Blood shortages
October 13
SIR – I have donated 141 pints of blood and agree that the current shortage has been “years in the making” (report, October 13).
It has become increasingly hard to donate. If you are lucky enough to find a centre nearby, the chances are that there won’t be an appointment you can book (the only way to donate since walk-in centres were discontinued).
If you are able to get one, woe betide you if you are late. I was on one occasion, due to traffic, and it was a real struggle to persuade the staff to let me give my precious A negative blood. Fortunately for the eventual recipient, I succeeded.
Carol West
Welwyn Garden City, Hertfordshire
October 14
SIR – I was a regular blood donor but stopped doing it after four out of the last six booked sessions were cancelled at short notice (three of them while I was actually on the way there).
I complained but was fobbed off with excuses. If the donations management team holds donors in such low regard, it’s little wonder when we choose not to continue giving.
David Sharrock
Stockport, Lancashire
October 14
SIR – When I saw your report I felt I had to do something. I used to donate, but got out of the habit. I am O negative, the universal donor, which is in such short supply.
I tried to contact the blood donation service – a waste of time. No phone was answered, and I was in an hour-long queue to register online. What a useless response to an emergency.
Dr Paul A Reilly FRCP
Martock, Somerset
Maternity care
October 20
SIR – It is of real concern to see the number of avoidable baby deaths at Kent hospitals, and I suspect this is a widespread problem.
My daughter was booked in to be induced at a London hospital at a specific time last Saturday. It was the due date for her first baby, and there was concern over the baby’s movement. She waited eight hours to see a doctor, who apologised – and commented that the delay was a joke – then agreed the procedure.
After two failed attempts, they decided to intervene, and my daughter was told she was going to the delivery room at 8pm, then 11pm – and then 1.30am. She was never taken there, and was very stressed waiting.
On Tuesday she was told that she wasn’t a priority, and was asked to wait until they were less busy. At the time of writing, after four sleepless nights she is totally exhausted and has returned home until they have space for her.
What sort of service is this for a first-time mother in a highly emotional state who is now overdue by several days?
Sheila Powick
Crook, Co Durham
Elusive dentists
March 3
SIR – Since moving to Devon 15 months ago I have been trying to find an NHS dentist, with no success.
I regard the ability to eat as pretty fundamental. Likewise, I regard the ability to see what one’s eating as an advantage, yet eyecare has long since been privatised.
It would be nice if the NHS paid a bit more attention to basic “quality of life” treatments.
Justice Hawkins
Great Torrington, Devon
Dementia
March 27
SIR – Your report on dementia highlights the number of people with symptoms who have been left waiting for a diagnosis.
I am a doctor, and spend most of my time assessing patients in care and nursing home settings to determine whether they have capacity. It is heartbreaking to see the number of elderly patients who have been in these homes for years without being properly investigated. The term “dementia” is merely a collection of symptoms, not a diagnosis. (It is a bit like a doctor “diagnosing” a headache. It does not indicate whether the patient is suffering from stress or a brain tumour or any of the myriad conditions in between.)
There are many causes of dementia which are reversible, and treatments can give patients a new lease of life. The problem is twofold. First, the secondary services are overwhelmed by the numbers being referred. Secondly, GPs are not undertaking the basic tests that would identify the bulk of suspected cases. Blood tests and a CT scan are often sufficient. During my time assessing patients in care homes, proper investigation has identified two cases of hypothyroidism, three of vitamin B12 deficiency and one of normal pressure hydrocephalus.
It is essential that relatives and best-interest assessors hound GPs and secondary services to ensure that those who are affected, and are unable to speak up for themselves, are not allowed to suffer through lack of interest on the part of a broken NHS. Alternatively, we should acknowledge that the NHS is broken and find a different way to protect these people.
Dr Steven R Hopkins
Scunthorpe, Lincolnshire
May 27
SIR – The nursing home caring for my mother, a feisty 92-year-old former ward sister and district nurse who now suffers with dementia, called me to say she had been diagnosed with terminal liver failure. They wanted to discuss end-of-life care.
Distraught, I pressed for more information. The doctor had apparently conducted an examination by video link. I requested a face-to-face visit, which was refused. The only alternative to the end-of-life care option offered was a visit to A&E. I reluctantly agreed, worried about the distress this might cause my mother.
After 12 hours on a ward trolley, she was diagnosed with a simple infection, which was treated with antibiotics. Three days later she returned to the home and has made a full recovery.
The initial complacency of the NHS has left me speechless. Had my mother been aware of all the shenanigans, on the other hand, her views would have been unprintable.
Michael Gough Cooper
Chiltington, West Sussex
Notes from the coalface
January 30
SIR – I have been a full-time GP for 25 years and work in a practice where, for months, patients have been free to book directly to see their GP face to face. The waiting time to see me for a routine appointment is currently a little longer than I would like, but is nonetheless a not-too-unreasonable seven working days.
Despite this, last Monday, in addition to the 30 urgent requests for medical attention that were dealt with by other GP partners (alongside their routine appointments), a further 57 requests were received by the practice and passed to the duty doctor. Needless to say no lunch break was taken. The afternoon was a little quieter, with just 42 more urgent requests
for medical attention being received by the practice before it eventually closed at 6.30pm. Of these, 26 were allocated to the duty doctor.
