Yousaf: ‘No more money’ for NHS pay deals as strikes loom



HEALTH Secretary Humza Yousaf has insisted that he has no more cash to increase NHS pay deals in the face of a looming wave of industrial action this winter.

Mr Yousaf said that written requests for extra funds made to the UK Government by himself and his Welsh counterpart had been rejected.

It comes after the GMB trade union announced on Saturday that ambulance service workers will take part in a 26-hour walkout from 6am on November 28 after voting against the Scottish Government’s latest pay offer which would have seen eligible NHS staff given a £2,205 flat rate uplift in salary, backdated to April.

The deal has already been rejected by other staff groups, including nurses, midwives and physiotherapists, with trade unions describing the offer as “divisive” and saying that it fell short of the above inflation payments being sought.

READ MORE: Yousaf accused of ‘failing to act’ on ‘dangerous’ ambulance service cuts 

In some cases, better remunerated professionals would have been worse off on the £2,205 flat rate than they would have been from the Government’s initial five per cent offer set out in the summer.

Speaking on the BBC’s Sunday Show, Mr Yousaf said the trade unions’ demands were “not unreasonable” but stressed that the Scottish Government “[doesn’t] have more money for pay deals”.

He said he was “disappointed” ambulance workers had voted for industrial action, and remained “committed to ongoing discussions” to avoid strikes.

He added: “I don’t for a minute think that strikes are inevitable.

“We will be getting back round the table, not just with the [Royal College of Nursing], but with the other health trade unions.

“I believe trade unions also think that a strike is not inevitable. We will have to negotiate.

“We can look at the redistribution of that £480 million but the UK government have got a moral obligation to give us more money.”

In a joint letter to UK Health Secretary Steve Barclay ahead of the autumn statement, Mr Yousaf and Eluned Morgan – the Welsh Government’s health secretary – made a plea for increased funding for the NHS and devolved governments “primarily to pay our hard-working NHS staff a fair pay rise in the face of the cost-of-living crisis this winter, and avoid what could be catastrophic industrial action in the NHS”.

A UK Government spokesman said it was already investing “record amounts in health and social care”, adding: “We are hugely grateful for the hard work of NHS staff, including nurses, and that’s why we accepted the recommendations of the independent NHS Pay Review Body in full and have given over one million NHS workers in England a pay rise of at least £1,400 this year.

“This is on top of a 3% pay increase last year when public sector pay was frozen and wider Government support with the cost of living.”

If the GMB’s industrial action goes ahead, it will be the ambulance service’s first strike in decades.

Unite, which also represents SAS workers, has already announced its members will work to rule from November 25.

GMB Scotland organiser Karen Leonard said: “Staff in the Scottish Ambulance Service have worked throughout the depths of the pandemic on the frontline of our public services, all the while dealing with an understaffing crisis and now a cost-of-living crisis this winter.

“These strikes are a direct response to the Scottish Government who have failed to give key, frontline workers the pay rise that they deserve and who have overseen years of managed decline in the health services that so many rely on.

“Staff are rightly angry with how they’re being treated.

“They have been overlooked, overworked, undervalued and underpaid.

“The workforce is being expected to fill more and more gaps in service provision.”

READ MORE: Trade unions hit back at ‘insulting’ 7 per cent pay deal 

She said the current pay offer was well below inflation.

Last week, members of the Royal College of Nursing (RCN) voted to strike for the first time in its 106-year history, with walkouts expected to take place before Christmas.

Scottish Labour said ministers should now consider sending in the Army to keep ambulance services running if the strike goes ahead.

The party’s health spokeswoman Jackie Baillie said: “No one wants these strikes, but I understand that workers have been left with no other option.

“The problems that have been building for years are now at crisis point, but Humza Yousaf is just not listening.

“It’s not too late for the SNP to prevent these strikes by getting round the negotiating table and delivering a fair pay deal.

“We need to start contingency planning now to avoid disaster, and the SNP must consider calling in the Army – but that is no substitute for trained paramedics, who need to be properly valued and fairly paid.”

Dr Sandesh Gulhane, from the Scottish Conservatives, said it was “disgraceful” that things have been allowed to get to this point.

He said: “The Health Secretary has already shamefully lost the trust of our nurses, now ambulance workers feel they have no choice but to strike too.

