Twelve years and counting...

There’s no doubt that as we enter the 25th year of my professional life we’ve come a long way in the intervening quarticentenary*. Two generations of pills have near abolished surgery for stomach ulcers, a tiny bit of wire mesh has gone a long way towards doing the same for bypass grafting. Depression has been transformed by the introduction of SSRIs and the plethora of follow on alternatives. New wonder drugs have been joined by rehabilitated old wonder drugs like Aspirin. Endoscopic surgery and joint replacements are now commonplace and the protracted stays in hospital post op are a thing of the past for the vast majority. Cancers incurable a generation ago are so no longer…. I could go on, and on (stop that nodding there you at the back).

And yet, for all our technological and pharmaceutical accomplishments, as 2008 draws to a close I’m left fearful that we’ve "sold our soul", and ere long Old Nick himself will be paying us a visit to call in his marker. The NHS I joined, for all its evident faults, was a truly National Service. The ethos of the whole organisation was compassionate, aimed at the relief of suffering and the improvement of wellbeing. This morning on Radio 4 we hear of a Kings Fund report highlighting the loss of compassion. This has slowly but surely been eroded by the fragmentation of the service into a vast jigsaw of Trusts each as much determined to protect its borders and boundaries and keep the “undeserving” out, as to hit the targets set for service delivery to those fortunate few “deserving” of its attention. And those targets are all about process. Waiting times , cleaning regimes, infection rates and the like. All of the above are important, but so are the poor bastards stuck on the receiving end.

In the past month I’ve seen patients kicked off waiting lists for surgery because on one screening visit to a N’octor, their blood pressure or blood sugar are not exactly normal according to arbitrary criteria that are almost absurd enough to require that to be fit for surgery you have to be so well as to not require surgery. I’ve heard Doctor Neighbour bemoan the fact that he is unable to arrange a transfer ambulance to get a patient to see a Neurosurgeon at St Elsewhere’s in a nearby city because the Surgeon in question wanted to review them in the A&E department there and the Ambulance trust can only take patients to Outpatients there or to the nearest (Ambridge DGH) A&E but not the St Elsewhere’s A&E because those are the rules. And I’ve seen a patient denied much needed Opiate analgesia because staff at the residential home he lives in cannot find a cupboard to lock his medications in and the rules won’t allow them to do otherwise.

We’ve become afraid to care, and it’s getting steadily worse year on year. Maybe the Kings Fund will turn the tide and 2009 will see a return to the much needed basics. Every Trust in the land has a mission statement that declares in Government approved newspeak their commitment to “patient centred-ness”.

It’s time we all sat down and thought about what that actually means.

*probably not a real word, but should be.