Your Views on NHS care.

[rebel11]

The big problem is the political parties are on an ego trip to get into government. When they canvass for votes, what do they say? 'We spent X billion more on Health then Labour etc, etc'. Throwing money at the problem, but taking steps back every 5 years. The other problem is that when politicians are appointed Health Minister, they want to leave there mark on the NHS, a legacy, as they are pretty clueless it adds further chaos to the existing chaos.

[Lindamannion]

Hi Sali, l had the exact same experience with my Mum, she told me a couple of nurses had been rough with her, l got a shrug of the shoulders from the nurse who also heard the comment, very shortly after they put a IV in her hand, when l came back to ask for answers on the bruise's on her arm, they insisted it was caused by the IV. Nothing was ever connected to the IV. There was a catalogue of cover ups and neglect, which resulted in her death. I have been haunted by all this for two years, so angry with myself for not doing more. They even tried to give us a death certificate with an incorrect cause of death. Her care was shocking, no one person was ever as far as l know investigated, despite a serious accident report, numerous letters and meetings. As far l can see all is the same and nothing has changed, l also will never forget or forgive.

[Sali]

If that is true about binning medication when just one tab has been used from a blister pack, it's a disgrace. I wonder if that is an individual hospital policy or a general thing across the NHS. Maybe a nurse could supply the answer.

 

Many prescriptions are prescribed, dispensed and then not used by patients. Each step is a cost to the NHS - aka the taxpayer - and the money could be better spent. Additionally, I cannot help but feel that too much medication is issued, such as anti-biotics for viral infections in patients with no underlying conditions!

 

Nolegion, I have already read some of cases in the Patients Association report and they are harrowing and deeply distressing, aswell as depressing. My face streamed with tears of empathy. It's not just the incompetence and abysmal care, but the helplessness of the poor relatives who are powerless to prevent it. As one contributor said, "the Ombudsman, the Clinical Commissioning Group, the CQC and our local MP are all aware of our complaint, but no-one has any power to do anything."

 

Oh Lindamannion, I know exactly how you feel. Anyone who has seen a loved one harmed by people supposedly trained to heal and care will also be damaged. Patients/families should not have to fight for years to uncover the truth. Justice delayed is justice denied.

 

They say time is a healer. Here's hoping!

[red-ed]

This makes interesting reading:

 

http://www.dailymail.co.uk/debate/article-2381028/MELANIE-PHILLIPS-NHS-111-service-disaster-start.html#comments

 

The problem with the NHS is we don't realise how bad it has become until we need and have to use it. Being offered a complaints procedure when not being treated properly, when in fact you are desperate for help is just inappropriate (putting it politely) - and just adds insult to injury.

 

There is also an inherent pressure not complain when you are so dependant on help which means that the true extent of the NHS decline is not realised.

 

I am a supporter of the NHS principle. I believe it sets us part from other countries and is a benchmark for the whole world. It is for this reason we must use every forum, avenue etc, to drive improvement from the top to the bottom. This improvement must be driven not from complaints but from an inherent desire within the NHS to restore it old values and competencies.

 

Ed

Edited December 17, 2013 by red-ed

[mr_mastiff]

Over the last six days my grandson as been in hospital with breathing difficulties and I was very impressed with the care that he was given. From his admission via A&E to discharge I could not fault any part of his care.

 

All the medical and nursing staff were highly competent and the manner in which they carried out that care was exemplary. As an ex nurse I could not find fault perhaps there is hope for the NHS yet.

 

Well done to those at the LRI:-D

[Nystagmite]

That's good to hear, MM.

 

My dad was sent to A&E by his GP last year. After waiting around for some 8 hours, he then went home. He went back the next day, to which the nurse replies "oh, you're back then?". Why the nurse was shocked, I have no idea.

 

I am 2 months and still waiting for an MRI scan date. Really could have done with this scan 3-4 months ago. But instead, I just had paracetamol chucked at me and was told it was migraine.

 

When I lived in London, I had a referral to the Royal Free. At one appointment, they did a few tests and gave me eye drops. I then waited 3 and a half hours just for a routine medical appointment.

 

OTOH, I was diagnosed with pityriasis rosea, which is a skin complaint. I saw the GP who gave me some cream and some medication. After 2-3 weeks, it got worse (the skin on my hands had cracked and were bleeding) and I went back to the GP. He said there's a skin specialists within the practise who I can see, who may know more than him. Whilst it's not good to hear that your GP doesn't know what to do, at least he said this and told me he was going to get me some help.