“Our hard-working NHS staff have been pushed to the brink by years of SNP mismanagement, which has led to some of the worst working conditions in living memory.

“The SNP Government must now urgently work to avert these dangerous strikes and set out contingency plans in order to protect lives, if they fail to do so.”





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Movember: What men need to know about their family health history



To mark Movember and Men’s Health Awareness Month, experts tell Lisa Salmon what men need to know about their relatives’ health history.

Knowledge is power, particularly when it comes to something as important as your health.

And to encourage men to be more proactive about their health, the Movember charity (uk.movember.com) is urging them to learn as much as possible about their family health history.

“We know that for many men, taking care of their health isn’t high on their list of priorities – at least until they get older, or a problem becomes impossible to ignore,” suggests Anne-Cecile Berthier, Movember’s UK director.

“But you can increase your chances of living longer by dealing with any health problems quickly. Major illnesses can run in families, which is why it’s vital to find out as much as you can about your own family history. Find out if your parents, grandparents, aunts or uncles suffered from any serious illness, especially if they died prematurely, and share that information with your GP.”

Alan White, emeritus professor of men’s health at Leeds Beckett University and patron of the Men’s Health Forum (menshealthforum.org.uk), suggests men often don’t have the same awareness of their family’s health as women. “They’re not involved in the health chat as often as women are, so they perhaps miss out on what’s been going on within the family and what illnesses people have had or died from,” he says.

“Family history, although it doesn’t guarantee they’re going to get a disease, could increase their risk. They need to be aware of it, so they can increase their surveillamce of certain diseases, perhaps modify certain risk factors, and inform their GP or other medical professionals, so they’re aware of the potential increased risk too.”

Certain health conditions can run in families – these are some of the ones men need to know about…

Cardiovascular disease

White says if a family member developed cardiovascular disease (CV) before they were 50, it increases the risk it’s hereditary, and therefore the risk that another family member may develop it.

“You can say to yourself, ‘If they’ve had it early, do I need to keep a more careful eye on my health, and tell my doctor my father had a heart attack when he was quite young?'” White says.

Testicular cancer

According to Cancer Research UK (cancerresearchuk.org), the risk of having testicular cancer is around four to five times higher in men whose father was diagnosed with the disease, and the risk is eight to nine times higher in men with a brother diagnosed with the disease.

“It’s important you keep an eye out for cancer histories within families,” advises White. “Testicular cancer isn’t very common, but if you know your father or brother’s had it, it’s wise for you to be aware that you may be at increased risk.

“Early diagnosis is important, and while there are all sorts of things that might cause testicular difficulties, the only way of ruling them out is by having a check with a GP.”

He acknowledges some men will be embarrassed about asking a doctor to examine their testicles, but stresses: “Embarrassment kills. Doctors have seen it all, their job is to diagnose and treat. If something doesn’t feel right, get it checked out.”

Berthier explains that testicular cancer is the most common cancer in young men – although survival rates are high if caught and treated early. “It’s also one of the few cancers you can check yourself for,” she says. “The best way is to get into the habit of doing a self-examination in the shower every month or so.”

Prostate cancer

Prostate cancer – the most common cancer in UK males – can run in families, according to Berthier. She says early detection is key to successful treatment, although there are often no symptoms until the disease is advanced.

“Your risk of developing prostate cancer increases with age, but another major risk factor is your family history,” she explains. “Someone who has a brother or father with prostate cancer is two-and-a-half times more likely to get it than a man with no family history of the disease.”

She says men who are 45 or over and have a brother or father with prostate cancer should talk to their GP about their prostate risk, and whether they might need a PSA (prostate-specific antigen) blood test.

White adds: “If you have a close relative who’s been diagnosed with prostate cancer, it’s about keeping an eye on yourself and not dismissing changes. The problem comes when it’s left too late – family history is like an early warning sign to show you might be at increased risk.”

Colorectal cancer

Bowel Cancer UK (bowelcanceruk.org.uk) says the risk of developing bowel (colorectal) cancer may be higher if you have a family history of the disease.

If you have a relative who’s been diagnosed with colorectal cancer, White recommends thinking about your diet – eating more fruit and fibre – and reducing smoking and drinking alcohol. “These are all things that can definitely decrease your risk of colorectal cancer,” he says.

“People who have cancer in the family may be started on screening earlier, to rule out having some predisposition to it. A lot of cancer is about genes going wrong, and you inherit your genes.”

