Chris Lancelot on…The state of the nhs

It's 2007, and the NHS is falling apart. I can't remember it ever being in greater turmoil, or so hard pressed.

Hospitals are working under the threat of closure; at least a third of trusts are in the red and reducing their expenditure and services accordingly. Consultants are retiring, not to be replaced, and many departments are shut to new patients to avoid breaking the waiting-time rules.

Locally, no routine colorectal services are available in the country and most orthopaedic and medical outpatients are also closed. However, the Choose and Book (CaB) website says departments in several hospitals in adjoining counties are still open.

How can I advise my patients which to choose when I don’t even know how to get to them, never mind what quality of care they provide? Perhaps this is why the PCT has been telling us to provide brochures about hospitals under CaB — because we won’t know the first thing about them.

Two recent cases have highlighted this appaling situation. One of my patients needs screening for familial colonic cancer. She would be managed best by the team that diagnosed her relatives — but the department is closed to new patients. Is she expected to consult an unknown surgeon in an hospital 30 miles away?

The second is a complex case. My patient’s rheumatology consultant asked me to refer him to the physicians. However, medical outpatients is now closed to new cases so he will have to travel to a hospital he has never attended and which doesn’t have his current case notes.

Increasingly, NHS patients cannot access the secondary care they need. They are constantly denied any choice, despite CaB. They are being shunted around to suit the convenience of the DoH with no concern for their clinical situation, nor for any inconvenience caused.

This is an appaling way to treat patients — clinically unsound and socially abusive. It also profoundly destabilises the hospital system. Yet this is the NHS that the government has introduced and stubbornly continues to promote. Sooner or later someone has to say ‘stop!’ The NHS must be saved from this madness.

Believe it or not, we doctors can do this. How? I’ll make some suggestions next week.

- Dr Lancelot is a GP from Lancashire.

Email him at

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