NHS – Writer-insighter

A sharp intake of breath

I had a really bad cold last year. It seemed to go on for weeks. I got what my doctor hesitated to call full-on pneumonia but she couldn’t think of anything else to call it. I had my ears syringed for the first time ever and I had ringing in my left ear afterwards. I went to Dorset trying to impress someone lovely with my hiking abilities which was slightly marred when she practically frog-marched me up a hill. And remained resolutely unimpressed, or at least she didn’t show it in a way I’d entertained.

My left ear has kept on ringing, or more accurately making a high-pitched whining noise but I teach so I’m used to that anyway. Two weeks ago it got really loud so I went to the doctor again. I thought she’d do much the same as my friend in Dorset; recommend neck massage, decline to do it herself and just be very nice. She didn’t. Instead, she sent me for an MRI scan to see if I have a brain tumour.

On Wednesday I still hadn’t heard when I was going to have this done after ten days so I rang the doctor. Odd, they said. It’s an urgent scan. I did the sharp intake of breath then. Phone the hospital. I did. They said it wasn’t urgent. At which point I had to put them right on some minor details. Like the fact I might have a disease which now that A Cabinet Minister has it will see attention and urgent something must be doning left right and centre. Given that Tessa Jowell’s government was quite keen on privatising the NHS and she seems keener on magical thinking and untrialled wonder drugs (wasn’t there an Austrian who did that too?) don’t expect anything much to change.

I phoned the doc again. It is urgent. We’ll email them now. I phoned the hospital and said I’d stay on the line until the email came in. It duly did seconds later. Oh yes. It is urgent. How about Saturday?

No four weeks, no rationed health service bullshit an American tried to tell me is normal in the UK on Facebook this week. Just the same as I’ve always experienced with the NHS: once something is flagged and it’s a dangerous thing they act fast and effectively. It’s always been the same with doctor’s appointments too in my not overly-funded rural area: if you need an appointment urgently then you get one. If you want an appointment that fits in with your lifestyle then you can obviously wait.

So I might have a brain tumour. And I might die within the foreseeable future rather than as an inevitable indeterminate abstract. My friends’ reactions, those I’ve told, have been mixed.

An ex is devastated and can hardly speak. My Dorset friend is taking her forthright view that there are lots of other things it could be. A friend in Spain is thinking of me. One in Portugal too, and making jokes to hide her shock. The biggest surprise was a very old friend who took the opportunity to launch into an attack on unspecified waste in the NHS, in her view substantiating this by recounting how she had to sit around Out-Patients with her son once.

I think she missed the point. If you’re in Out-Patients then you self-evidently are not a medical priority. I remember sitting there once, years ago, with a painful burn all one Sunday afternoon after I soldered my wrist to a car battery by wearing a metal-strapped wristwatch, which at least taught me to never wear plebian fashion ever again.

Today is Friday. A brilliant friend is driving me to the hospital tomorrow, in case it’s not great news, in which case she says I won’t feel like driving.

I don’t know what the news will be; that’s why we’re checking. But I do know that I won’t be charged a single penny for this scan. Not one. And if you want treatment free at the point of use, or you want to be bankrupted, then you need to ask specific questions and think very carefully next time you vote. Because one thing I do know from this. One day it will happen to you. As surely as the sun rises your sun will set for the last time. It really does toll for thee, and not a toll of the kind Jeremy Hunt thinks is a brilliant idea. You are not going to get out of this alive. How much do you want to pay first?

The lost time

I nearly died once. Actually, that’s not true. I nearly died quite a few times. The time I crashed a motorcycle, the time I walked into the middle of an Israeli Defence Forces ambush – and don’t even start me on the bullshit behind that name – or the time I jumped onto some railway tracks to rescue someone. Or the more fundamentally stupid time I jumped onto Tube tracks to rescue my hat. Or the time a friend and I got a lift in what we still call the Blue Mazda Truck, whose driver steered up Limpley Stoke hill st 70mph, steering with his knees while he rolled a cigarette, laughing to himself.

