There are no gleaming multi-million pound hospitals, no state of the art medical equipment, no modern fleets of ambulances with up-to-the minute pre-hospital care kits on board, But they do have pride in their health service...

The NHS: We don't know how lucky we are

WORKERS, SEPTEMBER 2008 ISSUE

A reader who works in the London Ambulance Service sent the article below. – Editor

I heard on the radio the other day that, per head of population, Cuba had more people who were 100 years old than anywhere else in the world. The report also stated that the general life expectancy had risen to 80. Those two facts are remarkable, and would be remarkable in any other country, even incredible in most, but taking into account the context of life in Cuba with people struggling against the backdrop of the American economic and material blockade (a blockade which also includes medicines, hospital equipment, ambulances and health related paraphernalia that we take for granted) those achievements have much more significance. Before the revolution in 1959 life expectancy was 55. By 2000 it had risen to 76. Eight years later it is 80. They even have something called the 120 Club, which certainly makes the 18-30 club sound a bit feeble!

Health in Cuba is sacrosanct. It can't be bought, it can't be sold, it can't be betrayed, it will not be privatised, it will not be 'Foundation Trust-ised' and it will not be starved into submission by a powerful neighbour.

People are at the heart of health in Cuba: it is outcomes that count there – not targets. A fully free health service (yes, including prescriptions and dental care) is an absolute right under the Cuban constitution, guaranteed by the state.

Ambulances in Havana Photo: Workers

This is not to say, of course, that everything is a utopian dream. The reality couldn't be further from it. There is a vast difference between the Cuban health service and the NHS here in the UK for instance. There are no gleaming multi-million pound hospitals, no state of the art medical equipment, no modern fleets of ambulances with up-to-the minute pre-hospital care kits on board, no fast response vehicles, no motorbike paramedics, no cycle paramedics (ironically in a country that could use them far more than us), no ambulance helicopters and yet – and yet – everyone supports, defends and is very proud of their health service no matter what!

Everyone appreciates the ambulance service, even if resources are sparse, control rooms are stuck in a 1950s time warp for lack of money, modern technology, telecommunications and crews who lack the most basic pre-hospital care equipment that even the most modest of private or volunteer ambulance services in the UK have an abundance of.

Health, the health service and the people who work in it are not used as a political football, taken for granted or abused by sections of the public. And this got me thinking! Here we are in Britain, the fifth biggest economy in the world with a National Health Service that is the envy of all the developed countries. It has: ultra modern hospitals springing up (with the help of private money); state of the art equipment; millions of pounds spent on research and on drugs; modern ambulances (in most services) able to reach every part of the UK; a free emergency 999 service that is available to all without any, or very few, limitations and high-tech computerised control rooms able to deal with a 24-hour demand that seems to grow year on year.

Thousands upon thousands of people use the service and are helped by health workers, treated by ambulance workers, seen by doctors and nursed by professionals every day of the year and yet – and yet – disappointment is in the air. People grumble and complain about the NHS, about ambulance services, about health workers, about ambulance workers, about their treatment, about their waiting times, about their hospitals, about their doctors etc etc etc.

Taken for granted
Why is that? Do we take the NHS for granted? Have we got short memories? Don't we understand that things could change on the whim of a political decision or a political reactionary force? Have we dropped our guard and become tired of defending our services? Ever since the NHS was founded, enemies of it have been chipping away day by day, night by night, week by week. The enemies are not just outside the NHS, but also inside.

Sometimes, as staff, we unwittingly play into the hands of those who would take us backwards by complaining and grumbling and failing to support or defend our own service. Instead of offering constructive criticism or helping to resolve the things that may be wrong, we sometimes find it easier to snipe, attack or throw "hand grenades full of negative cynicism" from the sidelines out of harm's way, not caring where they land or the damage they do.

Are we sleepwalking into American-style health provision based on "choice", competition and the ability to pay? Have we fallen hook, line and sinker for the sleight of hand deception of the apologists who say, "as long as we don't pay when we are treated it is still a free health service at the point of delivery"?

Our ambulance services and NHS are not perfect – far from it. The things that are wrong need to be put right. The people who hold us all back need to go. We have to find a better way of dealing with the ever-increasing call rates so that ambulance staff are not constantly pushed from pillar to post and suffer "burn out" at a younger and younger age.

Most ambulance services are now starting to get to grips with alternative responses so that those people who dial 999 in good faith, because at the time of calling they honestly thought they needed an emergency ambulance, can be dealt with in the most appropriate way. We have to deal with the usage of the 999 system. It is no good on the one hand having limitations on funding in Ambulance Services, yet no limit whatsoever on people's rights and responsibilities in regard to calling an ambulance. The theory of 'supply and demand' goes out of the window when it comes to this difficult issue.

The NHS celebrated its 60th birthday in July of this year. That is still a very short length of time within our country's history. The Health Service is still fragile. An oak tree takes hundreds of years to put down solid roots so that no amount of turbulence can push it over. Likewise, the NHS needs to have solid roots so that our children and their children's children do not look back and blame us for a lost opportunity.

Ambulance services as we know them within the NHS are even younger. They are constantly changing as they, and we, try to find the most comfortable fit. We are all part of it. There cannot be a "them and us". We all have to find real alliances, meaningful partnerships, and true visionaries from both sides of the union–management landscape to build and improve on what we have been given by those that went before us. Successful public services are in everyone's interest.

What can be done
It still amazes me (although I know it shouldn't) that a country like Cuba with its shortage of so many things can put its heart and soul into providing healthcare and that the staff, patients and people not only support, defend and struggle to improve it but also feel immensely proud to be part of it.

Contrast that with Britain with all our treasures, privileges and comforts. The NHS is taken for granted. Ambulance Services are overstretched to the point where some have to force staff and vehicles to rove around the streets in the mistaken belief that targets are everything, although the introduction of Call Connect will most probably not save one extra single life. This needs challenging.

Although some targets are important we seem to be forced sometimes to focus on the wrong ones. How can we work differently to relieve pressure on staff and managers and still focus on patients and get away from "the final push" mentality? All that is wrong notwithstanding, we really don't know how lucky we are.

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