerous acute on-call rotas. Don’t force them into early retirement. Respect the burden of on call, with increased leave, if not higher salaries. Am I qualified to make these comments? Some may say no. But, I did work for over twenty years as an NHS consultant paediatrician in Surrey, was lead clinician for paediatrics, led the hospital’s special care baby unit and was the director of medical education for the trust for five years then, after resigning, I worked as a non-executive director in an NHS trust and as an expert medical witness for the defence. The very existence of the NHS sits on a knife-edge. It’s time to open the debate…..

The NHS is trying to do everything for anyone and failing on every level. Something must change. 

In Charles’s book, Not in the Best of Health, published by Goldcrest Books International Ltd, Charles charts his career from the irresponsible antics of medical school, through a series of patient encounters, diagnoses, bizarre operations and personal crises, to later stages when the buck stopped at his desk and when clinical teams, patients and anxious parents awaited his decisions. Interwoven through the narrative is a series of case histories, using aliases to protect patient identities, presenting the many unusual cases he encountered in his career – the teenage girl with no anus in Papua New Guinea, the Zulu farmer whose aching tooth he pulled, the baby whose lungs were clogged from a misplaced feeding tube, another baby whose head he immersed in a bucket of iced water in order to reduce her heart rate, and the mischievous boy whose stubbornness and courage proved so moving, as he lost his long battle against cystic fibrosis. 

Dr Charles Godden, Consultant Paediatrician and former Non-Executive Director of an NHS Trust

Illustration by Elliot Elam


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