Fortunately I work in a supportive practice team and we all help each other as much as we can. As a result, the duty doctor was not left to cope with this massive workload alone. Even so, as well as dealing with countless blood results, repeat prescription requests and hospital letters (which themselves generated a further eight telephone contacts with patients), the
doctor still dealt with 56 urgent medical problems personally, which included seeing 26 people face to face. It was a 12-hour day.
This unsatisfactory way of working is, sadly, not unusual. Nor is it safe. General practice is working harder now than it has at any other point in my career, and it is not surprising that staff morale is low. This sorry state of affairs isn’t helped by suggestions that it is GPs who are to blame for the difficulties that patients are experiencing getting the care they require.
Dr Peter Aird
Wellington, Somerset
May 2
SIR –Your headline “Our feckless NHS is squandering Rishi Sunak’s tax raid” was insulting and inaccurate.
People throughout our NHS and social care system are moving heaven and earth to recover ground and reduce care backlogs while dealing with the continuing impact of Covid-19.
The pressure we saw pre-Covid across all NHS services has been massively exacerbated by the pandemic. Over the past few months, the NHS has faced a triple whammy of Covid-related challenges: high staff absences, many linked to Covid; more people in hospital with Covid than expected; and significant delays in discharging patients, partly due to Covid’s ongoing impact on social care services.
Yet, thanks to the hard work of frontline staff, ambulance services are working at a level never seen before, with call-outs a third higher than pre-pandemic. With more than 2.1 million A&E attendances, hospital emergency care saw the busiest March on record.
Activity to bear down on elective care backlogs has increased. GP appointments are exceeding pre-pandemic levels. More people have been seen for suspected cancer and more CT scans are being conducted than before the pandemic.
NHS leaders are passionate about improving health outcomes. They do not see the NHS as a sacred cow that cannot be improved, and recognise that transformational change is vital.
But they also know that their frontline staff are as committed as ever and are working flat out for the people they serve. Those staff speak of feeling burnt out and exhausted, but still strive to give patients the best possible quality of care.
Chris Hopson
Chief executive, NHS Providers
Professor Martin Marshall
Chair, Royal College of General Practitioners
Matthew Taylor
Chief executive, NHS Confederation
London SW1
May 8
SIR – The CEO of NHS Providers, the chair of the Royal College of GPs and the CEO of the NHS Confederation say that “frontline staff are as committed as ever and are working flat out.”
In military terms the writers are commenting as staff officers, sitting in their ivory towers and totally removed from what is happening on the frontline. Another way to put it is that their perception does not reflect my reality as an inpatient for 13 days. During my stay I was never seen by a consultant. As a result, my care was dysfunctional and I had to influence it on several occasions.
On admission I did not mention that I was medically qualified, had been a director of A&E, and had been a medical director and chief executive of a hospital. As well as not seeing the consultant, I always saw the nurses and junior doctors independently. Had there been a clear clinical plan the dysfunction would have been addressed. That is what used to happen.
This is not about resources and money. It is simply about care and clear planning.
D W Spence FRACGP
Sheffield, South Yorkshire
July 24
SIR – On the day that the co-operatives started, I told my partners that general practice had died. They disagreed, and joined up to get more time off.
I never joined my local co-operative, as I hated the thought of GPs not having their own personal patients, for whom they were always responsible.
I was proud of my partners and my surgery. Now surgeries are just places of work, like offices, rather than places where all partners know their patients and their partners, and benefit from mutual concern and support.
GPs now miss so much. I quite understand why they are leaving.
Dr Martin Porter
Lenham, Kent
August 31
SIR – Among all the challenges faced by the NHS, little has been said about reduced productivity.
As a cardiac surgeon I was performing up to 350 major cases a year in the 1990s, but by the time I retired 10 years ago that number was around 120.
There were many reasons: a consultant contract (motivated by the erroneous suspicion that consultants were skiving) that decreased my sessions by 30 per cent and increased my pay by 20 per cent; a pension policy that resulted in the risk of actually paying to work extra sessions; the working time directive that reduced the support of trainee surgeons, despite their desire to gain experience; the General Medical Council requirement for revalidation, which, despite the lack of any concrete data that it is beneficial, has become a time-consuming and expensive industry; the necessity to undergo “mandatory and statutory training”, taking front-line staff away from patients; the highly vaunted IT systems, the navigation of which wasted half an hour each day.
The “Blob”, working in committee rooms in Whitehall, divorced from the coal face, may well have thought these initiatives were beneficial – but every one has come at the expense of doctor-patient interactions. We are now seeing the catastrophic results of this approach.
Edward Smith FRCS
London SW20
November 24
SIR – I recently retired from general practice.
When I started, almost 40 years ago, the job was about giving advice. Today, it is necessary to “sell” the same advice and justify it in writing to prevent potential complaints from the entitled customers. It now takes two or three times as long to do the same job, and these increased patient demands have resulted in reduced GP access and longer working hours.
Dr Andy Ashworth
Bo’ness, West Lothian
Strikes
December 11
SIR – Whatever the rights and wrongs of the nurses’ pay claim (report, December 8), it can surely never be right to go on strike at the risk of endangering life.
Yes, nurses have a right to strike, but they also have a responsibility to care for and save the lives of their patients. Surely that responsibility trumps any pay claim.
Mark Calvin
Tretower, Brecknockshire