Mental health problems

“There are links between family history and developing most of the main mental health problems, such as schizophrenia, psychosis, depression and anxiety-related disorders yourself,” suggests White.

Type 2 diabetes

According to Diabetes UK (diabetes.org.uk), you’re two to six times more likely to get type 2 diabetes if a parent, brother, sister or child has it.

“Diabetes has a potentially inherited aspect to it, which can be moderated by lifestyle changes,” explains White. “If you’ve got relatives who have diabetes, it’s important to know about it.”

Osteoporosis

Although osteoporosis, or thinning of the bones, is often seen as a woman’s problem, White says a lot of men suffer from it too.

“If there’s a history of osteoporosis in the family, men should be aware of it, so if they have a fracture they know it may well be as a result of bone thinning from an inherited tendency,” he says.





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Health: RSV, what parents need to know about the common virus



Cases of respiratory illness RSV are rising. Lisa Salmon speaks to experts about how to spot the virus.

Comedian Amy Schumer has revealed her young son was been rushed to hospital after suffering from the respiratory illness RSV (respiratory syncytial virus).

The common childhood infection usually only causes mild cold-like symptoms in young children, but around three in every 100 will have symptoms severe enough to need hospital treatment – like Schumer’s three-year-old son Gene.

Schumer wrote on Instagram: “This was the hardest week of my life. I missed Thursday rehearsals [for Saturday Night Live] when my son was rushed to ER and admitted for RSV. Shout out to all the parents going though this right now.” Now, Schumer says Gene is “home and better”.

“Respiratory syncytial virus (RSV) is a common virus that most commonly affects babies and children under two,” explains Erika Radford, head of health advice at Asthma + Lung UK (A+LUK asthmaandlung.org.uk).

“The latest data shows that there has been a steady rise of RSV cases in recent weeks, with an increase in the number of children under five being admitted to hospital. There has also been steep increase in hospitalisation rates in children under one with bronchiolitis, a viral chest infection which is most commonly caused by RSV.”

Dr Conall Watson, consultant epidemiologist for the UK Health Security Agency (UKHSA), suggests this rise in hospital admissions is “in line with what we typically see at this time of year”, he says. “For children under two, RSV can be severe – particularly for babies and those born prematurely.”

So what are the signs of RSV, and how can you tell if it’s causing serious illness in your child?

Symptoms of RSV

“RSV it is a common virus, and most of the time the symptoms are very mild and can be managed at home,” says Radford.

“Like most other colds and viruses, RSV starts with a blocked or runny nose and can progress to cause a cough, fever and sometimes breathing difficulties. The good news is that for most children it will clear in a few days and children can be looked after at home.

“However, some children do develop more severe symptoms. RSV can sometimes lead to bronchiolitis, an infection of the smaller airways in the lungs. Warning signs to look out for in your children include if they are finding it difficult to feed or eat, they are breathing more quickly, they have noisy breathing (wheezing), or seem very tired.”

Watson stresses: “If you’re worried your infant has cold symptoms with any unusual breathing or difficulty feeding, please contact 111 or your GP. If your child seems seriously unwell, trust your judgement and get emergency care.”

Who gets RSV?

The virus is most common in young children – the UKHSA suggests over 80% of children will have had the virus by their second birthday – but as they get older, children usually develop more immunity to it.

A+LUK says babies under six months old are more likely to develop more severe RSV symptoms, and babies born prematurely, or those with long-term lung conditions, are also at increased risk of developing a serious illness from RSV.

How to prevent RSV

Just like other viruses – including Covid – RSV is spread through coughing and sneezing.

Watson says: “With RSV rising, actions like using tissues and handwashing can reduce spread to the most vulnerable. If you’re ill, do not visit babies.”





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Humza Yousaf demands more money for NHS pay to prevent strike action



SCOTLAND’s health secretary is demanding the UK Government provide extra funding for NHS pay to stop “catastrophic” strike action by nurses this winter.

Humza Yousaf, along with the Welsh health minister Eluned Morgan have written a joint letter to health secretary Steve Barclay ahead of the autumn statement by Chancellor Jeremy Hunt on Thursday.

The move comes days after members of the Royal College of Nursing voted in favour of strike action for the first time in the 106-year history of the union in protest over pay and staffing levels. There are currently some 6000 nursing and midwifery posts unfilled in Scotland.

