Sir, An NHS patient must make the following six pledges:
To be diagnosed with a clearly defined problem that can be cured by surgery; not to have any other illnesses that might lead to unforeseen complications; to be able to travel to a distant location; to be willing to be tended by an unknown healthcare team, and to put trust in their abilities; to share facilities with others; not to have any psychological difficulties that might interfere with decision -making.
The reality is that 85 per cent of bed days in hospital are taken up by 25 per cent of patients because they do not fit this simplistic formula. We are all living longer with complex illnesses which require specialist management; decisions about surgery are often ill-defined; real people have hopes and fears and behave in an unpredictable manner. Are patients really involved in defining their medical care?
Yours faithfully,
JOAN HESTER,
(Consultant in Pain Medicine),
King’s College Hospital,
Denmark Hill, SE5 9RS.
joan.hester@kingsch.nhs.uk
February 14.
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From Mr Julian Neely, FRCS
Sir, The current reconfiguration of the hospital health service has been primarily influenced by the training demands of the Royal Colleges and the effects of the European Working Time Directive on the hours of junior doctors. The result is the concentration of medical services in major centres with the closure of several smaller units.
Thus, in spite of the NHS’s topical slogan: “the patient at the centre of the NHS”, the public, especially in rural areas, are geographically farther away from medical help. This is not merely inconvenient but in critical situations may be associated with increased risk. Unacceptable travel times to hospital from even sizeable towns are not uncommon.
Delay in treatment may more than cancel out the advantages of the concentration of medical expertise. Critically ill patients must reach hospital within an acceptable time, which may mean more ambulances and more ambulance stations. Funds must be found to ensure this; the NHS must work up to a standard, not down to a price.
Yours faithfully,
JULIAN NEELY,
(Retired consultant surgeon),
27 Springfield Park, North Parade,
Horsham, West Sussex RH12 2BF.
February 14.