[Sali]

There's no doubt that sometimes the NHS performs outstandingly - but I think we have to face the fact that the service is rapidly deteriorating. I don't see a future for the NHS unless it radically changes and the politicians have to convince the public, who are pretty much in the camp of it's better the devil you know. When has a politician ever made anything better?

 

On a different subject, Nolegion, some weeks back and in a different thread, made me aware of the intention of our illustrious politicians to allow our medical records, held by our GPs, to be 'mined' by the Health and Social Information Centre. It's supposed to be for our own good - enabling better planning of services (ummm).

 

GPs should be advising their patients (although I'm not sure whether this will be by letter or just posters in the surgery) of this in January, but if you do not opt out then your NHS number and postcode will be included, enabling you to be identified. I don't doubt that this data will be passed (probably sold) on to private companies who will look at ways of exploiting the information to make money.

 

I am at a loss to understand (but not surprised) why this decision has not been challenged by the ICO as I consider it a breach of confidentiality.

 

I'm not waiting. I'll write to my GP today and I'll make my views known to my MP too.

[nolegion]

I am convinced that the approach of the preceding post, i.e taking the initiative about 'data mining' and the "Heath and Social Care Information Centre" is absolutely correct. Now that the "care.data" project is actually being rolled out, I think the topic deserves its own thread:-

http://www.consumeractiongroup.co.uk/forum/showthread.php?414742-quot-Better-information-means-better-care-quot-Don-t-be-fooled.(14-Viewing)-nbsp

[think about it]

Whilst it's not good to hear that your GP doesn't know what to do, at least he said this and told me he was going to get me some help.

 

To be fair, I can’t think of a better response, remember that your GP is just that – a General Practitioner – not a specialist, at least he recognised his own shortcomings and referred you to someone who may know how best to help. Far better that than politely ignoring your concerns or prescribing yet another medication and having you go away and try that.

 

I blame this on cost (practice managers watching the budget like hawks?)

 

When requesting medication for a problem, they will often fob you off with:-

 

''I can't prescribe you that'':-

 

a) ''It can be addictive'' (NHS speak for '' it's addictive and we're likely to spend so much time trying to get you back off it that it's not clinically indicated in your circumstances'')

b) ''It can cause cancer'' (NHS speak for ''it's carcinogenic and the risk far outweighs the benefit'')

c) '' Have you tried relaxation methods? (''in certain cases the psychosomatic symptoms are worse than the real ones, not any less genuine but the cure might not be in a bottle

 

D) It's not clinically indicated and no, Google doesn't always hold the answer in a manufacturer's website

 

Do I watch the budget like a hawk? Yes - Do I have any input on the GP's clinical decision making? No. The community pharmacy team may well seek to guide prescribing decisions and NICE and the health boards will tell the GP's what they can and can't prescribe. The PM takes no part in it besides writing the cheques to the pharmaceutical distributor.

 

You’re right, Vets may well be far more willing to write prescriptions to people who have to pay – the same way that prescription only medicines are advertised on TV in the USA. Your GP has a genuine interest in helping you and that help isn’t always in a bottle or blister pack, regardless of what wikipedia says.

 

We're subject to phenomenal amounts of guidance and constraint and regardless of what the Daily Mail says, we do actually care about our patients and do all we can to help.

 

What Sali says about misuse of repeat prescriptions is absolutely true - people order things they just don't use and it sits in a drawer until it goes out of date.

 

Two examples of this:

 

Steroid Inhalers, cost to the NHS - about £60 each (that's right, £60.00 per inhaler) and people order one a month and then leave them in a drawer gathering dust.

 

Viagra, up until last summer cost price £25 per pack - now just a couple of pounds for the generic Sildenafil Citrate (same stuff, different packet after the patent expired) we had a gentleman who ordered two packs per month - and why not, good luck to him... However, he passed away some years later and his family returned almost 40 packs to us, unopened. That's £1000 sat in a drawer just in case.

 

We can't re-use medication, for us to give out medication that we don't know if it's been tampered with, stored incorrectly, replaced with fakes etc would be an unacceptable risk and I certainly wouldn't be happy as a patient in my practice accepting second-hand drugs, would you?

 

We will however split bulk medication so whilst we'd never use one tablet from a blister pack, the dispensers may provide a 'part pack' of sealed medication for the same reasons mentioned above.

[Sali]

I wish a few more GPs - and many other professions - recognised their own shortcomings. My brushes with the medical profession through loved-ones have not been positive. More honesty and humility would be nice.

 

Whilst the community pharmacy team, NICE and health boards may tell a GP what he can prescribe, what influences a GP to choose one drug over another or any drug at all? You say you watch the budget like a hawk. Does this mean that prescriptions are restricted at the beginning of the financial year, only to be dished out like sweeties at the end in order to use up the budget and prevent the next year's budget being slashed? This is what happens to departmental budgets in private companies. Whilst it's not life or death when a company splurges on art work at the end of the year, it would be a little different in your business.

