‘Cleanliness inspector in every hospital’

The service has changed out of all recognition over the past five years because of a dominating centralisation by administrators and managers who have no real understanding of medical care, and no respect for the professionals who provide it.

The major point that they fail to understand is that for patients, and for healthcare professionals, in addition to the quality of care, an important factor is the quality of the experience of that care. There is a target-driven culture now, and although clinical outcomes do improve in areas such as cardiology and cancer, the improvement is less than that which would have been achieved by medical advance and breakthroughs over the same time period.

The effect on inpatient wards is to increase infection and readmission rates. Medicine is an apprenticeship; advancement for doctors in training must be as a result of assessment of competence and performance, and the direct support of those who have been doing the training. It cannot be just a ticking-the-box computer exercise.

Solutions: An independent health board to run the NHS, rather as the Bank of England has been given authority over inflation and interest rates. A recognition that advice from professionals is more important than soundbites from politicians. A return to the Royal Colleges of the responsibility for standards and career structure.

MALE MENTAL HEALTH NURSE

Problems: I left the NHS a year ago, after 21 years, surrendering after I finally realised that the NHS was dead in the water.

I trained as a registered mental health nurse in the mid1980s and have worked across mental health, general medicine and primary-care services both a as a clinician and as a manager.

The NHS was put in place during a postwar era, when people were grateful for what they got; it is expected now to deliver everything, at the highest quality – no matter what – to a population with unrealistic expectations of what a public service can do. This is its key problem.

Solutions: They are probably unpalatable. First, ration care to a set level of cost and technology, with new advances being restricted unless they demonstrate a cost saving.

Secondly, offer contracts to deliver health and social care to the best provider from any area, not just within the NHS.

Thirdly, offer core care through the NHS, with top-up through private insurance, while providing a base level of care provision for the unwaged/poor.

FEMALE NHS MANAGER

Problems: The single most serious problem affecting healthcare is the loss of trust, which has profoundly affected relationships at all levels, most obviously between staff and government.

Solutions: We should be given space to focus on patients and our jobs. For example, last week clinicians from two NHS Trusts from whom I commission services worked hard to find a placement for a man whom we, as mental health professionals, felt might be a risk to himself and to others if he was not managed quickly and effectively. They simultaneously made arrangements for a woman to be brought back to this area so that we can bring her nearer to her family. This requires a series of decisions and movement of resources. The next day we were chasing data to try to reach a government target on a new service which is unfunded, reduces our nursing staff and might not be effective. Which of these do you think will contribute to our ratings? And which should?

FEMALE NURSE

Problems: I have been a nurse for 35 years. When I started, practice nurses were a new phenomenon. We used to see 15 patients a day – now we now see more than 35. In addition, a large part of our work is the result of earlier patient discharge from hospital.

When the Government congratulates itself on the number of operations that have been carried out, it does not think of the knock-on effect on primary care: burst wounds, postoperative infections, deep vein thrombosis.

As to cleanliness, hospitals will never be clean again because contracted staff simply want to earn their wages and go home. When I started out, each ward had its own cleaning staff, who happily worked most of the day, handing out tea, unhampered by health and safety rules. They would kneel on the floor to clean bed wheels and climb on chairs to reach curtain rails. They were fiercely proud of their ward, and would tour it with Sister, while she checked that it was spotless.

Solutions: Reduce the number of managers, revert to training nurses on wards, not in the classroom, and employ a cleanliness inspector in every hospital.

MALE CONSULTAND AND PROFESSOR

Problems: I retired 11 years ago after a lifetime in the NHS. I applied to do medicine in the year of its inception and after several junior appointments was made a consultant and later a professor at a London teaching hospital.

One of the saddest comments I remember was on my last ward round when I asked two of my best and brightest pupils what they were going to do next, and they replied, “the law”. They are both now successful solicitors. There are several reasons why things have got so bad. The first is the Department of Health, which is not fit for purpose. The second is the General Medical Council, which has to toady to public opinion.

This enormously expensive and professional time-consuming exercise is recognised to be a farce, but nobody has the courage to stop it. Thirdly, the British Medical Association and Royal Colleges must have been asleep: how could they allow the catastrophe that is the Medical Training Application Service, and an IT system that no one in the profession trusts enough to sign up to?

Solutions: The DoH should be demoted to a Ministry and allowed to manage public health, which it once did very well. The more alert members of the colleges should be picked and given 18 months to work out a blueprint for the NHS.

The foundation hospital principle should be extended, with reintroduction of small boards of governors. GPs should have their autonomy restored and be allowed to refer patients to the consultant of their choice (this is no longer allowed in many regions). The GMC should be composed of members appointed by the profession and managers should show proper evidence of experience in healthcare before appointment. There you are!

FEMALE NURSE

Problems: I work in a regional ambulance control room, having worked for NHS Direct and before that as a nurse since 1970.

My main task now is to triage low-acuity callers and, after assessing a patient and deciding that he/she does not require a 999 ambulance, to direct them to a more appropriate form of care.

The main thing that has changed is a general loss of self-reliance in much of the population. People call ambulances if they have cut a finger, say, or diarrhoea, or if the baby is crying. They also call if their credit has run out on their mobile phones or they have been asked to attend hospital as an outpatient but cannot get a lift. The worst bit is the foul language that many callers use: I have never been subjected to such horrendous verbal abuse.

The single most serious problem today is the assumption that the NHS will stump up the cost of every single health intervention, no matter how small.

Solutions: More communication with the public as to what they can reasonably expect from the NHS, and what is reasonable that they provide themselves. People must understand that they will have to start paying more for the NHS if they want to enjoy free healthcare for life.

MALE GP

Problems:I retired last year, having qualified in 1969. Anyone under the age of 58 was born after the inception of the NHS, so will not have experienced paying for healthcare. Only those in their seventies and above remember having to pay a doctor; as a result they were much more self-reliant, and appreciative of the NHS when it came in.

The abuse of the NHS is phenomenal. This is partly because it is free at the time of use, and partly because of complete and utter ignorance on the part of the population about even the most basic healthcare.

There is less willingness to take responsibility for one’s own welfare. There is impatience at having to wait for anything. The attitude of younger generations is appalling. They are rude, arrogant, and lacking in any sort of respect. A medical degree, postgraduate diplomas and 30 years’ experience counts for nothing in the eyes of a twentysomething.

Solutions:We need many more doctors and nurses; education of patients regarding minor illness, use of the health service, and how it is funded; core services to be provided for free only up to a certain number of contacts per year. After that, patients pay.