While you read this I would keep three questions in mind.
Who would oppose change most strongly?
How can we change their opinion?
How can we influence the situation?
Compared with other countries we are far behind – but we don’t know that. The NHS was best described to me by Swiss architect, who said, in deep distress at the care her elderly mother was receiving in Scotland: “I know you don’t pay much for your Health Service, but it shows.”
I know of no-one who has left this country and is with a medical scheme abroad who wishes to return to the NHS. I know people who are paying to avoid it. I know people who have the choice and say “No Thank You”. It may be free, but it is not comfortable.
On holiday, I met a British couple, who had moved to France and enthused about their improved relationship with their GP. no-one to come between the patient and the doctor. no-one to tell you when you would be seen.
There is no receptionist in France: no-one to come between the patient and the doctor. no-one to tell you when you would be seen and when you won’t be seen.
The patient/doctor relationship is sacrosanct there, and when patients phoned the Doctor’s Surgery, they spoke to THE DOCTOR. Of all the benefits of living in France, this was amongst the most important.
The doctor knew the individual, a time would be agreed that was suitable for both. There was no-one to broadcast details of your illness all over the surgery. There was a small fee to deter time-wasters, but the fee (£10) was far preferable to our system, they maintained. Should further treatment be required, it was freely available from the following day. There was no need to wait unless the PATIENT chose to do so. I was told it was absolute bliss, and it certainly sounded better conceived than what we have stapled together.
In the Surgery in France, behind the scenes secretaries typed up notes, and collated information, but they were never seen by the patient. The comment that these ex-pats made on the NHS, having lived in France for seven years?
“I don’t know how we put up with it for so long…”
My best patient experience was also in France, and there is nothing and nobody to compare in this country – the systems simply are not in place.
Dickinson and Ham make this point in their 2008 paper:
“integrated multi-professional care is only possible to the extent that professional and directorate barriers are broken down, and a culture of shared clinical governance is cultivated in which staff are empowered to accept responsibility and accountability at all levels of the hierarchy”
(Engaging Doctors in Leadership: Review of the Literature. NHS Institute for Innovation and Improvement)
Medical Centers are unexceptional – they conform to what the Government wants. No barriers are being breached: nobody is putting their head above the parapet. and the patient is minimally involved.
In other words, it’s as good as we are prepared to make it in Britain. Or as they say in Glasgow: