Friday, July 13, 2012

NHS Murderers

Who can fail to be angered by the appalling death of young cancer patient Kane Gorney, aged 22. Originally treated for a brain tumour, the treatment he had affected his bones so that he needed a hip replacement. This was performed at St Georges in Tooting, but died three days after the operation. What killed him was not a complication of the surgery but a simple lack of water. He needed to be kept hydrated at all times, which is what the doctors instructed, but nursing staff ignored him and he died a slow and agonising death of dehydration. Even now, writing these few lines, I can't help but get furious over this.

In the last few years I've had a lot of direct personal experience of hospitals, including spending several long periods in St Georges looking after my son. I've had experience of a number of hospitals in the UK, some NHS and some private, plus hospital treatments abroad. I've seen more medical treatments than most will see in a life-time. My conclusions from this? We've been sold a massive lie in the UK. The NHS is a second rate service in many respects, but no politician has the guts to say so. And most people will never see up close how it compares to treatment in Germany for example, or even to see the difference in treatment between the NHS and a private hospital in the UK (and thankfully, having a job that includes private health insurance allowed me to see it for the first time too).

When it comes to St Georges we got to see what's best and what's worst in the NHS. The good included fantastic doctors, particularly oncologists and surgeons, and excellent facilities in operating theatres and ICU. The absolute worst was experiencing nursing "care" by nurses who really didn't give a shit about patients. Dealing with a Soviet-style bureaucracy and layers of administration that seemed to drive everybody mad, from  patients to doctors. Not all the nurses were crap. But there were enough of them to make the overall level of nursing care abysmal. And this wasn't just one isolated incident. This happened again and again over a number of years and a number of different wards and treatments.

This poor level of treatment was not limited to St Georges. We had similar experiences at UCH in London. Again, good facilities, good doctoring, but a feeling that many of the nurses just weren't interested. Again, let me be clear, it wasn't every nurse, but the good were crowded out by the bad, and in fact the good seemed to spend a lot of their time chasing after the bad or correcting their mistake.

By contrast, nursing care at our local hospital or at the Royal Marsden was excellent. It was excellent in every private hospital we went too and in the hospital abroad.

Why is this?

You'll hear all kinds of lame excuses about 'systemic failures' and 'learning from mistakes', but the fact is that the NHS is a lumbering beast and like a dinosaur doesn't seem to be very responsive. It's a bloody scandal that a 22-year lad has to be dialling 999 in a vain attempt to get a drink of water before he dies. If this had happened in a prison there'd be a huge outcry. Heads would roll. What's happened here? A half-arse apology from the hospital and that's it. Fucking outrageous.

The real problem is that St Georges and UCH are both too big. They're huge lumbering giants and impervious to change, just as the nurses were impervious to a dying lad asking for water. St Georges is a merger of many smaller hospitals, all consolidated onto a massive single site. A feature of all huge bureaucracies is a culture of neglect, incompetence and self-protection.

The answer to the problem is the same as the answer to the many of the other problems in the NHS. Break it up. The Soviet-era NHS system doesn't work. Other countries manage socialised medical systems without having a single bureaucratic structure like the NHS. It's what we need. Unfortunately, trying to talk about real structural change in the NHS is all but impossible in the UK. Every discussion is framed as a simple NHS versus the US system - as though there's nothing in between.

Poor Kane Gorney, at the very least his death is manslaughter, but he isn't the first, nor will he be the last person to be killed by a system that's too big too care.


Dodgydosser said...

Whilst your description of the problem is very cogent, your prognostications are not.

France, Germany & Switzerland all spend more on healthcare. The introduction of private healthcare can only exacerbate the problem. It will increase costs and remove access for many people in this country.

Contrarian said...

Thanks for making my point clear - as I said, any discussion soon turns into a simplistic NHS versus private health care argument.

That's not the point I'm making. My point is about the centralised, overly bureaucratic system and how it tends towards a system where the patient comes last.

Man with Many Chins said...

I am interested in the comment by Dodgydosser.

According to the figures that I found, to gain the French levels of spending would require us to spend an extra $12 billion USD on healthcare. Considering that the French system makes ours look like the heaped up pile of shite that it is, and that the NHS IT computer project is now projected to cost more than £12 billion that is a very interesting figure.

They treat the NHS like some kind of shining white edifice, whilst in reality it is a corrupt and totally inefficient centralised organisation.

It needs to be utterly destroyed and be replaced with something like local health co-operatives for example.

Furthermore, it always fascinates me that a private hospital can be so clean, well staffed and run, and make a huge profit, whilst an NHS hospital is dirty, inefficient and unresponsive whilst overspending all the time. They normally trot out the old "private hospitals do not cover critical care" canard, however, I believe the actual physical cost of an operation in £ is broadly similar when taken privately as to the actual cost to the NHS. I could be wrong but I recall reading a report to that effect several years ago.

At the end of the day, the NHS is a massive bureaucracy, whose sole purpose is to protect and expand the bureaucracy at all and any costs. Patient care is a distant afterthought with these people.

Dodgydosser said...

Regarding the NHS. It's not a question of 'blind loyalty'. It's just that the NHS despite what you say is a very good system.

Your generalisations from the particular are not reasonable positions. We need to look at the overall picture.

For instance you talk about an overblown bureaucracy, but in fact the NHS has one of the lowest administration costs of any system. Before the introduction of the ridiculous internal market administration costs were only 5%. This compares favourably with social insurance systems like France or Germany.

The same is true of quality of care. Both France and Germany have higher error rates than the UK.

But finally, like many people who ignorantly slag off the NHS, you have ignored the issue of money.

We spend much less. Per capita spending in France and Germany is much higher than the UK.

The answer is to stop wasting time and money trying to turn healthcare into a business and to pump reasonable amounts of money (say reaching the OECD average) on the NHS.

Contrarian said...


I generalise not on this particular case but on a long and broad experience with NHS healthcare. I am closely involved with two cancer charities and have direct personal experience of the NHS and health care in Germany. And I have to say that the standard of care can be really great, but mostly it's not. In many cases it's downright appalling.

To pin the blame on a lack of spending is too simplistic. There's an endemic cultural issue within the NHS that puts patients low on the list of priorities.

Aside from the recent spate of scandals, and the numerous cases like this one, we can also look at the statistics from Professor Jarman.