Or the time I actually saw a bullet ricocheting towards me and somehow in that slowtime of big accidents skewing how time goes had the time to reason that if I could see it then it was heading toward me and moved and heard it spin through the air by my ear. Ok, that one probably wouldn’t have killed me. It probably wouldn’t have done my eye much good either.

Stuff, you know? Stuff. Everyone has stuff. It’s what you have.

The time I nearly died for four years I was reminded about this week. Someone I sort of know a bit on Facebook (as in we’ve PM chatted but not met) broke a leg in a minor accident. All well. She didn’t fall outside and get left in the snow or drowned in the floods or anything like that. She posted pictures of her cast and what a bore and never mind.

The next thing she knew was the elephant sitting on her chest. Or that’s how she described pulmonary thrombosis, the result of a deep vein thrombosis springing itself loose and going on a wander around your body. The “get well soon”s and “have a glass of wine and sit down” didn’t seem to cover it.

Having a glass of wine is good way of killing yourself if you’re on warfarin, probably the most common emergency anti-coagulant. Except it’s not. A good way of killing yourself would involve things being quick and painless and clean, rather than the long-term cold and pain and messily massive haemorrhaging that screwing-up with your warfarin dose usually brings.

I knew about deep vein thromboses because I had five of them. They took four years out of my life thanks to a series of doctors at Leiston surgery in Suffolk who refused point blank to do a blood test that would have cost about 80p, let alone refer me for a scan. Which would have told them exactly what I told them: I was doing a lot of long haul flights. I’d had the word thrombosis in my head since I was fourteen. I don’t know why. Nobody in my family had had one.

I kept getting sudden skewering pain that dropped me to my knees and five minutes later I was fine. Except I wasn’t. For some reason I couldn’t fathom I’d often, or if not often then regularly vomit for no reason I could see, but associated with the stabbing pain attacks. I felt cold all the time. My pelvis ached and I didn’t want to move. I felt colder and older and slower and sadder, feeling that I was dying. For the simple reason that I was.

DVT is massively serious. Your blood stops flowing. It clots because it’s not flowing. That’s bad enough. If the clot breaks away from where it formed it goes first to your lungs, where apart from being excruciatingly painful it can kill you. If it moves on from there it will go to your heart. Quite often it goes through your heart but gets stuck the other side, so your heart will be happily and very soon unhappily pumping blood into a blocked artery until it literally bursts or gives up wasting its time. If that doesn’t happen your clot will continue its way to your brain and block a blood vessel there, which means if you survive that you might have to learn how to talk again and eat with a plastic spoon. You might want to have a think about whether you actually do want to survive and do all that again. And leave some written instructions for your next of kin, somewhere they can find it in a hurry.

There is nothing good about DVT. In the same way there is nothing good about a Suffolk health service which refuses to even acknowledge DVT as an issue. It should be obvious to anyone that someone with a broken leg is a major DVT risk candidate. In France they’d get an anti-coagulant jab as a precaution. But not here. That would cost about £2 a day. Far cheaper to wait until you have a proper bill for treating a pulmonary embolism. Or the person just quietly dies and stops bothering the doctor, the way the government and some clinicians would apparently prefer.

Starting late

I did a thing people have told me to do for years. I went to the doctor and asked to be referred for and that’s the problem.

I don’t know what. You walk in. You don’t know where to start or what to say. I’ve got, I’ve been told, a warm, nice, calm voice. The kind of voice girls like. I speak clearly. I used to have the most awful Sloane bray and if I can’t hear and I’ve been drinking, I still do, but the doctor’s surgery was quiet and and I haven’t had a drink today. I’m going to when I’ve finished writing this.

I sat down. I watched the doctor getting impatient. I could see her face clouding. So I told her I’d been abused as a child. She thought I meant sexually, but I don’t think I was. Physically and mentally. As Meatloaf used to sing, out of three ain’t bad, doc. Two out of three ain’t bad.

