Elephants

It has been a long time since my last post but my family and career must come first and if anything I write threatens them, I need to temper my emotions; thus less to say of pertinence.

This week I was invited to sit on a panel during a live national television debate on the 'NHS Crisis' and so, after four busy night shifts in a row, I appeared, bleary-eyed, in front of the nation, along with other healthcare professionals and an assortment of politicians, celebrities and members of the public with a story to tell.

The programme, called 'NHS in crisis - the live debate', which you can see here, discussed the failings of our great healthcare system - the strain it is under and the possible causes. It ran for an hour and I sat, for the most part, in the audience, whilst waiting to take my seat in front of the cameras to say my piece.

I watched the audience and I listened to the panels that came before mine and it became clear that there was an awful lot of hatred for the Government and its policies. Fair enough, there is indeed a major problem with the way the NHS is being run and financed and politicians seem to be avoiding the issues that could break the system. But money gets thrown at it from all angles; every time there is a warning of impending collapse, it seems like a few more hundred million is injected into it. This, to me, is much like injecting antibiotics into the body of someone with a deadly viral condition.

At times I felt overpowered by the feelings of hostility and a few totally irrelevant things were said; things that will go nowhere and do nothing to fix the NHS. One extremely angry woman almost spat venom in her attempt to get a point across but it was anger that would serve to change absolutely nothing about the way the system works and the way I operate within it. It did, however, lend us all a moment of the public's frustration.

I was given a very short time to make a single point - I had many points to make and a lot to debate but I got nowhere near the time I needed to do so. The NHS 'front-line' was heavily represented by doctors and nurses. Apart from myself, there was just one other paramedic present to say something, and he only got seconds to make a statement from the audience.

Now I don't mean to be picky here, but let's define the 'front-line'. A hospital, and therefore its medical staff, is not on the front-line. Patients either present themselves there or are referred there by other healthcare professionals. Doctors and nurses working in hospitals do not go out and get these patients; they do not see them when they are at their worst, or at the moment of their deaths in the streets or at home. They are not subject to the same level of unprotected aggression and violence that ambulance professionals are.

They do an amazing job under very difficult circumstances and they are under extreme pressure, just as we are, but unless they are face-to-face with a patient, away from the protection and backup of a hospital or surgery, they are not truly front-line.

There are very few doctors and nurses working on the front-line as I see it. HEMS teams do and out of hours GPs and nurses do (when they actually go out).

Why does this make a difference? How can you debate the failings of a system like the NHS unless you are at the raw edge of it and can actually see what some (not all) of the problems might be.

The NHS is an old system, designed for a post-war population, when people were generally a lot more responsible for their own health. I find it highly unlikely that as soon as the doors opened to the first Accident and Emergency department, it was inundated with individuals with sore throats, mild back pain and drunkards. I wasn't around then so point me in the direction of a news item or photograph that says otherwise.

A proper debate on the subject needs to be given a balanced representation. Those not on the front-line will see the political problem, whereas we tend to see the root problems.

The cheering and applause was loudest for anyone who said something about Government policy and how they are to blame. Most of the negative responses, especially by some of the doctors and nurses in the audience, were elicited by any comment that appeared to blame the patients themselves.

In the audience sat an obese man who knew he'd brought it upon himself but still felt the NHS should pay for his treatment. And a young man who is suing the NHS because of a nose-job gone wrong. In both cases, when the presenter attempted to shine a light on the possibility that they represented part of the problem, the audience jumped up and down about it. I got a real sense of a massive drop in value of common sense and truth and I have to say, I found it unnerving. We seem to be a nation that defends those who may actually be contributing to the situation because we feel its better to blame a Government rather than an individual.

And of course, no individual is to blame for all of the problems of the NHS but if we don't open our eyes and see the little contributions to impending disaster, we are going to implode.