Mr Yousaf said the planned strike would be “catastrophic” for the NHS in Scotland but that he does not have funds for the pay rise the RCN is demanding.

The RCN says real-terms pay is 16 per cent lower than a decade ago. It wants a rise of 5 per cent above the retail price index level of inflation, which stands at 12.6 per cent.

But Mr Yousaf has said he had mustered all of his resources to offer an average 7 per cent rise to nurses, rising to 11 per cent for the lowest paid.

“We wanted to write to you in advance of the Chancellor’s Autumn Statement on 17 November to once again make the case for additional funding for our hardworking NHS staff,” said the letter by Mr Yousaf and Ms Morgan.

“The Royal College of Nursing have announced a sweeping legal mandate for industrial action across the UK. In Scotland, they have joined several other unions representing NHS staff in gaining a legal mandate for industrial action with ballots expected to confirm a mandate in the rest of the UK.

“The risk to the NHS of industrial action this winter is profound, and we all need to do all we can to avert industrial action in any form. The NHS across the UK continues to feel the effects of the pandemic as it recovers and remobilises, and any action is likely to have catastrophic effects in all parts of the UK. “

Their letter added that anger among NHS staff amid the cost of living crisis  “is entirely understandable” and blamed former Prime Minister Liz Truss’s mini budget for high interest rates and the spike in inflation, currently around 12 per cent.

They went onto urge the Chancellor not to reimpose a policy of austerity through extensive spending cuts saying such a move would be “a disaster for our public services, including the NHS, at a time when they need more investment, not less”.

Meanwhile, the Scottish Conservatives accused Mr Yousaf of presiding over ‘500 days of failure’, as they repeated calls for his resignation. 

The party said that since the Health Secretary took office in May 2021, a new record low for the percentage of A&E patients waiting more than four hours has been set 14 times.

A further analysis by the party shows that – on the three different measures used (4, 8 and 12 hour) – record-worst A&E waiting-time statistics have been set 68 times. 

The Scottish Government’s own target for A&E waits is for 95 per cent of patients to be seen within four hours, yet for the last five weeks less than 95 per cent of emergency patients have been seen within 12 hours.

The Tories also pointed to:

• Cancer waiting times – which fell to their worst levels earlier this year, with one in four patients waiting more than 62 days for treatment after an urgent referral. 

• Delayed discharge – which hit the highest level on record last month, with an average of 1,832 beds occupied each day due to delayed discharges.

• NHS backlogs – almost 600,000 patients were waiting for NHS treatment according to the latest figures, the highest number since statistics were recorded in their current form.

 “Humza Yousaf’s stint as Health Secretary has been record-breaking for all the wrong reasons,” said Scottish Conservative Shadow Health Secretary Dr Sandesh Gulhane.

“Cancer treatment waits are reaching dangerous levels, delayed discharge is getting worse and backlogs are spiralling out of control. 

“A&E waiting times alone have broken new records almost once a week on average since he came to office.”

He added: “Humza Yousaf has presided over 500 days of failure – and now he has lost the trust of frontline staff as Scotland’s nurses have voted to go on strike for the first time ever….If the Health Secretary won’t do the decent thing and resign, it’s time for him to be sacked.”

Speaking at First Minister’s Questions on Thursday, Deputy First Minister John Swinney said a demand by Scottish Conservative leader Douglas Ross for Mr Yousaf to be sacked was “laughable”.





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Voters are to blame for crisis in NHS


Edinburgh GP Dr Gavin Francis is beloved around the world for his books which unravel what it means to be human. However, he’s got some harsh truths when it comes to what’s gone wrong with our health service, and why. He talks to our Writer at Large Neil Mackay


FAME is a strange concept these days, rendered trashy and meaningless by the celebrity machine of reality TV and the reputation-devouring lure of social media, where the rich and powerful go to swap acclaim for notoriety and kill their legacy for a few clicks.

Some, though, still carry fame with dignity – like Dr Gavin Francis, the internationally acclaimed bestselling author. Despite his accolades, every week you’ll find him at his GP surgery in Edinburgh, treating patients from morning to night.

Francis is part of a long line of doctors who’ve balanced stethoscope with pen and took up the literary life while still a medic: from Scotland’s Sir Arthur Conan Doyle to Oliver Sacks, who wrote Awakenings.

