The NHS is a complicated beast actually made up of lots of different pieces, and that seems to reflect my feelings on it.
I've worked with local health commissioners in my CCG (replaced PCTs) and have to say that every single one of them was absolutely dedicated to improving outcomes for the disabled children we were talking about. Significant improvements, clearer pathways, better communication, more efficient partnerships with non-NHS services were all implemented and had significant impact.
On the other hand, CCGs now have to work with at-times private companies who bid to run pockets of services for a period of years. In Bristol we were lucky enough to hold onto an NHS-led group for our community children's services; elsewhere in the country, they've been less lucky, and, consequently, families are being denied essential services such as continence products, O2 tanks and basic hygiene items (for cleaning central lines and trachys) for their kids. These companies are answerable only to their shareholders; they do not engage in the type of feedback participation I'm used to delivering, they do not care about the patient experience.
I don't doubt it's a similar story in adult services, too.
GPs now have to work in profit-led practices (see how Dr Unwin won a prize for drastically cutting medication costs - I'll find the link later) while demonstrating a positive impact on their local communities. This is done through heavy-handed monitoring where, year on year, surgeries have to demonstrate an increase in specific demographics: carers, BAME (Black, Asian, Minority Ethnic), victims of addition, obesity and so on. This has led to practise managers who are no longer GP partners but administrators who literally target patients ("quick winners") and crunch numbers. We're almost at a point where you do or don't get the treatment you need because of your profile instead of your need (speaking as someone who has literally lost their mobility because, for 3 years, the advice was "Lose some weight").
Hospitals have become so specific that if you get sent to the wrong one (in Bristol, we have 9), that has a group of specialities your case doesn't fall under, it could be days before your are correctly diagnosed and sent to a place with the correct group of medics on hand. The flip side is that, if you're sent to a hospital with the correct specialties, you'll be diagnosed, treated and looked after very well. By and large, people tend to be sent to the correct hospital, but, increasingly, with hospitals now being funded by which specialities they deliver and the outcomes of their patients, there is less encouragement to try to save the almost-hopeless patient (see any OAP awaiting heart surgery) than there was before the specialty system was implemented.
The cost of medications is rising steadily, and the price is being paid from "non-essential" budgets, such as procurement and A&E. While acute and emergency medicine targets are being met (people not dying in A&E departments), waiting times are rising, and triage is becoming an evermore relied-upon process. Which doesn't seem bad, except nurses aren't trained to recognise all the symptoms that require immediate attention and, increasingly, slip-ups are made (see any story where someone with meningitis was sent home, eg).
In Bristol, the Children's Hospital was awarded several million pounds (via an education fund they applied to in partnership with Bristol's 2 universities) to recruit acute nurses. There was funding for 45 full-time nurses. After advertising across the south of Wales and the south-west of England, they were able to hire less than half that number. There just aren't enough nurses being trained to do the job. And now EU nurses needed to make up essential staffing numbers will find it even harder to work in the UK. The unspent money had to be returned; it couldn't be spent on bank nurses.
While I'm grateful to have such ready access to GPs, medication and acute services, I can't say that I've been delighted with the treatment I've received. I appreciate the dedication of the staff I've been treated by, and understand that their hands are tied by a system that limits what they're able to do. But with NHS England and NICE (the dual spines of the every day NHS) constantly having to compromise, I suspect the NHS's glory days are behind it unless serious investment is made immediately available.
Yes, it's worse elsewhere in the world. But that's no reason to be okay with the way things are now. I love the NHS, I admire the idealism upon which its founded. But something drastic has to change and it has to change fast if its to remain the jewel in the UK's crown.
Edit: Sorry, I forgot to mention, as well, the "war" on junior doctors and the pay freeze which has seen nurses and front-line staff essentially take a heavy pay cut in the last 8 years.
http://www.independent.co.uk/news/n...octors-dentists-nurses-midwives-a7654251.html