Patients First – A personal view of the ailing NHS

When my husband was dying three years ago we experienced the trauma created by a chaotic system of so called joined up care in the community.

We witnessed lack of communication between services at the most basic level, astounding waste of professional time and money in the same assessments being repeated many times, delivery of equipment which was inconsistent with his developing health problems, absurd restrictions on professionals carrying out basic procedures, gross over-prescribing of medication based on a computerised repeat prescription system and most distressing of all, lack of access to urgent care.

Following his death, I had a number of meetings with senior professionals from all levels of health and community care involved in his case, and it was our hope that improvements would be made in the future.

The current crisis in the health service is not simply a matter of money or an ageing population. Within the multi-faceted maelstrom the focus has shifted from putting the needs of patients first to one of money, resources and “systems”.

Examples include:

  • Patients who are medically fit for discharge from acute hospital beds, but not fit to return home to look after themselves.

It can take days or weeks for community care to be implemented even after patients have been sent home.  These patients need continuing care.  This used to be done by smaller nursing units housed in convalescent homes, nursing homes and cottage hospitals, no longer in existence.  A return to these GP linked local residential nursing units could help to relieve the pressure on beds in large acute hospitals.

  • Patients clearly need 24 hour access to primary care to ease some of the burden on A&E units.

A & E departments also need more doctors, nurses and beds to provide the patient care they were trained for.  Surely, instead of reducing the number of A&E units and locating in city areas we should be increasing them and the staffing levels within them. If necessary  additional A&E admission wards could be built alongside them.

  • Medical staff at all levels in the service are apparently under unprecedented pressure. This was illustrated last year when junior doctors took industrial action in protest against the imposition of new contracts. Rather than expecting more from existing medical personnel, the service should be increasing the number of trained doctors and nurses working within it, so that all staff can work efficiently within safe limits for the benefit of staff and patients
  • Millions of pounds are wasted in tiers of “intermediate” services designed to filter but also effectively delay patient access to health care professionals.

Delay in treatment potentially prolongs the period of ill health, can result in readmissions, clogs up the health service and costs millions of pounds in staff who are unable to provide advice or treatment directly to the patient. Sick people need access to medical staff with the qualifications to make medical decisions.

  • In our experience medical staff did what they could, but availability to treatment was often decided by a tick-box culture which could not take the needs of the patient into account.

This “system led” culture persists at every level of patient encounter – one example being the 111 service –  patients usually have to go through an automated telephone multi-layer queueing system to speak to an operator and then, despite explaining symptoms, they are asked a battery of questions totally unrelated to their individual problem.  While designed to ensure safety, these procedures waste much time, delay patient access and often result in referral through to the emergency services when consultation with a doctor is what is needed.

While more money and systems can be poured into this acutely sick patient, until the whole structure of the NHS alters to put patient needs at the head of the agenda,  money and vital professional resources will continue to be wasted at all levels in the system.

Patients need doctors and doctors need to be able to make medical decisions based on a patient’s presenting medical needs at the time.   While recognising that the NHS is grossly underfunded in relation to the demands place upon it, putting patient needs first should be the starting point for assessment and treatment of this severely ailing service.

Published: 8th February 2017
Category: Sally Goddard Blythe

Pressure on children under seven

“My 6 year old child gets angry and frustrated when he is made to write”.

“My daughter is tearful about going to school because she is afraid that she won’t get all her spellings right”.

“My son has become anxious and is tired all the time since starting school”.

“My child is 5 and won’t read”.

These are just some of the concerns that parents increasingly voice to me every day, worried that their child, only in their first year at school, already has a problem.

While some children will struggle in mastering the 3 “R’s” and will need additional support, there is also considerable variation in the age and stage at which individual children will be “ready” to read and write, with natural differences occurring between boys and girls of the same age.

Girls for example, tend to develop language and fine motor skills slightly ahead of boys, while boys generally need more time and opportunity for robust physical play.  The current school system does not take these different needs into account.  Some children are ready to read from four and a half years of age, while others may not be ready until nearer seven.  Respected experts in child development from yesteryear such as Rudolf Steiner and Maria Montessori observed that the time of reading readiness tends to coincide with the shedding of the first milk teeth, usually from around six years of age.  Despite this, and playing lip service to the importance of developing the whole child, the application of the early years’ curriculum in many schools is dominated by a “top down” approach, which focuses on outcomes and targets at the expense of the developmental needs of the child.

Mastery (and enjoyment of!) reading writing and numeracy develop in the context of a child’s physical, social and emotional understanding of the world and are nurtured in the milieu not only of instruction but also of play and reflection.  Language skills for example begin with hearing, listening, vocalising and interactive communication.  This is because written language evolved from an oral tradition in which knowledge and experience were passed down through the telling of stories, singing of songs and ballads.

While vision is the primary sensory pathway through which children learn to read and write, visual processing alone is not enough. Visual symbols must then be translated into an auditory “image” as if hearing a silent voice inside the head.  This auditory component is necessary to facilitate decoding of complex words, spelling and to aid short-term memory. In other words, we read as much with our ears as our eyes.

Preparation for the aural aspects of written language develops through one-to-one conversation with a responsive adult; through practising sounds, repetition, singing, listening to stories and learning to hear the ‘music’ of language, sometimes described as the non-verbal aspects of language, which convey meaning and intention through subtle changes in tone, inflection, timing and intensity.

Writing involves even more than this. Writing needs coordination between the hand and the eyes – together with the ability to readjust focusing distance at speed, if copying – and the ability to translate thoughts into visual symbols on the page when free writing.  This is a complex skill for which there are considerable individual variations in the time when a child will be “ready” to master the mechanics involved.

The education system is based on the assumption that children enter the school system with the physical abilities in place to meet the demands of the classroom and that this is universal for all children of the same age.  Research has shown that this is not the case and many children enter the system at a disadvantage in terms of physical readiness for school[i] [ii].

Of course teaching of specific skills and practise are important.  Practise is the process by which newly learned material is translated from working memory into long term memory and through which those skills become automated freeing “higher” brain centres to concentrate on cognitive aspects of the task and releasing creative expression.

But, if children start to become frustrated, anxious or repeatedly fail at a task, teaching and testing more of the same is not the answer.  Teaching and practice need to be aimed at the level from which the child succeeds and built up from that point with the ground for those skills being prepared in a more holistic environment of sensory-motor experience.

Children learn best when they enjoy what they are doing and the key to success in any form of learning is to meet the child where he or she is in terms of their understanding and tools.  Unless a “prescriptive” system of education takes child development into account and allows some flexibility in how it is applied we will continue to see an increase in young children and parents suffering unnecessary anxiety.

[i] North Eastern Education and Library Board (NEELB) 2004.  An evaluation of the pilot INPP movement programme in primary schools in the North Eastern Education and Library Board, Northern Ireland.  Final Report.  Prepared by Brainbox Research for the NEELB.

[ii] Goddard Blythe SA, 2005.  Releasing educational potential through movement. Child Care in Practice. 11/4:415-432.

Published: 8th February 2017
Category: Sally Goddard Blythe

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Published: 1st February 2017
Category: Sally Goddard Blythe