Paul Muller: The radical surgery needed to save the heart of NHS

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During the last 25 years, more and more managers have been employed in the National Health Service. They now outnumber the doctors and have run the NHS into a financial pit – and unfortunately they keep digging.

They are now blaming the fact that people are living for longer for causing the present chaos in the health system.

When I first qualified in medicine I was told that my duty to my patients was to care for them 24 hours a day, seven days a week. Medicine is a full-time job. patients need help any time of the day or night and the GP is their first port of call. It is their duty to see the patient that day or night.

Yet the European work directive has all but ruined the training and duties of doctors.

Most junior doctors work more than 48 hours a week. In Germany and France they are paid for the work they do. In the UK, however, managers will only pay them for 48 hours a week, but then have to pay exorbitant fees to doctors to fill in the times not filled by junior doctors – thus wasting millions.

As health policy returns to the political spotlight following the Labour conference, and the passionate speech of 91-year-old Barnsley war veteran Harry Smith, who warned his poverty-stricken past would be others’ future if the NHS did not survive, general practice must change from being a gate keeper and a referral service.

There should be an open door policy in GP surgeries with each GP trained in different specialities in medicine – such as general medicine, cardiology, diabetes, paediatrics, dermatology, geriatrics (dementia), psychiatry and the early diagnosis of cancer.

In the UK there are fewer hospital beds available per 100,000 patients than anywhere in Europe.

All the closed wards in hospitals should now be reopened for patients. This means the nurse and the medical staff who ran these wards must be reemployed.

This can be costed by removing most of the management staff who have run the NHS into the ground.

At the moment there is hardly any care in the community. This must be run by GPs together with the district nurse, meaning the GP will have to see their patients at nights and weekends.

The GPs will have to be able to take blood and urine samples and take them to the pathology labs, as well as do ECGs at home and learn to read the results and know what to do for the patient with their findings.

They must be able to diagnose pneumonia. They must be able to diagnose bipolar disease and schizophrenia and refer them immediately for treatment to an expert in their practice.

The one patient who usually can’t be treated at home is the older patient, as you get older you become more and more incompetent at looking after yourself and this usually gets worse when you are ill.

In hospitals admission wards must be closed. Nurses and doctors cannot deal with many different illnesses and injuries on one ward. The patient that is seen by the GP or in accident and emergency must be referred urgently to the appropriate surgical, orthopaedic, medical, paediatric, gynaecology ward.

The initial diagnosis in A&E must be made by the most senior doctor and then referred immediately to the appropriate ward for treatment. Waits in A&E of up to four hours are a disgrace and do not happen anywhere else in the world. A&E departments must see their patients immediately, with triage done by the senior consultant – not a receptionist or porter or junior doctor. The patient must then be sent to the appropriate ward or operating theatre for treatment.

The future for the Health Service can only start when Dr David Kelly’s plan for care in the community has been sorted out. That means GP surgeries working for their patients 24 hours a day and weekends too.

Patients sent home early after operations and serious illnesses must be seen by the GP and the district nurse on a daily basis for on week at least to make sure the patient is getting better.

Their wounds not becoming inflamed and that the medical patients are taking their tablets correctly 
charts must be made of their pulse 
and respiration rate their blood pressure taken on a daily basis and an input and output chart made of their fluids.

This care in the community will be more expensive than hospital care. Nurses have lost their jobs because one half to one third of hospital beds have already been closed.

So few nurses have been trained that we are now going to Spain and Portugal for hundreds of properly trained nurses that speak perfect English.

We must start training many more nurses and midwifes to run our hospital wards and nurses to work in general practice as district nurses. Health care workers should only be in small numbers on the wards.

Health care workers must be properly trained for nursing in care homes so that patients are no longer abused.

Managers in the NHS must be seriously reduced in numbers. They earn far too much for what they do their idea of efficiency is to reduce the number of nurses and their salaries and to get rid of consultant secretaries.

There are more senior managers in Mid Yorkshire hospitals than there are Cabinet members in the Government, and they earn two to three times more than the Prime Minister and members of Parliament.

Let the doctors and nurses treat their patients without interference from hospital managers.

Less following of targets and turning guidelines into rules and more love, empathy and proper compassion for your patients and relatives should be the hospital motto.

• Paul Muller, from Wakefield, is a retired general surgeon and fellow of the Royal College of Surgeons.

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