My father was a bigamist. Probably. He was definitely a professional liar. He pretended he’d been born in Australia, but he wasn’t. I found out by going to get a copy of his birth certificate. He’d removed it and mine and my sister’s and my other sister’s and every other piece of official paper in the house when he finally left, but for most of my childhood he was hardly ever there, just two or three times a week as I remember it. We went on holiday a couple of times, and he had to do bizarre things on his own, like going to visit a church to see the special window dedicated to the RAF, which he claimed he was in as well. He never, ever went near a church in all the time I knew him, so I’m presuming this story, like every other story he came up with was pure horseshit. He was probably phoning his other family, the one he ran at the same time.

Trashing the NHS

The nurses are on strike today. In the usual way that people speak to very small children the government has told them they can have a 1% pay rise or something else but not both because Mummy and Daddy can’t afford it.

So far as I’ve seen, nobody in government, the press or officially, the health unions has stood up and called this the utter horseshit that it is, that if a government can increase ‘the deficit’ and call it reducing it and at the same time commit to an endless war against abstract nouns when it doesn’t even know who’s on which side, assuming there even are any sides, then clearly it can afford anything it wants to.

But that’s unsayable. As Goering pointed out at his inevitably-decided trial at Nuremburg, the kind we should have had in 1997 except we didn’t know then we’d just voted in the same thing but with more hand-movements and a smile, it’s easy to get people on side with the idea of a war they don’t want. You just call them traitors if they say anything against it and tell them the enemy (anybody, it’s never really mattered, take your pick) wants to rape their dog and take away their iPad so they can’t watch X-Factor. Or the contemporary equivalent. And it always works, because it takes a bit of an effort to find out the truth and dogs and iPads don’t pay for themselves and there’s stuff to do.

Another truth that is a bit hard to find out because the media themselves are a bit too busy to mention it is that there will never be an NHS privatisation bill. There doesn’t need to be. It’s already been done.

For the last six months I’ve been working for the NHS, at a mental health Foundation Trust. It was supposed to provide services to two large rural counties to help people in fragile and damaging states of mind. Effectively now, it can’t, by design.

The first project I worked on was to provide a drug and alcohol service for around one and a half million people. We calculated what it was going to cost to provide it, working on the NHS overhead figures which usually come in between 20% and 25%. It pays for things like training, pensions, and all the expenses you can’t get rid of, such as the maintenance of buildings that have had to be shut almost as soon as they were opened, because there isn’t the money to run them. I can show you two, boarded up and unused as one of them has been since the last brick was laid. The maintenance building is closed now as well, so anything that needs doing won’t be done by the NHS and will have to go out to tender.

We thought somebody like SERCO would bid for the Drug & Alcohol work, along with other NHS Trusts from other areas. We thought SERCO would put in a bid at about 70% of our own NHS bid, because SERCO can afford to do that, operating on an overhead margin of 6%. Of course, SERCO don’t have to pay for training, or full-time staff and quite often deliberately underbid to get the work, as they did when they provided GP cover in Cornwall, where SERCO felt one GP was enough to cover the entire county some nights, and if that wasn’t really quite enough they’d falsify the records to make it unhappen anyway. Which is why SERCO is facing multiple different counts of criminal fraud. Which is not why SERCO is barred from pitching for any further NHS work, because it isn’t. This behaviour is entirely acceptable and in no way will or even can count against any further bids SERCO put in. Because that’s the system you voted for, especially if you didn’t vote.

None of it mattered anyway, because when we got the official budget from the county council which has the statutory duty to provide these services and can’t, so they contract them out to the NHS or anyone else who fancies a go, the money available was just over half the amount the NHS thought would be needed to do the job. So the NHS didn’t bid, because it couldn’t do the job for that money. Someone who thinks they can will be doing it instead. The NHS budget Cameron was talking about wasn’t even relevant. Any journalist could have found that out, if they’d wanted to. They just didn’t want to. This was County Council money. This is how it works.

