Opinion
Once a thing of grandeur; but now in the doldrums of an appalling abyss of gloom
MBBS(Cey), DCH(Cey), DCH(Eng), MD(Paed), MRCP(UK), FRCP(Edin), FRCP(Lon), FRCPCH(UK), FSLCPaed, FCCP, Hony FRCPCH(UK), Hony. FCGP(SL)
Specialist Consultant Paediatrician and Honorary Senior Fellow, Postgraduate Institute of Medicine, University of Colombo, Sri Lanka.
The National Health Service (NHS) of the United Kingdom was the proudest and the most fantastic facility that all citizens of that country were intensely delighted to have, even just under 50 years ago. That is first-hand information from this author who had the privilege of working over there as a postgraduate doctor during his mandatory training period as a practising NHS doctor before being appointed as a Specialist Consultant in Sri Lanka.
In those halcyon days, our leanings towards the NHS as well as our connections with it made it virtually imperative that we got the final polishing of our vocation in the UK. All of us who trained over there learnt many things in that alien environment including the invaluable commitment to put the patient first in all our dealings. There was hardly any waiting time for all emergencies that were brought in to be attended to and referrals to consultants were promptly dealt with, within a maximum of one week. As a Registrar in General Medicine, this author has dealt with all emergencies within a matter of minutes. All referrals of admitted patients to another unit were dealt with inside of a couple of hours. The NHS functioned like a well-oiled machine performing at its best at all times, day and night. The axiom of the NHS was never to allow a patient to perish without a fight.
In a normal course of progression, one would expect even a very fine healthcare institution such as the NHS, to get even better with time. However, what has happened is exactly the opposite. In an article titled Satisfaction in NHS has now dropped to the lowest level ever recorded thanks to long waiting times and widespread staff shortages, published on 29th March 2023, Hanna Geissler, the Health Editor of the Daily Express Newspaper laments that shockingly long waiting times and widespread staff shortages have led to the public losing faith in the NHS, a statement based on a damning report titled British Social Attitudes Survey. Satisfaction in the National Health Service of Great Britain has now dropped to the lowest level ever recorded, thanks to the massive backlog in treatment caused by the COVID-19 pandemic. It was indeed a double whammy of shortages of staff and a pandemic causing unparalleled misery.
Although the public still overwhelmingly supports the NHS’s founding principles, including the provision of completely free healthcare at the point of delivery to all British citizens, just 29 per cent of the respondents in the survey said they were now satisfied with it. The crisis in the NHS means 7.2 million people were waiting for further assessment and treatment in January 2023, with three million of them having to wait for over four to five months. The battle to try and reduce the backlog has been hampered by low staffing levels with around 137,000 unfilled posts across the NHS and more recently by industrial action by several grades of healthcare professionals. The latest findings for 2022 have been published by the think tanks; The Nuffield Trust and The King’s Fund. Co-author Dan Wellings, a senior fellow at The King’s Fund, said the results should ring “loud and continuous alarm bells in the corridors of power”. He added: “It is easy to become desensitised to the relentless flow of bad news about struggling health services, but we cannot underestimate the significance of today’s unprecedented results. In 2010, satisfaction with the NHS stood at a record high of 70 per cent. Yet, satisfaction has now plummeted to its lowest-ever level, at just 29 per cent. People are struggling to get the healthcare they need, particularly in an emergency, which is borne out by the extraordinary spike in dissatisfaction with Accident and Emergency Services.” He concluded by saying “It is still the thing that makes us proudest to be British but these results are very clear – it is not working for large numbers of people right now.” To compound matters further, there has been industrial action being brought about by junior doctors from time to time, which has completely ruined the ability of the struggling NHS to provide the necessary services.
What is not working right now is a National Health Service in the UK that is under-staffed, and overworked, with disgruntled workers, as well as healthcare staff, being made to work under very difficult conditions. Dissatisfaction in a winter of discontent has led to many echelons of healthcare workers, especially the doctors and nurses leaving the country in droves to seek greener pastures abroad. This is compounded further by the failure of the NHS to attract young people into healthcare services, including the medical profession. Some highly specialised portals like newborn medical services known as neonatology have been made to feel the pinch even more than other healthcare providing services.
The fundamental problem is not shortages of medicines, nor is it a telling lack of infrastructure. It is a dreadful dearth of human resources across all strata of the NHS. Those who still work in the NHS are dissatisfied with their poor pay and difficult working conditions. Many areas of the healthcare provision services are terribly understaffed, stretched to the maximum and also made to work under the most trying conditions. The average waiting time to be attended to in emergency services in hospitals could be as long as four to six hours. Even ambulances that have brought in severely ill patients are made to wait in line at the Emergency Services to get the patients attended to. There are documented instances of patients losing their lives while waiting to be attended to at the Out-Patient facilities and Emergency Services. The referral services where medical specialist attention is required and requested are left in the lurch with consultation appointments being given sometimes at months long periods. Routine surgical operation services have very long waiting lists. All these are such drastic changes from the situation that prevailed half a century earlier. It is indeed quite a bleak scenario at present.
Now then…, let us look at the situation in our resplendent little isle. Of course, it is common knowledge that our health services too have had some significant and even drastic problems. Shortages of essential drugs, healthcare personnel resorting to trade union action, and staff shortages created by a significant exodus of healthcare workers; mainly doctors seeking greener pastures abroad, have been the bane of the National Health Service of Sri Lanka. In addition to all these woes, the patients were made to suffer for a couple of days when healthcare staff resorted to strike action. Although it is a service free of charge at the point of delivery in government healthcare institutions. out-of-pocket expenses for patients went through the roof due to the non-availability of quite a few drugs.
Yet for all that, even with a multiplicity of problems in our system, our scenario is nowhere even near as bad as it is in the UK at present. Even during all these trying times in Sri Lanka, emergencies were attended to without delay, even when healthcare staff were on strike. Staff were exempted from resorting to strike action in maternity hospitals, children’s hospitals and those units and hospitals providing cancer care. Referrals to consultants were attended to within a very short time. Specialised care was also available in the private sector for those who could afford it. All in all, ill patients were not left to die without the staff fighting tooth and nail in providing the best possible care for the sake of their patients.
True enough, the Sri Lankan National Health Service has had its fair share of problems. The newly-implemented draconian tax structure has imposed unbearable hardships on healthcare personnel. They have been made to protest and even resort to trade union actions. Loads of them are going abroad for greener pastures as the grass always looks greener on the other side. However, the general populace of our country also has short memories. They will not remember for very long the number of times healthcare personnel have gone even beyond the legendary extra mile for their patients. They will not remember how the healthcare personnel put their collective shoulder to the wheel to deal with the miserable COVID-19 pandemic, not so long ago at that.
Let us face the current situation with some gratitude and resilience as the provision of healthcare services in Sri Lanka at present is far better than that provided by the NHS in the UK. Most unfortunately, judging by all reports, that is the inevitable conclusion arrived at by this author who was trained to be a Specialist Consultant in the very same UK National Health Service, in what now looks like aeons ago.