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Holby City or the real NHS

Firstly I would like to thank you for inviting me to come and talk to you at your Annual General Meeting. Ever since I moved into my Office in the Greenway Centre some nine and a half years ago we have been neighbours, and I have watched with pleasure and interest as Crossroads has developed. I know that this has only been achieved with the hard work and dedication of all the staff in the organisation, and reading your annual report only serves to increase my admiration of your work. I know as I go round the constituency how much your work means to carers who do need a break from the duties which they undertake so willingly. Nearly 43000 hours of care from Crossroads makes a huge difference to local carers. I was particularly impressed to read the results of the survey of your users, and I don’t think that many organisations could get 96% of its clients to say they consider the service to be excellent or good. I certainly don’t know any MPs who could claim this amazing vote of confidence.

At the start of my talk I must say that as a Labour MP you would expect me to support the Government, and of course I would say that I know that the NHS has made enormous steps forward in the last ten years. Nevertheless the service is still undergoing change, and whenever change is introduce into such a well respected service which affects all of us to a greater or lesser extent during out lifetimes, then it is always going to be a difficult process with people reacting defensively to any changes which they perceive will affect “their bit of the service”. In this talk I want to touch on the changes and possible further developments which will I feel improve the service as well as keep it closer to people’s homes. However, the views I express in this talk are my own, and are based on my commitment to the NHS over the last 40 years.

So why I have entitled my talk “Holby City or the real NHS”? I think it is because the TV and media only portray one aspect of the service and very much based on dramatic situations with patients facing life threatening emergencies whilst the doctors and nurses battle (usually successfully) to save life. I think these programmes are important because they give an insight into a very important part of the NHS, although I would hope that most NHS staff don’t bring their personal relationships and problems to work as most of the cast of Holby City seem to do. However good these dramas are however, it can mean that sometimes people are left with the impression that the hospital service is the most important part of the NHS. Really though the service (dramatic as it is) is only the tip of the iceberg, and most people rely on services in the community for their health care.

How often do you see on the TV a District Nurse going to dress a patient’s ulcerated leg, an occupational therapist suggesting a walk-in shower or additional handrail, the Practice nurse giving advice about diet to an overweight person, or even the older person having a flu jab. Yet these things and thousands of other examples are happening day in day out up and down the country. You will very rarely see these aspects of the service featured on medical dramas and yet these examples are much more typical of the service the NHS has provided over the years, and will continue to provide.

I know that the NHS isn’t perfect, but I get quite annoyed at times when I learn from the media about some incident where someone has been let down. Unfortunately the press never publicise the hundreds of thousands of times the service gets it right, and often gives the impression that the occasional bad experience is the norm.

I know that most people are well aware that the NHS is much more than the services available in a high tech acute hospital such as the BRI, Southmead or Frenchay. Services are changing and it is important to recognise this and to realise that the best outcome for patients and certainly for quality of life is for people to be treated as close to home as possible. A good example of change is with the Ambulance Service. In the past when an ambulance was called the priority was to reach the patient quickly, and then to race through the streets to get the patient to hospital as soon as possible. Nowadays, a first response person (on a motorbike or in a car) can often reach the patient before an ambulance, and can deal with a wide range of problems on the spot. For instance a qualified paramedic acting a first responder can stitch wounds, sort out problems with catheters and generally assess the appropriate service someone needs. Often this can mean that the ambulance which is on its way as a result of a 999 call can be diverted to deal with the next emergency. Conversely a first responder can administer thrombolitic drugs before the ambulance arrives, and the sooner these are administered the better chance of recovery from a heart attack, and again when the ambulance arrives the first priority is to stabilise the patient rather than to rush him or her to hospital.

But changes are happening in the NHS, and again you would think if you read the press that the Government is out to undermine the service in some way. I think most people get very blasé when they read about “targets” being set for the NHS. I can understand this but there is no doubt that the NHS has been transformed since the current government came to power. Waiting lists are now well down. I remember when I first became an MP, I regularly had people coming to my Advice Surgeries because they had in some instances been waiting for up to two years for an operation. Now I can’t remember the last time someone contacted me about a long delayed operation. I also remember the elderly man who needed a hip replacement, but had no relatives close by to help him when he came out of hospital. His son lived in Redditch near Birmingham and the man asked if it would be possible for him to have his operation at Redditch Hospital so that his son could care for him afterwards. At that time the answer was no – now that should not be a problem. Some years ago the Government set a target of a maximum of 4 hours for a wait in A &E. A & E Consultants said this could not be done – now consultants will admit they were wrong, and the target has transformed the way they work in A & E.

But there is still a long way to go. I would like to tell you a story about Trudy. She is an elderly widow who lives on her own. Trudy has been admitted to hospital 5 times in the last 12 months, either after an accident or to treat one of her long term conditions. Trudy says her care could not be better. When she is taken to A & E she is seem within 4 hours, and Trudy says the care she gets from the hospital staff couldn’t be better. But can the NHS do more for Trudy – of course it could.

When Trudy comes out of hospital she should be met by a short term re-enablement team whose services cut across traditional health and social care boundaries. There are so many issues as I am sure that you all know only too well when someone first comes to of hospital. One simple example – how do you carry a cup of tea when you are walking with a frame? So it is important that someone visits the home and assesses the need for equipment or other help, and that whatever is need is provided very quickly, and is there when the person comes out of hospital. I am sure that you and your colleagues pick up examples where someone comes home to a house which is ill equipped for their needs, but this really should not happen.

Even better if it were possible to prevent Trudy having a fall in the first place. In County Durham the press mocked a campaign by the local Primary Care Trust to replace worn out slippers for elderly residents. It was claimed that this exercise was a waste of money. But this campaign actually helped to cut the number of falls by the elderly in the area by 60%

Other ways of improving life for the frail and elderly could include touch sensitive pads which turn on lights as soon as you get out of bed – so no stumbling around in the dark. There are monitors which stop rooms getting too hot or too cold, and others which raise an alarm if a person stops moving for a prolonged period.

It has been calculated that if the NHS can reduce the number of elderly people suffering from a fall by just 15% the quality of life for thousands of people will be transformed, and incidentally save the NHS around £260million a year.

I know the NHS is not perfect, but almost everyone who has had need of the services has nothing but praise for the doctors and nurses both in hospital and working in the community. Even at the recent lobby of Parliament by the Trade Union, Unison, it was confirmed that in a recent survey 63% of patients rated their care by the NHS as good or very good.

There are developments in the pipeline to move more services from hospital into the community including a new generation of community hospitals, (including one at Southmead alongside the new Acute Hospital which is to be built there). These will provide services like diagnostic checks, minor surgery, intermediate care and basic primary care. There are also plans to encourage the extension of GP surgery hours, and better integration of social care. The recent Government White Paper is promising better support for the army of informal carers, and I know that all of you would wish to support this. I will certainly support these proposals when they come before parliament.

In conclusion I would like to quote to you from the original White Paper which led to the setting up of the NHS in 1948. It said “The Government … want to ensure that in future every man, woman and child can rely upon getting all the advice treatment and care which they need in matters of personal health; that what they get shall be the best medical and other facilities available; that their getting these should not depend on whether they can pay for them, or any other factor irrelevant to the real need.”.

I believe that for the first time in many years the Government are endeavouring to bring the service into the 21st century whilst at the same time retaining the core principles of 1948. Change in a service which is valued so highly by all of us is difficult, but I am convinced that the changes being introduced will keep people well and not just treat them when they are ill.