Francis’s works include Adventures in Human Being which won the Saltire Award; Intensive Care: A GP, A Community and Covid-19; Shapeshifters: A Journey Through the Changing Human Body; and this year’s bestseller Recovery: The Lost Art of Convalescence. Although these books explore the human condition through the eyes of a doctor, Francis is equally admired for his adventure and travelling writing – works like True North: Travels in Artic Europe; Island Dreams; and Empire Antartica. A doctor for 23 years, he’s a fellow of both the Royal College of Physicians and the Royal College of GPs. His books have been translated into 18 languages.

He’ll surely hate the notion, but Francis is probably the most famous doctor in Scotland, if not Britain. In person, there’s no hint of fame, though. He’s thoughtful, considered, quietly spoken – the quintessential community doctor, not a literary celebrity. Though he does bear a slightly unsettling similarity to Ewan McGregor, both in looks and accent.

However, his renown gives him clout. His words matter – and today, Francis has some rather challenging points to make about the state of the NHS in Scotland and the rest of Britain.

Crisis

The NHS is in “crisis” and urgent life-threatening procedures could soon be in jeopardy, he warns. Francis fears for the future of the NHS. But he doesn’t simply blame politicians in Edinburgh and London. As you’d expect with a medic, he’s ruthless with facts – he gives bad news honestly so the patient can make the most informed choice about their future.

So here’s the bad news: we’re to blame for the state of the NHS, the great British, and Scottish, public. We elected the politicians who made this mess – and we keep electing them. Like the best medicine, it doesn’t taste good, but it’s necessary.

The illness that besets the NHS is “chronic under-funding”. Discussing mental health, as an example, he says the NHS must “concentrate on the severe end of the scale – people who need sectioned, are suicidal, dangerously psychotic. There’s not enough slack in the system, not enough resource to deal with everything.”

The NHS needs more money. That means taxation. “There doesn’t seem to be any political party on offer suggesting to people that we find more money from the national budget … Parties that say, ‘right, we’re going to have to charge you all more money and we’ll get better health services’ – they don’t get voted in.”

Although “frustrated”, Francis says: “I also have to accept that we live in a democracy, and this is the level [of services] voters want, because they’d vote to pay more if they wanted a better NHS, but they don’t seem to want to vote for a better NHS.

“I’d rather people pay a large proportion of the national budget towards healthcare but my view isn’t widely shared because we’re seeing general NHS funding drop off. We certainly haven’t keep pace with our European neighbours. So this is very deliberate underfunding by our political masters – north and south of the border.”

Anger

Overworked and overstressed GPs are quitting as “that’s what happens when you pressurise the system”. Waiting times mean “people can’t access what they know they need and they get angry and take it out on the person closest to them who’s often the GP or district nurse”. Phone consultations, which have become normalised, aren’t what’s best for patients.

Compared to the late 1990s, the change in the NHS is striking. “There was massive funding put in,” he says, which drastically reduced waiting lists. “There was a feeling of optimism, that society wanted to back [the NHS], that we’d adequately fund the NHS – but that’s just fallen away. I don’t get the sense at all that there’s a willingness among our political masters to adequately fund what we need.

“We’re constantly told as clinicians to work smarter, more efficiently – to do more with less. We’re all working as hard and efficiently as we can.” In Francis’s experience, waiting lists for dermatology, vascular surgery, ear nose and throat and a “whole load of specialities are absolutely enormous.” For routine specialist appointments for non-life-threatening conditions, “it’s not unusual to wait a couple of years. Ten years ago, that was unthinkable.”

Overwhelmed

The state of the NHS means GPs know some patients “need the expertise of specialists but are unable to access that because waiting lists are so long”. Some colleagues are “overwhelmed by demand”. An ageing population means demand “is going up but provision and resource isn’t”.

He refers to “mendacious” Brexiteer claims of £350m going from the EU to the NHS weekly, adding: “We’re reaching a real crunch point. I’m now worried that urgent things aren’t going to be seen in a timely manner.” Waits for ambulances are going up. “It’s getting harder to get an urgent ambulance; it’s getting harder to get a patient seen by specialists.”

Francis says he isn’t making party political points. “I just want to talk about facts. We’re not getting resourced adequately. That seems a democratic choice because politicians do focus groups. They work out what people want to vote for, and they presumably keep finding that people don’t want to pay more for their health care.

