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GPs Kill Retail but Hospitals Kill Wholesale

Hospitals are terrible places. People die in them. You should go into hospital only as a last resort. And you should escape the minute you can. As a doctor I am ashamed, saddened and embarrassed to have to tell you this but hospital patients are routinely neglected, humiliated and left in pain. Thousands of patients have died as a result of poor treatment. One independent enquiry documented cases where patients had been left unwashed for up to a month and left without food, drink and medical treatment. The conclusion was that managers had been ‘preoccupied with cost-cutting, targets and processes’ and had lost sight of their basic responsibilities. Astonishingly, none of the responsible managers responsible was taken to court. Nor were any of the doctors and nurses punished.

I have little doubt that in all the hospitals where patients have been dying unnecessarily the staff (including doctors and nurses) managed to convince themselves that they were providing patients with excellent service.

And, equally, I have no doubt that an enormous number of patients and relatives and hospital visitors must have ignored all these awful things and believed that the hospitals concerned were doing a wonderful job.

It wouldn’t surprise me in the slightest to hear that the managers responsible for all this pain, agony and death, have thick files of letters from patients and relatives thanking them for the excellent care.

The truth is that neither patients nor relatives know precisely what to expect from hospitals.

Walk into an NHS hospital and you will find demented patients in awful pain. You will find patients with terrible bedsores (the bedsore is a classic sign of bad nursing). You will find patients who are starving to death or dying of dehydration because the staff can’t be bothered to feed them or give them fluids. You will see patients so dehydrated that their lips are bleeding and sore and, when gently pinched, their dried out skin stays where you’ve put it. You will see patients dumped in a chair, sitting in urine soaked incontinence pads which have clearly not been changed for hours. You will see obvious signs of malnutrition. These aren’t patients in Third World countries. They aren’t patients in badly run care homes. They are patients in major NHS hospitals. I know it is true because I have seen it time and time again with my eyes.

Patients awaiting surgery are sent home because the hospital has run out of money and can’t afford the sutures and other surgical equipment needed to operate on them. An 83-year-old woman with dementia was sent home from hospital in the middle of the night without her family being informed. The next day she was found dead, alone in her bedroom.

Dirty sheets are reused in hospitals, just as they are in the dirtiest, cheapest, nastiest doss houses. But hospitals aren’t supposed to be doss houses. They are places where the people in the beds are, by definition, all ill. Many of them with infectious diseases. I can understand bureaucrats accepting the re-use of dirty sheets. They are nasty, uncaring people. But doctors and nurses?

Dignity and respect are not words which the modern hospital employee understands. Not, at least, when applied to patients. Many hospitals still have mixed wards – with male and female patients forced to abandon their natural dignity in the interests of hospital economy (so that the administrators can take yet another huge pay rise). Governments repeatedly promise to make sure that mixed wards are done away with. Inevitably, this promise is quickly forgotten and abandoned.

A generation or so ago most hospitals employed an almoner. It was her job (and the job was invariably held by a woman) to take care of patients’ social problems. If an elderly patient was worried about the cat she’d left at home the almoner would find someone to feed it. If a patient was going home after a long stay in hospital the almoner would help ensure that the house was prepared. The almoner played a vital part in helping patients rest and recover.

Today, none of these things is done.

And yet our hospitals are awash with social workers who regard practical problems as beneath them and spend their days organising meetings to discuss meetings.

The result of all this is that NHS hospitals are best at dealing with mechanical, easy solvable, easily identifiable problems. If you have an uncomplicated broken leg then a hospital will probably be able to deal with it efficiently and relatively safely – as long as you manage to convalesce at home rather than on a hospital ward. With other, more complicated problems, however, hospitals can do a great deal more harm than good.

Back in the Middle Ages people were terrified to go into hospital. They knew it was a sentence of death. Relatives started digging your grave as you went through the doors of the local infirmary. Things are getting that way again.

British hospitals are now among the worst in the world. One survey of NHS staff showed that only 44% thought that they would be happy with the standard of care provided if they were patients in their own hospital. Many British patients are now travelling half way round the world to get treatment in hospitals where patients are treated quickly, efficiently, hygienically and with respect. So, for example, hospitals in India are offering attractive package deals for British patients who can’t wait two years for treatment or who don’t fancy the idea of being killed by an antibiotic-resistant hospital infection. Officially, adverse drug reactions kill 18,000 people a year and cause 600,000 hospital admissions in the UK every year. In reality, things are far, far worse than that.

And although it is called a National Health Service, it isn’t. In 1971, I made a television programme for the BBC (they used to hire me as a medical expert 50 years ago) in which I explained that there were massive variations in the types of treatment available in different parts of the country. I used a blackboard, a long stick, a large map and several large sheets of paper to explain how treatments varied in different parts of the country. (This was, of course, long before the days of computer graphics.) There was, I claimed, no real ‘national’ health service. Nothing has changed in principle although I suppose it is quite likely that there have been changes in the nature of the inequalities prevalent in the various regions. To call it a ‘National’ Health Service is an absurdity that should merit investigation.