Obviously, whoever gets the contract won’t be providing training or pensions or standard terms of employment or company cars or even minibusses to get staff from one end of a poorly served hump of land jutting out into the North Sea with hardly any trains and busses about as rare as a Labour voter around here. Because the NHS is safe in the Conservatives hands. They’ll take good care of it. So that when the last service the NHS currently does is put out to tender, when more staff have left, when the last bid can’t even be pitched for because it simply can’t be done for the money the local authority thinks is a perfectly reasonable amount, all that lovely prime development land on the edge of the town can be sold, mature trees, bus stop and all mains services connected.

Buyers are advised to carry out their own surveys and advertised services may not actually work, obviously. But that’s not really the point, is it? Nobody’s interested in how the NHS operates or what works and what doesn’t. You shouldn’t even be asking questions about it. Can’t you see the enemy are making you think that way? What are you, some kind of ISIS apologist?

NHS – a breach of trust

Contract by contract, one reorganisation at a time, the NHS is being rearranged so that it can’t really do anything that would warrant the word ‘national’ in the title. Where I work, in a mental health foundation, services are split not just between two counties but into different parts within the same county. The level of service is not the same.

A lot of the time services have to be outsourced to external organisations, ‘third sector’ charities using sometimes untrained staff on lower wages as well as the SERCO/G4S end of the commercial spectrum who can also spectacularly undercut NHS bids for contracts by using minimum wage staff on zero hours contracts. SERCO has an operating profit target of 6% instead of the NHS’s 20% to 25%. The NHS profit goes on training. SERCO get the trained staff free, inherited from the NHS until they leave.

Everything has to be tendered. If you want ambulances the NHS ambulance service has to bid for the work. If you want community services, or a drug and alcohol treatment service, that has to go out to tender as well. The fact that the services my hospital can offer have been pared to the minimum and each NHS Trust has to compete against other N HS Trusts makes it easy to pick off the contracts one by one, leading to more closures and cuts as there are fewer and fewer NHS patients to cater for. There are more patients, or service users as they’re supposed to be called, overall, but not for the NHS. SERCO et al got those. You don’t see this on the news for the same reason there will be no massive NHS Privatisation Act; it’s already being done, without fanfare and so far as I can see, without any media paying much attention at all. Or maybe they know all about it and think as it’s the government doing it then it must be a good thing.

I think of it as a breach of trust. The NHS was not set up to work like this, which is why it doesn’t work like this and this is being done deliberately, to “prove” it doesn’t work and justify the cheery picking break-up of services so that the NHS is left with the difficult and expensive things to do and everything else can be jobbed off to the cheapest bid.

The easy things, for example. But private contractors breach trust even with these. My hospital jobbed off its wages administration to a private contractor for the usual reasons: it was supposed to be done better and cheaper and more competitively, because everyone knows that private contractors work that way and nationalised industries don’t. It’s gospel, since 1979 and you won’t find many MPs in any party who say otherwise.

Quite why that means everybody at my hospital has to chase their wages almost every month isn’t clear. People only go to work for somebody else in the expectation they get paid. Otherwise they might as well work for themselves. So when wages aren’t paid on time, when you have to phone up to ask when you’ll get the money for the job you’ve done, when you’ve learned there’s never, ever any point in asking why your wages haven’t been paid because there’s never any reason that you’re going to be told other than ‘we felt like getting some more interest on the money in our account instead of paying it out to people like you,’ or ‘you know all that stuff about how we’re more effciient? That was just crap we said to get the business,” and you certainly won’t be told either of those things, at least one of which is true by definition at any given time, the privatisation work is petty much done. Hardly anybody wants to work there. Simple because it takes more to build trust than simply putting it in your name. Obviously the new chairman is looking into this as a matter of urgency. I wonder if he’s paid on time?