Via The New Yorker, a must-read article about former doctor Adam Kay and his book This is Going to Hurt, about his time in the National Health Service: Laughing, Crying, and Worrying About the N.H.S. Excerpt:
The success of “This is Going to Hurt” has coincided with a period of deep anxiety about the future of Britain’s health service. The N.H.S. was founded, seventy years ago, in 1948, as part of the new society that emerged after the Second World War. Since then, its fortunes have served as a kind of E.C.G. for the country’s political and economic health. Under Tony Blair’s New Labour government, the N.H.S. received huge increases in funding—between 2000 and 2010, spending rose by ninety-two per cent—and was subjected to an array of reforms. There were missteps but waiting times fell, and health outcomes improved.
Under the austerity program of Conservative-led governments since 2010, however, the N.H.S. has suffered. Spending has never actually fallen (this year, it will surpass a hundred and twenty-five billion pounds for England alone), but the budget has not kept up with the inexorable needs of an aging population, the rise of chronic conditions such as obesity and diabetes, and the cost of increasingly personalized care. Since 2014, the N.H.S. has been attempting to reform itself for the twenty-first century and save money at the same time—a project that appears impossible.
Last winter, faced with the predictable, seasonal surge in demand for treatment in the nation’s hospitals and emergency rooms, the N.H.S. in England more or less fell over. In January, twenty hospitals declared “black alerts”—discharging patients whose lives were not in danger and cancelling tens of thousands of operations.
The writer James Meek chronicled the disaster in a twenty-one-thousand-word essay for the London Review of Books: “Between them, the hospitals in Worcester and neighbouring Redditch had to divert emergency patients elsewhere at least 65 times. At Derriford Hospital in Plymouth, staff were stretched so thin they were unable to take breaks. Memos between managers at Southmead Hospital in Bristol in early January, leaked to the local press, warned that beds were ‘104 per cent full.’ ”
The winter passed, but the sense of an ongoing crisis has not. Doctors, nurses, and administrative staff are all leaving the N.H.S. and not being replaced. Last week, with winter approaching again, workforce figures revealed vacancies for eleven thousand five hundred doctors and forty-two thousand nurses across the system. Nine per cent of N.H.S. posts are currently unfilled. “Widespread and growing nursing shortages now risk becoming a national emergency,” the King’s Fund, the nation’s leading health think tank, reported.
“It is much worse now than it was when my book ended,” Kay told me. Nonetheless, his diary conveys the sense of working in a monumental, maddening machine. The N.H.S. is by far Britain’s largest employer, with one and a half million staff members. Employees are bound by outdated hierarchies and quixotic management targets. Its I.T. failures are legion: Kay’s e-mail address, given to him on his first day at work, was atom.kay@nhs.net. (“It’s good to know that no matter what happens today, nobody could accuse me of being the most incompetent person in the hospital.”)
Every year, on the same day, junior doctors in the N.H.S. move to a new hospital, an administrative nightmare known as Black Wednesday for the accompanying rise in death rates. Doctors are buzzed throughout their shifts by beepers that give no information except an extension number to call, making it difficult to prioritize requests.
At night, a single junior doctor, fresh out of medical school, is often given responsibility for every patient in the hospital who is not in surgery or in the emergency room. “The fucking lot of them,” Kay writes. “You’re up on the wards, sailing the ship alone. A ship that’s enormous, and on fire, and that no one has really taught you how to sail.”
See also this Guardian review of his book, which I have just bought online as a Kindle book.