One of the common arguments in favour of the NHS is that everyone gets the treatment they need without having to pay for it. This is, of course, a myth. Even allowing for the fact that some patients are denied treatment on the grounds of cost, and others are denied treatment simply because the area where they live does not offer the treatment they need, there is another big problem: NHS staff select patients for treatment on the basis of their perceived need and ‘value’ to society.

Some readers may be shocked to know that the National Health Service already operates a selection system for treatment.

But it has done so for many years. (English patients are particularly likely to be affected. Scottish hospitals have plenty of money; though it comes, of course, from English taxpayers.)

When treatment is expensive, it is provided for those patients who are regarded as the most deserving. And how does our system decide which patients are most deserving? Simple. A young married man with lots of children will be at the top of the list. An elderly man who lives alone will be right at the bottom of the list.

And so the NHS will provide life-saving treatment for an unemployed scrounger of 36 who has a wife, a mistress and eight children. But a great, elderly painter or composer will be allowed to die.

Nurses, not doctors, decide whether or not patients should die. It is nurses who decide whether or not patients should be resuscitated.

And is it not absurd, unfair and just plain wrong that NHS money is spent on providing couples with fertility treatment and women with breast enlargement operations while thousands of patients are dying because they have to wait weeks for essential, simple diagnostic X-rays?

Surely, life-saving should come first and life enhancing come second?

In military hospital units, doctors operate a simple but effective system whereby those whose need is greatest get seen first. It’s a sound principle. Life-saving should come first and life enhancing should come second.

But in the NHS the people who receive the best (and fastest) treatment are the patients who are represented by the most efficient lobbyists. The elderly, needless to say, have no one fighting in their corner. And so people wanting cosmetic surgery, sex change surgery, infertility treatment and other lifestyle medicine have their needs met while the elderly are denied basic treatment which would in some cases transform their lives and others save their lives.

The sad truth is that these days, hospitals are terrible places – far worse than they should be or need to be. You should go into hospital only as a last resort. And you should escape the minute you can. As a doctor I am ashamed, saddened and embarrassed to have to tell you this but hospital patients are routinely neglected, humiliated and left in pain. Thousands of patients have died as a result of poor treatment. One independent enquiry documented cases where patients had been left unwashed for up to a month and left without food, drink and medical treatment. The conclusion was that managers had been ‘preoccupied with cost-cutting, targets and processes’ and had lost sight of their basic responsibilities. Astonishingly, none of the responsible managers responsible was taken to court. Nor were any of the doctors and nurses punished.

I have little doubt that in all the hospitals where patients have been dying unnecessarily the staff (including doctors and nurses) managed to convince themselves that they were providing patients with excellent service.

And, equally, I have no doubt that an enormous number of patients and relatives and hospital visitors must have ignored all these awful things and believed that the hospitals concerned were doing a wonderful job.

It wouldn’t surprise me in the slightest to hear that the managers responsible for all this pain, agony and death, have thick files of letters from patients and relatives thanking them for the excellent care.

The truth is that neither patients nor relatives know precisely what to expect from hospitals.

Walk into an NHS hospital and you will find demented patients in awful pain. You will find patients with terrible bedsores (the bedsore is a classic sign of bad nursing). You will find patients who are starving to death or dying of dehydration because the staff can’t be bothered to feed them or give them fluids. You will see patients so dehydrated that their lips are bleeding and sore and, when gently pinched, their dried out skin stays where you’ve put it. You will see patients dumped in a chair, sitting in urine soaked incontinence pads which have clearly not been changed for hours. You will see obvious signs of malnutrition. These aren’t patients in Third World countries. They aren’t patients in badly run care homes. They are patients in major NHS hospitals. I know it is true because I have seen it time and time again with my eyes.

Patients awaiting surgery are sent home because the hospital has run out of money and can’t afford the sutures and other surgical equipment needed to operate on them. An 83-year-old woman with dementia was sent home from hospital in the middle of the night without her family being informed. The next day she was found dead, alone in her bedroom.

Dirty sheets are reused in hospitals, just as they are in the dirtiest, cheapest, nastiest doss houses. But hospitals aren’t supposed to be doss houses. They are places where the people in the beds are, by definition, all ill. Many of them with infectious diseases. I can understand bureaucrats accepting the re-use of dirty sheets. They are nasty, uncaring people. But doctors and nurses?

Dignity and respect are not words which the modern hospital employee understands. Not, at least, when applied to patients. Many hospitals still have mixed wards – with male and female patients forced to abandon their natural dignity in the interests of hospital economy (so that the administrators can take yet another huge pay rise). Governments repeatedly promise to make sure that mixed wards are done away with. Inevitably, this promise is quickly forgotten and abandoned.

