As I write this review, my medical compatriots are struggling to treat the sick (and the not-so-sick) who are overflowing the A&Es nationwide while private outfits and healthcare ventures are acquiring contracts running into millions (even as the first privately run hospital admits its failure). I got a few hours to trace the source of current misery to an incredulous health policy "redisorganisation" that transpired merely 30 months back, that of passing of the Health and Social Care Act 2012. Being a recent, obviously elated medical graduate of that year who joined the medical workforce, I remember dedicating an awful lot of time reading endless stream of vacillating editorials, half-hearted post-mortems and trivia-driven, context-free reportage in the popular and the medical press. None of it however made the Bill, the eventual Act that passed and its implications any clearer. I lost interest as everyday commitments of being a young clinician took over and the curiosity to have the bill's legalese spelt out and discussed fell by the wayside. Moreover, despite being an active member of BMA (with a new BMJ copy through the door every weekend), I did not see any sustained campaign against the bill, any persistant alarm-calls that would mobilise or alarm me out of my stupor. I kept on conducting ward rounds in overcrowded hospitals, joining the team's sighs at the medically fit patients taking hospital beds as there was nowhere to discharge them what with the rapidly declining and funding-strapped social and community care networks. With no nurses to sometimes change patients into their gowns during my many A&E on-calls (forget basic, important observations), overworked and badly tempered senior nurses, screens glaring red with patients breaching four hour targets, I quickly started seeing A&E as the coalface of humanity where no respite from attendant chaos was in sight. I had the benefit of seeing one of my favourite emergency medicine consultant- a stickler for perfection, a pedant with a P, running like a headless chicken managing acute patients, firing lessons at his juniors eventually resign under myriad of pressures from non-medicos whose concept of medical treatment is little beyond a conveyor belt stream of "attend patient, fill a proforma, send for scan/bloods, prescribe or operate and/or discharge in no more than fifteen minutes".
To give context of the gossamer of misery that the current NHS hospitals are, I was relieved on finding a book like NHS SOS . I was familiar with Prof Tallis' oeuvre in neurology and his Hippocratic Oaths, a sort-of prequel to this I had read and reviewed in the spring of 2012. One of the book's foremost triumphs is it's spelling out of the most outrageous clauses of the Bill: the revoking of responsibility of the Secretary of the State to provide healthcare for all and how the repeal of this basic accountability for nation's health set the first stone to the path of privatisation. The second most readable part for me was seeing the hidden true anatomy of the Clinical Commissioning Groups (CCGs)-derivatives of American insurance providing outfits, with an execrable attached patchwork of monitoring pseudo-structure conceptualsied and run by American consultancy firms which has completely supplanted the Primary Care Trusts, Strategic Health Authorities/Health Boards.
In nine pithy chapters, eleven authors write a convincing expose of the current politicians who expectedly get unmasked as blatant profiteers with little interest in national health, the supposedly neutral media organisations which are hand-in-glove with the Establishment in driving up opinion of fringe approval as mainstream and driving down criticism and real denunciation from medical professionals at all stages, and finally the anaemia, impotence and complacency that has run amok amidst trade unions and royal colleges supposedly representing the medical establishment. With all the supposed buttresses of population's health and welfare corroded and corrupted by short term munificent agendas, with every passing page, the nationalised health service with its foundation tenets and lofty humanist goals seemed more and more like a modern-day anachronism that I was surprised had not dismantled sooner.
The answer for this lies probably with the steady work of doctors and nurses who besides applying themselves everyday in treating people, believe in the health service's founding mission. The politicians around them keep burning them out by dropping ridiculous, additional grids made of managers and targets, commissioning and contracting; keep finding new spinwords like "patient choice" to sneak in private companies which they have personal stakes in, and have slowly but surely turned hospitals into businesses, community health and social care networks into markets. The full impact of this grotesque transformation is slowly going to unveil as more private contractors who have found their feet through the doors desert or de-register patients with chronic illnesses. Already, cancer-patients are finding erstwhile-available treatments being off-limits due to drying up for funds. The familiar spin of NHS-being-a-black-hole with unending financial needs and the inevitability of privatisation in the face of "improving technology" and "increasing elderly population" will drown all debate. Profits, expectedly will supercede any obligation to provide healthcare for all as sensible models of delivery will languish either in unlearned golden years of history or unread, new white papers. If there is any barrier to this already-commenced decimation, it probably is in a mass awareness and campaign.
Of course, like all viewers of agit-documentaries and all readers of agit-non-fiction, unless you are sympathetic with the authors' train of thought, incredulity and ethos, this will pass you by without much effect. For those sharing the authors' concern, much future caution, alertness, and future campaigning will be required to douse a fire that has already been started by the ConDems. The book has certainly given me some confidence to follow the continuing narrative of this national mismanagement, and I hope to keep the bud of political conscience alive even as I maneuver through the unrelenting stress of career-building and treating patients in a rapidly transforming and despondent working environment.