Sunday, 29 November 2020

To Save the NHS from collapse we have trashed our economy, Why?

So overwhelming has the covid 19 pandemic been that Health Services have not been able to cope. It is too late to wind back the clock. In a future pandemic hopefully the UK will close its borders more quickly, and not allow foreign holidays to re-infect the country. We also need to make investments to stop infectious diseases destrying our livelihoods. This is unlikely to be a "one time" crisis. Llanelli, my local town, has less footfall and more beggars, hard times for many. The banking district of Frankfurt is a long way from Llanelli but both face a real economic threat from this crisis, and even Frankfurt has beggars on the street. This crisis is definately worse in the UK because of mismanagement of our NHS. Staffed by heroes and led by the blind.
To "save the NHS" we are enduring lock downs and serious economic damage where we can least afford it. The income of the people must suffer, the economy must take a big hit or the NHS will be “overrun” by sick people infected by Covid 19, and none of us will get decent healthcare.Many of us are already not getting good healthcare, suffering on waiting lists, unable to see clinicians and having problems with access to prescriptions and other basic services. Why can’t the NHS cope?
The Truth is that the NHS is no longer a “health service” in the round, Constant cuts by governments, both red and blue in the last decades,“reorganisations “, supposedly to” increase efficiency “have stripped services. New management structures with the emphasis on economy and the removal of most doctors and nurses from representation on the executive boards has led to a service which far from promoting health throughout our communities, simply “deals” with the sick guided more by fiscal goals than the true welfare of the population. Much of the NHS estate has been sold off for development and there has been no real planning for massive health emergencies other than a possible influenza epidemic. Now, to disguise the fact that the hospitals and GP s can’t cope, we have to prevent community viral disease by personal isolation, social distancing and reducing human to human contact. A virus parasite needs a host to live in, multiply and ideally have a chance to release the new generation before the host’s immune system wipes them out. We are reduced to similar methods as those used to control the Black Death.
The economic consequences of lock down are grave, especially in areas of Wales where hospitality and tourism are big employers. Citizens unlucky enough to develop common serious diseases now, such as cancer and heart ailments may suffer delayed diagnosis and treatment, and add to the mortality and morbidity and distress , simply because the NHS cannot give them decent and timely treatment, as covid swamps all. After the first days of Covid 19, when huge efforts were made in Wales to construct field hospitals for which there did not seem to be either staff or patients, there is no clear health policy except “keep away from other humans” until the vaccines come. WE MUST CHANGE THE NHS SO THIS DOES NOT HAPPEN AGAIN Where are the plans to rebuild general capacity and infectious disease units within the NHS? This would help to stop new diseases spreading in the future, protect staff from infection, and allow control of future outbreaks without stopping treatment for all the other illnesses and injuries.Years of asset stripping have oriduced a system which cannot cope. A vaccine may help but it is not here yet. The virus may become endemic, may mutate and be a player in many winters to come. We cannot and must not repeat the “shut everything down” when any new infection arrives. Management discarded the old isolation hospitals, closed the convalescent wards and sold off everything else we could have used for extra capacity. We have no replacement state of the art infectious diseases units. Instead we have had multiple outbreaks of Covid 19 in our own hospitals, which were never built to prevent the spread of novel airborne infections like Covid. William Beverage and Aneirin Bevan planned and set up a welfare state in the 1940’s said to be available “From the Cradle to the Grave”. It has been recently been found seriously wanting. The grand ambitions have run aground not only because of a new virus, but also because the NHS has been failed both by our own Government in Wales and across the other UK nations. It has been whittled down to the cheapest options using the least inpatient treatment. Care in the community, works well for many chronic diseases. It certainly does not work for virulent infectious diseases, in fact it can spread them efficiently to the most vulnerable . The Welsh NHS has been emasculated, whittled to the bone, and was unprepared when a pandemic struck. If you keep cutting any service , the point comes when it can’t cope. Stressed, it is no longer fit for purpose. In fact some of the health management actions in this epidemic made things much worse, decimating care homes by sending them infected cases and even in hospitals professional staff were often infected by their own colleagues and their patients, in wards never designed to house serious infectious cases. The Welsh NHS needs a change of direction and cries out for leadership. (these are trainee doctors in Iceland where they do try to train enough doctors from their own country )
We are living in a nightmare caused by those who apparently had little interest in maintaining our NHS , our first line protection from disease and infection, paid for by our taxes. Where was the oversight, who was watching out for us? Can we even trust our Welsh Government to make good the mistakes and lack of resources that brought us here? The sticking plasters are being applied, but without major changes in the NHS, and planning properly for the future, we may repeat the nightmare all over again. Air travel will one day re-start, the economy will take the hit and recover, but the threat of another similar infection will still be there. We need to learn the lessons from this. Vaccines, drugs and the new treatment paths will probably help control Covid 19. But without an NHS infrastructure to isolate and treat new diseases, or resurgent old ones, we can easily find ourselves in the same nightmare by still running an NHS system with only “Just enough” to provide the minimum standard care, with no slack at all. We need a few empty emergency wards, some extra convalescent wards, all of which which could be used routinely for other uses but re-utilised quickly at short notice. How about a Welsh infectious disease centre with the proper staff compliment, and every hospital having some isolation cubicles where patients can safely be treated but disease cannot leak out to infect other patients and staff. When we don’t have an outbreak these specialist staff could tour the country,’giving lectures, training and checking readiness. This would probably cost less than the many field hospitals and emergency morgues built in haste and never used. Managers hate empty buildings and underutilized areas , but the nature of healthcare is that the needs are always changing, and disasters happen.. Keeping a few isolated empty wards, training a couple more infectious disease specialists won’t break the bank, but may save the economy in future. Many people have died with Covid. Many others have died or are expected to die because they could not access timely medical treatment for many other diseases such as cancer. Others have suffered severe mental stress and utter despair due to the social and economic wounds of the outbreak.
Could Wales cope in the future? The lack of NHS capacity and proper planning for pandemic emergencies has made a bad situation a lot worse . As a small country we could probably have done a lot better , and hopefully in the future we will. A manageable population of around 3 million and a country which can easily share knowledge and resources and in emergencies transport and share staff and kit around.Wales has decided not to train sufficient docotrs and nurses for reasons that are officially unknown.I suspect it simply is to save money- Why train our own doctors and nurses when we cam attract health workers from other counrtries by our high salaries?The UK has the best paid doctors outside of the USA. Why bother to trin our own when other countries do it for us? We have built a Welsh Health service with artificial boundaries and barriers to sharing and co-operation , unnecessary duplication of scarce resources in some cases ,We certainly have been selling off the family silver for a pittance in a vain attempt to balance the books of individual Health Boards with little consideration of the Health of the Nation as a whole. A vaccination program will be rolled out, the virus may well be checked and case numbers drop. Victory will be announced and the problem temporarily reduced, and even perhaps a new bank holiday to celebrate, "Covid day", But the NHS itself is sick in many ways and we need to mend it before then next new infectious disease arrives. But if the lack of capacity in the Welsh NHS itself is not addressed , if our scarce resources are not husbanded , and short term financial savings allowed to trump future quality improvements, the armistice will be only temporary. Another enemy may yet appear in similar guise and once more expose the poverty of our ambitions to keep our people safe for the long term.
Dr Sian Caiach

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