This time it really does not appear to be hot air. I read the actual text
of the Budget speech, and the NHS is being promised 6.1% a year
compounding up to a remarkable £19 billion. The current spend on the NHS
is £45 billion, so this is an enormous input.
I wonder how much of that will actually filter down to the coal face, as
if my hospital is any guide, considerable amounts of money need to be
spent simply to repair the infrastructure and bring services up to a
sensible standard.
However, I think we could do worse than try and arrive at a consensus
wishlist. Here are some that would seem to be a positive start from the
patient's viewpoint, not necessarily in any particular order; I'm sure
there are many more:
1. 80% of patients are seen within 1 hour, irrespective of complaint, by
the end of March 2002. Any patient with significant pain is seen
effectively immediately.
2. 90% of patients have access to a major A&E unit
within 30 minutes' normal road travel (i.e. not a blue-light ambulance);
every town of 50,000 or more has a major unit.
3. All A&E departments have access to 24 hour pathology services by end
March 2001.
4. All A&E departments have access to 24 hour CT, MR and ultrasound by end
March 2002.
5. The Government's closure programme is halted immediately and all
threatened units are reviewed individually in the light of target 2.
6. The BAEM staffing recommendations are accepted in full, with
implementation of training and middle grade levels by end 2002 and career
levels by end 2006.
7. A review of nursing numbers required for patient
care is undertaken nationally to determine what the correct staffing
levels are for various sizes of department, and the recommendations fully
implemented by end 2004.
8. All departments to be computerised by end 2002.
9. No patient waits more than one hour for a bed.
Many of these look unattainable, but I believe that we must regain the
initiative from the managers and remind them that humanity is a large part
of medicine. The one thing I find terribly demoralising is to have a
continuous stream of exasperated punters who see no good reason for being
dammed up in a waiting room - indeed, the very presence of such a room is
an admission of failure of sorts. Better staffing, more efficient use of
support services and not closing major units - it has to be the way to go.
Best wishes,
Rowley Cottingham
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