Alida Baxter

Renowned London journalist and author

 

Alida Baxter

London's NHS Crisis

alida baxter

You can hardly open a newspaper or watch a television documentary without hearing what nuisances we all are when it comes to our health.  Consider, with shame, the much criticised selfishness of people who, in hordes, clog the waiting areas of hospital Casualty Departments when all they really have to do is to go and see their GP with their little problem.  This occurs all over country but is worst of all, we’re told, in London, where at the best of times A and E Departments are overstretched to bursting point.

I can certainly vouch for the degree to which they’re busy:  a friend who accompanied an elderly, seriously ill person in an ambulance to University College Hospital’s A and E one early evening waited with the patient throughout the night until, at last, he’d been seen and a bed found for him at four o’clock the following afternoon.  And this wasn’t even on a weekend (Saturday nights are especially rich in those who may be quite literally legless).

So no argument about that then:  thanks to the NHS we have these wonderful facilities, which we should treasure, and if they’re overwhelmed it’s all the silly, selfish public’s fault.  Except that it isn’t.

At a time when London’s population is greater than ever before, the capital’s A and E Departments are being shut with a clang to the ambulance cases which most need them.  In September, 2014, the BBC reported that both Hammersmith and Central Middlesex’s A and E units had closed, so that anyone needing an ambulance would have to call for help elsewhere, such as Charing Cross or Ealing.  But the Daily Mail had already given headlines to the fact that the Charing Cross A and E was also to be closed!  And this despite a specific pledge made by the Prime Minister, before the election, that the A and E services at Charing Cross would be retained.

The BBC, missing nothing, stated that not only Charing Cross but Ealing’s A and E Department was also “being reviewed” – the most doom-laden euphemism since “What are you frightened about, you aristos – you’re just going for a nice outing in those tumbrils!”

What’s going on has been described by Andy Slaughter, MP for Hammersmith, as the biggest hospital closure programme in NHS history.  It’s not an isolated opinion, and has gained a great deal of sympathy from the frightened public who are seeing their A and Es disappear.

But that’s neither all, nor even the worst, of what’s happening.  Return to the criticism that people are going to hospitals when they should be seeing their GP and you discover that, for many, the wait to see a GP is at least three weeks.  Some practices offer emergency appointments if patients telephone first thing in the morning, but all too often people who do so report finding the number engaged until the window of opportunity has passed.  What to do then, if you’re really worried?  Someone I know was desperately concerned about her sick mother and, faced with too long a delay to see the GP, found no alternative but to take her to an A and E Department, where the staff insisted on blood tests – but the place was so packed that the blood testing had to be carried out in the open waiting area, with no privacy or protection from the stares and infections of the heaving crowd all around.

Even this, though, doesn’t present the whole picture, because the reason for the long wait to see a GP isn’t usually some caprice on his or her part.  It’s because there just aren’t enough of them, so that practices become overloaded.  And what is being done about that?  Well, in London the answer is truly extraordinary.  We need more GPs, so – GP practices are being closed.

Here in Soho we have an excellent Health Centre, with two GP practices.  One of these is especially popular with the large Chinese community, for the doctors speak Chinese dialects and many elderly residents speak nothing else.   In the summer of 2014 NHS England abruptly announced that this practice was to be closed, although there’d be nothing to stop patients transferring to the other practice at the same address – nothing but the fact that it would have been totally impossible for the doctor there to absorb at a stroke the thousands of Chinese patients involved.

As if this shock were not enough, NHS England made a monumental mess of it by writing not to the patients affected by the proposed closure, but to all those with the practice that was to remain open, warning them to change their GP within weeks!  Phone lines at both practices were jammed, as people tried to find out whether anything at the Health Centre was to remain open, and managers and receptionists reassured one frantic crowd whilst confirming the bad news to another.

At Heaven knows what cost to the tax payer, NHS England despatched a whole new set of letters to those who’d still have a GP, telling them to calm down, it’d been a mistake, and another set to the truly dispossessed, with the stern warning that they’d better get a move on and find another practice to take them.

Incensed, the entire, normally quiet Chinese community rose up, supported by a Councillor, the Soho Society and many other sympathisers.  A packed meeting was held, and a procession was led by a Chinese dragon of the type used at parades and at the Chinese New Year, dancing furiously through the Soho streets.

The result of all this was a reprieve for the surgery:  senior figures in NHS England met and agreed on the reprocurement of the contract for the practice.  (To reprocure, in NHS speak, is to supply needed services.)  Meaning it wouldn’t close.

All of which leaves me thinking that people in every vulnerable area of London should consider hiring those Dragon dancers, for the Soho surgery was only one on the NHS hit list, and many other patients in the capital had and continue to have as little notice as the Chinese community were given:  find yourself another GP within six weeks.

How are we then, the general public, to square this impossible circle?  We mustn’t overcrowd an A and E Department – always provided we can find one – but we may have a frighteningly long wait to see a doctor.  He or she will have an increasingly overwhelmed practice, and some GPs simply won’t be able to take on yet more patients.

It’s little wonder that the half-way houses provided by Walk In Centres are so popular, and so packed, but the apparent advantage of not needing an appointment is a double edged sword.  You don’t need an appointment, but you may wish you could have had one, when you’re waiting hours in premises that are crammed to the doors.

Walk In Centres are a wonderful and efficient service, usually staffed by excellent nurse practitioners, but there aren’t nearly enough of them (here we go again).  Would you believe that London, the bursting capital city, has only three?  And they’re not meant to be a complete substitute for a GP.  They can deal with immediate problems, but aren’t meant to handle ongoing medical conditions, and they usually aren’t allowed to treat babies or young children.  They don’t provide the wrap-around service of a GP, and more GPs are what we in London need – as well as A and Es and hospital beds.

In fact we, the public, can’t square this circle, it’s beyond us.  We can only complain about it.  Just as doctors, and nurses, and GPs do.  And maybe some day someone will listen, before this crisis becomes a catastrophe.

© Alida Baxter

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