DR MAX PEMBERTON: How to fix the NHS? Sackmakers and take an axe to managers

By Liam On Jul 29, 2024

Dear Wes Streeting,

Last week, you wrote in the pages of this newspaper about the crisis that was ravaging the NHS. You repeated what you said on the day you were appointed Health Secretary — that the NHS was “broken”. “Sunlight is the best disinfectant,” you wrote, and asked frontline staff and patients to diagnose problems so that you could “write the right prescription”.

Well I have worked full time in the NHS for over 20 years and I can certainly show you the ropes I am truly appalled by the state of the health service.

The biggest thing is that people are afraid — of getting sick, of going to the ER, of having to go to the doctor, of having to have surgery. They’re afraid because they’re afraid that they’re not going to get the treatment that they need, when they need it.

There is a huge will among staff to turn this around, but you will need to make some very bold decisions. In the long term, we may need to fundamentally change the NHS – how it works and how it is funded. In the meantime, here is what needs attention now!

Health Secretary Wes Streeting wrote in the Daily Mail last week about the crisis plaguing the NHS

More beds to solve the crisis in the corridor

In recent years we have tried to save money by reducing the number of hospital beds and moving services into the community. It doesn’t work. The UK now has shockingly low numbers of beds: 2.43 per 1,000 population versus 5.73 in France and 7.82 in Germany.

Don’t listen to the management consultants who tell you this is the answer. You said you wanted to know if patients were being “left unattended and unsafe on gurneys in corridors for hours”. Just go to any ED anywhere and see for yourself. It’s happening now.

Abolish university fees

There simply aren’t enough frontline staff. We need to encourage the best to train and retain them when they graduate. Abolish tuition fees for nursing and medical students and reintroduce full scholarships. In return, they must commit to working in the NHS for a minimum of, say, seven years.

This will help restore the sense of loyalty and duty that is present in my generation of physicians (who did not pay fees and received grants), but is often lacking in the younger generation (who did). Resist the temptation to plug holes with physician associates — it takes years to train a physician for a reason, and I worry about patient safety as PAs bear the brunt.

Take an axe to management

There are many layers of management that do little for patient care and we doctors spend far too much time filling out useless forms for them.

A consultant friend of mine says that the hour and a half of NHS paperwork following a patient assessment takes just 20 minutes in the private sector. When he works privately, all he has to do is write a letter to the patient’s GP.

It is interesting that if time is money, all of these forms become obsolete and redundant.

You have to cut whole layers. There is no excuse for managers only managing managers. Those who survive should spend the equivalent of one day a week on the frontline. This is already happening in some trusts – where I work, for example, the medical director spends one day a week in dementia care, assessing patients. It should be mandatory across the NHS.

Make waiting lists your top priority

These are out of control. There is no magic answer — but increasing beds, staffing levels and efficiency will all help. Use the private sector in the short term, but be careful about relying on it in the long term, because it will drive up costs.

Exterminate sloths

There are matrons again, but we need them in the wards to improve care, not in the management offices where they spend too much time.

It should be much easier to fire staff who don’t try or don’t care. And we need ironclad protections for whistleblowers.

In some areas, there has been a real deterioration in attitudes and productivity since the pandemic, with some staff becoming accustomed to less work. It’s a painful truth to acknowledge, especially when so many are working themselves to death, but we need to weed out the slackers.

Stricter A&E targets

It is often pandemonium in the ED. Various policies have attempted to improve this and the ‘four hour rule’, which states that 95 percent of patients should be seen and treated within four hours, certainly focuses attention on the issue.

I think it is more than fair to ensure that from the moment someone reports to reception, they do not have to wait longer than an hour before they are seen. And if someone needs more complex care, they are admitted or referred within those four hours.

Place other specialists in general practices

GPs are the scapegoats – everyone blames them for the problems in the NHS, but most of them work very hard. Is it any wonder so many are quitting?

Yes, sometimes it is almost impossible to get an appointment. We need to encourage more young doctors to choose primary care as a career and we need to think creatively about how to retain them.

In my opinion, psychiatrists have been placed in GP practices to see patients with mental health problems and to provide support for less acute psychological diagnoses. It is a brilliant idea and means fewer referrals to secondary mental health care. Surely something like this could be implemented nationwide — and with other disciplines?

These suggestions are just a start, Wes. I’m sure there will be readers who can tell you their own stories, and many who will have clever and clever solutions.

I trained as a doctor because I wanted to work in the NHS. I am devastated to see it come to its knees. Please do your best. We may not agree on everything politically but I wish you success from the bottom of my heart.

Maximum

Pit Celebs Against the Pros

The Strictly saga reaches a climax today with the announcement of the BBC’s verdict on the feud between professional dancer Giovanni Pernice and actress Amanda Abbington. Whatever it finds, the mental health of both has suffered and the Corporation urgently needs to protect future contestants.

Perhaps the problem lies in the culture clash at the heart of the show. Professional dancers require very different personality traits than celebrities. Discipline is everything. Dedication to their craft consumes their lives. The professional dancers I know tolerate training and a lifestyle that few could sustain. To some, it may even feel sadistic, but to the dancers, it’s a means to an end—a necessary sacrifice for their art.

Celebrities are motivated by different things: admiration, adoration, being in the spotlight.

I wonder how many people understand the difference before they sign up for the show. And whether the BBC prepares them for it.

The BBC’s verdict on the feud between professional dancer Giovanni Pernice and actress Amanda Abbington is announced today

One in ten people have problems with continence. But how often do you hear someone talk about it?

Now the estimated eight million Britons living with overactive bladder (a cause of incontinence) could have a new lease on life after authorities approved the drug vibegron.

We should no longer be ashamed of this problem and seek treatment.

Dr. Max prescribes… Blood donation

The NHS has issued a warning saying that there are only a few days of blood left after the recent cyber attack which led to thousands of operations being postponed. The supply of O negative is at 1.6 days, while for all blood types it is 4.3 days.

People with O-negative and O-positive blood – the most common types – are encouraged to donate.