“I get people getting cross with me about waiting lists to see specialists and I say, ‘well, you can write to your MSP. We live in a democracy. You’ve got lots of options to make your voice known about how unhappy you are with this state of affairs. I’d urge you to take those up, and I’ll do the best I can for you in the system I work within’. So I can only presume this is either the NHS people want, or our democracy doesn’t work – because it can’t be both.”

Honesty

Francis adds: “It feels like we’re at a real low at the moment. It felt like this towards the end of the Major government – we were getting to a real low and things needed to reverse and there was a sense, certainly within the NHS in the late nineties and early noughties, that things were reversing and the NHS was being adequately prioritised. That sense is certainly gone.”

He doesn’t “have an opinion one way or another” if the Conservative or SNP government handles the NHS crisis better or worse, but adds: “If the people of Scotland had a radically different opinion of how much they value the NHS then I hope they’ll make that known to their political masters. But my experience at the frontline of the health service is that there isn’t enough resource to meet demand. And I don’t know how we get around that.”

HeraldScotland: Dr Gavin Francis says the public must be honest with what they want from the NHS and what it will actually take to deliverDr Gavin Francis says the public must be honest with what they want from the NHS and what it will actually take to deliver (Image: Colin Mearns)

Francis suggests we need an “honest” national conversation where the public is told “there’s just not enough resources to have the kind of NHS you believe you’re entitled to, and so we’re going to cut these things … cut certain kinds of elective surgeries”. The alternative is “finding a way of putting it to people that you’re going to have to pay a bit more somehow”.

Given that the public constantly talks of its “love” for the NHS, Francis says: “I’d like to see that love recognised and spoken about with more direct honesty. At the moment, the message seems to be that it’s all going fine, and if we just worked a bit more efficiently it’ll be hunky dory … That’s not true. We’re already working very hard, very efficiently.”

Austerity

Discussing the effects of Conservative austerity policies on health, he says: “Society makes its priorities and chooses where to spend its money.” Does austerity kill people? “Of course it affects health. Everybody knows that increasing poverty increases ill health. Everybody also knows that’s what the Tory Party are happy with. They’re happy with wider inequalities because they see that as the path to creating greater wealth in society … so that’s the choice society has made.” The “lever” to change that is “the ballot box”.

Francis refers to the well known professor of public health Michael Marmot who carried out a “famous study of Whitehall civil servants”. It overturned the assumption “that those at the top had very stressful lives and that justified their pay packet. [Marmot] showed that actually the lower you are in the hierarchy, the more stressful your life is, and the younger you die. The people at the top have the easiest time.”

Marmot, Francis notes, also had a famous encounter with a group of American doctors. America, Francis says, “has one of the most expensive healthcare systems in the world, they spend well over triple what we spend, yet they’ve the worst outcomes in the developed world. In terms of infant mortality, maternal mortality, big public health crises, we think we’ve got it bad here – they’ve got it terrible”.

Marmot addressed an American doctors’ conference and, says Francis, told them “you live in a democracy. This must be the level of infant mortality you want because if you believed it was really important to save the lives of children you’d have different health policies”. Francis adds: “The science is there, if you want better outcomes, you know what to do. It’s political. So this must be the level of the NHS – the level of health inequalities – that society wants, or it would change.”

Pandemic

Evidently, though, he acknowledges prioritising healthcare means other areas – defence, education, energy, industry – suffer. Government’s job, Francis says, is to “give us the least worst society”.

Francis was on the frontline during pandemic. It was devastating, he says, in terms of the trauma of lockdown and widespread deaths, yet it also, counter-intuitively, had some “silver linings”. He’s praises cities like Edinburgh where local politicians and charities worked to house the homeless during Covid, and how red tape was slashed to develop vaccines. Now, when politicians say social ills can’t be tackled, the public can reply “hang on” and point to what happened during pandemic. Remember when we were all told there was no “magic money tree” by the Conservative government, he notes. “Lo and behold, Covid came along and so did the magic money tree.”

The fact that homeless people are now back queuing at soup kitchens simply reveals that “people are showing they’ve got different priorities again. What I’m saying is the silver lining is that we now know it can be done. Nobody can say ‘we can’t solve problems’. Because actually, we did.”