I spoke about young binge drinkers - those individuals who go out for a night and get so drunk that they end up in hospital. I felt this was a very important point to make but I could feel the audience distancing themselves from the suggestion that those individuals should be fined and that they should pay for their stay in A&E. Its simple; we bring them in because they are not fit and unsafe. A doctor examines them and declares them to be drunk (as if that really needs a medical exam to confirm). They sober up and they get a penalty ticket for £75 or whatever would be seen as suitable.

Drunk people take up a large number of beds in hospitals. In fact, alcohol-related visits to A&E account for most of the violence and wasted time experienced by staff. They are also a major cause of delays when it comes to getting ambulances to truly sick and vulnerable people. We still get calls to elderly people who are on the floor and have been for hours, especially during the weekend. A 19 year-old female who is said to be 'non-responsive' or 'unconscious' or 'not breathing properly' due to drinking, is likely to get a faster response than an 80 year-old on the floor and 'can't get up'. We are all sick of it, and when you look at the descriptions I've given for the young girl, don't they just sound like the sort of things that happen when you are very, very drunk?

How many drunken young people have died in the street or in a club or pub because an ambulance wasn't called or was delayed for hours? How many elderly people have, or could have died waiting for us? To me, the sums are easy.

The debate solved nothing and it created no force for change. Only one of the doctor guests (most of the doctors on the panels were TV celebs), made a statement about people taking responsibility for their own health. She got nothing back from the audience. Obviously, like myself, she was blaming the patient and not the Government. What she was doing was telling it like it is.

On my panel, a doctor stated that there was 'an elephant in the room' but failed to make the point. Funding and Government inadequacies are not elephants in rooms because they are plain and obvious problems and we all shout about them. The elephants are the problems we dare not talk about for fear of ridicule or attack from people who believe everything going wrong is the fault of the ruling party.

Sure, we need a cash injection to help modernise the NHS and bring it up to date. We need to pay doctors, nurses and paramedics what they deserve. We need to change the way the system works to better cope with a larger and more elderly population. But we also need to be honest and stop pretending that it's all about money - it's also about attitude and responsibility.

Demand for emergency services has risen dramatically because we are importing large numbers of people who use them because they are free. More and more tourists are descending on the country each year and they don't know how to use the NHS. Alcohol-related calls are increasing and nothing seems to be slowing the tidal wave of irresponsible youth. The elderly population is on the rise because people are living longer, ironically thanks in part to the NHS - these people fall a lot, they injure themselves and they have chronic or terminal illnesses that require treatment and emergency care.

The social care structure is also failing because emergency ambulances are being asked to go to more and more calls where the problem is social, emotional or mental health related. We can do nothing for these patients, so why are we there?

We bring all of this, and more, into hospital A&E departments, or we use another clinical pathway and we turn a steady flow into a Tsunami. If we just took care of one of these elements, we could start to reduce the flood. I suggested penalising those who get drunk and then expect the tax payer to pick up the bill for their night out. I'm suggesting making them responsible for their actions. That's just one idea and it might, just might, make weekends in A&E that little bit less critical.

I noticed that on New Year's Eve we had fewer drunken patients to deal with. This was the year that Boris Johnson charged an entry fee. If you wanted to get into Central London and watch the fireworks at midnight, you had to pay a tenner. I can't say for sure, but I think that small penalty put a lot of people off and therefore a lot of irresponsible drinkers (who'd rather have the extra money for alcohol) simply didn't show up. Voila!

This is a complex argument, I know and it's almost impossible to debate this subject without provoking anger and upsetting people. We all have different views but I think this live debate was mainly about what doctors, nurses and politicians had to say. The input from paramedics was dilute at best and that's a shame because if you had a room full of us, you'd soon get ideas for solving some of this crisis. Many won't like them and they may not be popular but they'd all make people responsible for their actions and more aware of their own health.

The alternative is to spend billions more and keep throwing money at it until another generation inherits the wreck of it. That's what we seem to do best.

Be safe.