Tuesday, 21 September 2021
UNLESS you have been living under a rock (or just overindulging at Henley Royal Regatta) you may have noticed that last week signalled 70 years of the NHS.
Cue intense media coverage, live television broadcasts from hospitals and, coincidentally, now a new Health Secretary.
There is so much information out there about such an enormous organisation that sometimes it can get quite confusing, even to those who work within the service. To that end, I feel it would be useful to write about what it actually is and how it works at the most basic level as well as what that means for us locally.
Health is obviously very important for a population and there are lots of different ways health can be managed. Services that can have a positive impact on our health, for example doctors, nurses and social care were, before the advent of the NHS, generally available to only those who could pay for them. In many countries, this is still the case, meaning there is a large gap in wellbeing between rich and poor.
When the NHS was introduced 70 years ago, our taxes began funding health care for everyone at no extra cost at the point of use, thus to a great extent ironing out those health inequalities. This means that if you have an accident and require hospital treatment, no matter how complex, it is all free and nor do you require insurance.
If you want to see a GP, you can ring up and arrange an appointment to see one for no fee. If you need a physiotherapist to sort out your dodgy back, you can ask to be referred to one and you don’t need to pay for it. That’s pretty amazing when you think about it. We are all used to that (those of us who are under 70, that’s all we’ve ever known) so we can be forgiven sometimes for being a bit complacent.
Times have changed however and, as our population has grown older, and we have learned how to treat more conditions in more innovative and technologically advanced ways, it has become more financially challenging to provide all of this for free. Hence the phenomenal pressure on the service we see currently.
I’m sure you will be familiar with the plethora of allegations about healthcare spend and percentage of GDP and the like – this is not the time or place to go into it, though I would say that if there were an obvious easy answer to it all it would have been implemented by now.
For the purposes of this article, it is in everyone’s interests to know how it all works and what services there are available. Each discrete NHS service is often run completely separately from others surrounding it. You may say this is extremely inefficient but, with such a broad and wide-ranging organisation, comprising GP surgeries, pharmacies, hospitals, social care, community hospitals and more, integrating everything is incredibly difficult.
The system in place at present does its best to do this. The Department of Health sits above all else and, put simply, manages the overall budget to provide money to the NHS. In the past it has had more to do, but much of this is now delegated to the organisation known as NHS England which is a non-governmental independent body. This service undertakes more of the management of the NHS as a whole throughout the country and diverts the finances onwards to more local management organisations.
These local organisations are known as clinical commissioning groups (CCGs) and in turn they commission services in their local areas in response to the needs of the local population.
There are more than 200 CCGs in Britain. They meet regularly and are largely run by GPs. Examples of services they may commission with the budgets they are given by NHS England include hospital care, rehabilitative care, urgent and emergency care, including out of hours, most community health services and mental health services. GP surgeries may get some money to provide local services from the local CCG too but they also receive payments direct as part of their contract with NHS England for providing general services on a per patient registered basis as well as extra services such as immunisations and flu jabs.
Our Oxfordshire CCG is further split into different localities (we fall into the South East locality) which have their own regular meetings to discuss demands and how best to spend the money available.
Initiatives such as hospital at home (teams based at community hospitals that are able to see patients at home to provide treatments such as intravenous therapies and thus avoid admission to hospital) and out of hours provision are all commissioned by these CCGs.
Our area includes the hospitals at Townlands and Wallingford, providing services that range from outpatient consultant care, radiology, minor injury units and community nursing. The list is quite long!
That is essentially how things work in a nutshell. How do we give it a helping hand? You may have heard of many stories about people attending A&E inappropriately. For example, for a broken fingernail (this is true by the way).
While such extreme inappropriateness is thankfully not that common, the fact remains that a high number of A&E attendances and GP attendances are still inappropriate.
It is up to us all to think about what action we need to take in the event of accident or illness and this may not always be to visit your GP or hospital.
Too often, people who genuinely need urgent treatment are unable to get it in a timely manner because the system is full of people who could manage their illnesses either by themselves or with the help of a pharmacist.
If you have a cold, you don’t need to see a GP, even if you want it to be better before you go on holiday the next week. Similarly, if you have an appointment and can no longer attend, it is important that you cancel it in a timely manner so that someone else can be seen.
If you do have a minor issue, check either with your pharmacist or on www.nhschoices.com first as often these will give you the same information or advice as we can.
All of that said, I occasionally see people who have delayed coming in but are genuinely ill saying that they were reluctant to take up an appointment because “I know how busy you are”.
This only goes to show how wide the differences are in our expectations of what a healthcare professional can offer. I would hate to think that people stay away in circumstances where they really need help.
Overall, it is of vital importance to the NHS that people take some responsibility for their own health. Just as we tend to pick up a free newspaper even if we don’t particularly want to read it, the NHS is a service that by its very nature is prone to being taken advantage of on occasion.
In order to use it in the spirit in which it was created we need to utilise the information readily available to us a bit more, keep ourselves healthy and get out to the gym once in a while. That way, when we really do need it, it is there for us all.
23 July 2018
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