Lockdown

The impact of lockdown on the young was catastrophic, Francis says. Their lives were suspended – at the most crucial point in their development – as society told them “you’ve got to stay home. If you don’t you’re a danger and putting everyone at risk, you’ll kill granny”. This happened, he notes, even though “the proportion of people under 20 who got ill was absolutely minuscule”.

He’s not saying there shouldn’t have been lockdowns. “If we didn’t have lockdowns, we’d have needed hospices beside hospital carparks … there’d have been a much higher death rate,” Francis explains. Rather what he’s saying is that we should now prioritise the young to repay what they did for society. “[The young] paid a very high price to ensure the safety of their elders … Those lockdowns had terrible consequences.” We need to “thank that generation for the sacrifices they made.”

During lockdown, his mental health caseload rose from a third of his appointments to two-thirds. Surprisingly, he saw few anti-vaccine conspiracists. “They make a lot of noise on social media but people almost always want the vaccine in real life. We’ve got pretty much the highest take up in the world.”

Pressure

Francis also warns against politicians ‘medicalising’ society’s woes and piling responsibility onto doctors, like recent moves around GPs “prescribing fruit and vegetables”.

“When the NHS is under such huge pressure, you have to draw the line about what health services can do.” On a home visit, one patient asked Francis to fix her boiler.

His average day is pretty relentless. With hospitals so overstretched, GPs must take on additional duties. He starts work at 8.30am with a mountain of admin. Patient appointments between 9am and noon must be just 10 minutes. “That’s often inadequate.” If appointments run over the knock-on effect can be dire. Then he’s got reams of paperwork like blood tests and hospital reports to get through, before it’s back to seeing patients until 6.30pm. He does home visits too for the frail and elderly. You also might hear him on the phone if you call NHS 24 where he mans lines. As his own working life shows, in terms of NHS staff efficiency, “the electorate are getting the most bang for their buck. In order to get more bang, they need to put in more buck”.

When it comes to “non-urgent medical presentations, the can is being kicked further and further down the line, as the NHS has to turn its resources to dealing with urgent presentations … It keeps cutting the non-urgent stuff in order to preserve its capacity to deal with the urgent stuff”.

Cutting non-urgent cases, he says, “causes all sorts of suffering and eventually leads to poor outcomes in lots of ways”. The NHS “still does manage urgent life-threatening illnesses very well … We do still have the capacity to deal with urgent life-threatening stuff but I’m worried that’s going to go. I’m worried urgent care is soon going to start to suffer if this crisis isn’t adequately addressed.”

Succumb

Francis feels the word ‘crisis’ is apt as it means “the point in an illness’s evolution at which everything hangs – either the patient recovers or succumbs”. Today, someone suffering cardiac arrest in Glasgow would get to hospital and be treated, “but I’m worried that we’re at the moment now that if things don’t improve I wouldn’t have that confidence that this time next year you’d get the ambulance … We’re at a point in the development of the NHS where I’m starting to feel that even urgent things are harder to get addressed”. Patients with non-urgent ailments that harm their quality of life, like severe eczema, sinus problems or mobility issues, are on waiting lists for years. “Myocardial infarction, stroke, road traffic accidents … if we don’t see adequate resources, those things will also start to suffer”.

Governments are “an emanation of us … it’s not a case of ‘us and them’. We keep telling them what we want them to do. We vote for them, we chose them. If we want to be a modern European country, we have to compare ourselves to modern European countries, which spend a lot more than us on health”.

Unthinkable

He doesn’t believe there’s too many managers in the NHS, however – a common refrain from politicians. The problem is money and resources. Patients are increasingly using their savings to go private due to waiting lists. “When I began studying medicine 30 years ago, that was unthinkable.”

Privatisation, he warns, is simply “bad medicine”. The central idea of the NHS was “a doctor speaking to a patient without thinking about the patient’s wallet. In order to make good decisions, you need to take money out of the consulting room. Privatised medicine leads to over-investigation and over-treatment.”

If this all sounds very dark – well, surprisingly, Francis disagrees. He’s eternally optimistic. Society has vastly improved from a century ago when “it was routinely acceptable to have Poor Houses. The trajectory is in the right direction. We’re less able to tolerate big inequalities”. We need to focus more on the positive, he says. The front page of every newspaper should, he adds, carry the headline: “Success! Humanity has done wonderful things transforming life expectancy”. Instead, the media focuses on elderly ‘bed blockers’. “We’re looking at it all the wrong way around,” he concludes.


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