A generation or so ago most hospitals employed an almoner. It was her job (and the job was invariably held by a woman) to take care of patients’ social problems. If an elderly patient was worried about the cat she’d left at home the almoner would find someone to feed it. If a patient was going home after a long stay in hospital the almoner would help ensure that the house was prepared. The almoner played a vital part in helping patients rest and recover.

Today, none of these things is done.

And yet our hospitals are awash with social workers who regard practical problems as beneath them and spend their days organising meetings to discuss meetings.

The result of all this is that NHS hospitals are best at dealing with mechanical, easy solvable, easily identifiable problems. If you have an uncomplicated broken leg then a hospital will probably be able to deal with it efficiently and relatively safely – as long as you manage to convalesce at home rather than on a hospital ward. With other, more complicated problems, however, hospitals can do a great deal more harm than good.

Back in the Middle Ages people were terrified to go into hospital. They knew it was a sentence of death. Relatives started digging your grave as you went through the doors of the local infirmary. Things are getting that way again.

British hospitals are now among the worst in the world. One survey of NHS staff showed that only 44% thought that they would be happy with the standard of care provided if they were patients in their own hospital. Many British patients are now travelling half way round the world to get treatment in hospitals where patients are treated quickly, efficiently, hygienically and with respect. So, for example, hospitals in India are offering attractive package deals for British patients who can’t wait two years for treatment or who don’t fancy the idea of being killed by an antibiotic-resistant hospital infection. Officially, adverse drug reactions kill 18,000 people a year and cause 600,000 hospital admissions in the UK every year. In reality, things are far, far worse than that.

And although it is called a National Health Service, it isn’t. In 1971, I made a television programme for the BBC (they used to hire me as a medical expert 50 years ago) in which I explained that there were massive variations in the types of treatment available in different parts of the country. I used a blackboard, a long stick, a large map and several large sheets of paper to explain how treatments varied in different parts of the country. (This was, of course, long before the days of computer graphics.) There was, I claimed, no real ‘national’ health service. Nothing has changed in principle although I suppose it is quite likely that there have been changes in the nature of the inequalities prevalent in the various regions. To call it a ‘National’ Health Service is an absurdity that should merit investigation.

One of the common arguments in favour of the NHS is that everyone gets the treatment they need without having to pay for it. This is, of course, a myth. Even allowing for the fact that some patients are denied treatment on the grounds of cost, and others are denied treatment simply because the area where they live does not offer the treatment they need, there is another big problem: NHS staff select patients for treatment on the basis of their perceived need and ‘value’ to society.

Some readers may be shocked to know that the National Health Service already operates a selection system for treatment.

But it has done so for many years. (English patients are particularly likely to be affected. Scottish hospitals have plenty of money; though it comes, of course, from English taxpayers.)

When treatment is expensive, it is provided for those patients who are regarded as the most deserving. And how does our system decide which patients are most deserving? Simple. A young married man with lots of children will be at the top of the list. An elderly man who lives alone will be right at the bottom of the list.

And so the NHS will provide life-saving treatment for an unemployed scrounger of 36 who has a wife, a mistress and eight children. But a great, elderly painter or composer will be allowed to die.

Nurses, not doctors, decide whether or not patients should die. It is nurses who decide whether or not patients should be resuscitated.

And is it not absurd, unfair and just plain wrong that NHS money is spent on providing couples with fertility treatment and women with breast enlargement operations while thousands of patients are dying because they have to wait weeks for essential, simple diagnostic X-rays?

Surely, life-saving should come first and life enhancing come second?

In military hospital units, doctors operate a simple but effective system whereby those whose need is greatest get seen first. It’s a sound principle. Life-saving should come first and life enhancing should come second.

But in the NHS the people who receive the best (and fastest) treatment are the patients who are represented by the most efficient lobbyists. The elderly, needless to say, have no one fighting in their corner. And so people wanting cosmetic surgery, sex change surgery, infertility treatment and other lifestyle medicine have their needs met while the elderly are denied basic treatment which would in some cases transform their lives and others save their lives.

(This article is taken from `The Kick-Ass A to Z for Over 60s’ by Vernon Coleman, available as a paperback and an eBook.)

Copyright Vernon Coleman September 2022

https://www.vernoncoleman.com/main.htm

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One Response to “GPs Kill Retail but Hospitals Kill Wholesale”

  1. Belyi says:

    Three weeks ago I had a massive nose bleed. I’d had one in the other nostril a few years ago so I knew the vein had to be cauterised and that can only be done by an ENT specialist.

    It was on a Sunday and off I went to hospital (I live in Switzerland and this ia a big teaching hospital) and was taken to casualty. I was rapidly seen by a doctor who fussed about my blood pressure. As I was stressed, that would be normal for me.

    I didn’t wait long for the ENT specialist to arrive. She cauterised the vein with a little difficulty and I sat around for 30 minutes to ensure it was fine. Then I got a taxi home.

    However, if I had anything seriously wrong I still wouldn’t want to be admitted to any hospital in Europe for any procedure.