Consultant plastic surgeon Miss Philippa Jackson rails against health secretary Wes Streeting’s plans for NHS reforms as a “Sticking plaster on an ulcerated wound”.
There ‘will be no more rewards for failure’ health secretary Wes Streeting recently announced, outlining his plans to sack executives for failing to deliver and to reduce funding for struggling Trusts.
Is not having the resources to get ahead of the unprecedented pressures on the NHS really a failure by NHS executives, or is it, more likely, a systemic failure that demands a systemic solution?
Sacking executives for failing to meet targets is a temporary plaster on an ulcerated wound. The problem runs much deeper than playing catch-up on waiting lists, or even naming and shaming failing hospitals. If much-needed funding is going to the best-performing hospitals, how are the worst-performing hospitals, left with a limited budget and reduced staff, meant to improve? Improving is impossible if you don’t have the resources to do so.
As surgeons, we do not want to see patients facing long waits for surgery; we want them to undergo the surgery and treatment they need, as quickly as possible.
On the surface, improvements have been made by forcing through more appointments, but if these assessments result in surgery, the patients pile up at the other end. We cannot catch up. In addition, primary care is straining under the weight of bulging patient lists and inadequate numbers of trained GPs. Social care has been eroded over decades, so hospital beds are occupied by patients who require support at home or care packages, but not specialist tertiary hospital care. The pieces of the NHS jigsaw are becoming increasingly difficult to fit together.
Is the answer to punish executives? I truly believe not. They are in an impossible situation in which they must ask overworked staff to do more than their contracted hours in order to meet targets, or risk losing their job. Staff, including surgeons, anaesthetists and theatre staff, are then doubling down on the pressure: we do not want to see people fired, so we take on the extra work. This is to our own detriment.
Many of us are finding striking the balance between work and personal lives is becoming increasingly challenging. I cannot reiterate enough times: if we are to carry out more surgeries, reduce waiting lists and stop the arbitrary firing of NHS execs, we need an overhaul of the existing system, not a set of rules that demoralises and forces us into choosing between patient welfare and that of ourselves and our families. Because the reality of the situation is that when we try to meet these demands, despite the challenges, we then must deal with the personal consequences. Our mental health suffers from never being able to switch off from work, and our family lives bear the brunt of our absence. We agree to longer hours. We agree to work weekends. We agree to triple our surgery lists. But none of this is sustainable. Something has to give, and ultimately, it will be the surgeons and their anaesthetic colleagues.
And then what? Wes Streeting will be left with fewer surgeons, as those who aren’t already burned out will be off sick, pushed to the precipice of their mental capacity. He’ll have fewer executives too, having ordered their dismissal for failing to meet impossible targets. It’s an unworkable situation where everyone loses – and, as always, the ultimate victims will be the patients.
The answer will be complicated, of that I am certain. There is no quick fix for this – we are past the point at which we can simply demand ‘more hospitals and more surgeons’. The perceived quick fix of ‘clamping down’ simply will not work. Do we need to reimagine the NHS? Perhaps that is the answer. It is not my job to work out how to fix the NHS, but it is my job, as a frontline member of staff, to point out that every day it is breaking a little bit more.
Miss Philippa Jackson is a consultant plastic surgeon and board member of the Confederation of British Surgery.