 

Another point I often muse over is how much a doctor is influenced by reps from pharmaceutical companies. There is also the long-term problem of pharmaceutical companies not releasing ALL of their clinical trials data where it may not be conducive to business. NICE et al may be making judgements on what drugs can be prescribed on incomplete information. On top of this the NHS has a history of locking itself into contracts (but not just for drugs) for longer than the term of the patent, meaning they do not buy competitively and consequently waste huge amounts of money.

 

Having said that, I believe we all need a wake-up call. We take too much for granted because the NHS is free at the point of use and many people, for one reason or another, do not even contribute towards their prescriptions. It has made us careless. We need to remember it is OUR money and not to be wasted.

 

However, GPs too have a responsibility. I mentioned anti-biotics in an earlier post. Through unnecessary prescription and patients failing to finish the course, we can expect the emergence of a super-bug that no current anti-biotic (and I think there are no new ones in the pipe-line) will cure.

 

And the chap who was prescribed Viagra - what on earth was the GP thinking to allow this repeat prescription to go unchecked? Unless he told the GP he was working as a gigolo, (and I'm making an assumption on what condition it was used to treat) there were certainly grounds for a patient review.

 

I don't think the Daily Mail or any other newspaper has made us believe that GP practices do not care for their patients. We just have higher expectations, are better informed and are less likely to be fobbed off. What's wrong with that?

[think about it]

Sali, you’ve got some excellent questions there and some equally good points. So I don’t lose track I’ve broken your post up and I’ll do what I can to respond to each of the points in turn.

 

I wish a few more GPs - and many other professions - recognised their own shortcomings. My brushes with the medical profession through loved-ones have not been positive. More honesty and humility would be nice.

 

Whilst the community pharmacy team, NICE and health boards may tell a GP what he can prescribe, what influences a GP to choose one drug over another or any drug at all? You say you watch the budget like a hawk. Does this mean that prescriptions are restricted at the beginning of the financial year, only to be dished out like sweeties at the end in order to use up the budget and prevent the next year's budget being slashed? This is what happens to departmental budgets in private companies. Whilst it's not life or death when a company splurges on art work at the end of the year, it would be a little different in your business.

 

There is indeed an annual prescribing budget, it is generally based upon the previous years with an adjustment for any changes in list size.

 

In all honesty it’s a bit of a misnomer – the Dr’s prescribe what’s needed and the budget lands where it lands.

 

We do have targeted changes in prescribing from the health board – for example the one I used in a previous post to take people off a branded medication (Viagra) and onto a generic (Sildenafil). That said, the Dr’s can and do over-rule this if they feel that there is a clinical reason for doing so and this is taken account of. Another is the reduction in prescribing what are called luxury items of gluten free foods. No one says you can’t have the bread / pasta etc but if you want Jaffa Cakes then the NHS isn’t too keen on paying for them.

 

The prescribing budget is just one aspect of our funding and in all honesty is the one that I have the least control over – that doesn’t mean however that I simply ignore it. It tends to be an aspect that the use of generic drugs over branded has the greatest impact on or our excellent dispensary team who will negotiate deals with the distributors on commonly used items.

 

So yes, we do watch, we do ensure we’re getting best value but it’s watching and best value on what’s necessary and not exerting control over prescribing.

 

I’m not a Dr, I do however work with a few, am married to another and have a few with whom I’m good friends. So, my understanding of the choice of medication and prescribing by a Dr is a relatively well informed simplification:

 

The decision to prescribe is based upon the condition, the available research on how effective a drug might be (clinical indication) and which drugs are approved for use by the Health Board/NICE. There’s also a part of the decision that weighs up the risks associated with using that drug. Using something like Ibuprofen over a long time can leave you with an exceptionally sore stomach. So, a Dr takes into account the side effects and risks. They also weigh up what effect it’s likely to have alongside other treatment.

 

Generally, the stronger the medication the greater the risks and side effects are associated with it. There’s a balancing act there, do you first try the safest treatment that’s been shown to work in 80% of cases or do you plump straight for the industrial drain cleaner that will almost certainly kill the infection but might also kill the patient in the process? Okay that’s a bit dramatic but hopefully it illustrates the point.

 

Another point I often muse over is how much a doctor is influenced by reps from pharmaceutical companies. There is also the long-term problem of pharmaceutical companies not releasing ALL of their clinical trials data where it may not be conducive to business. NICE et al may be making judgements on what drugs can be prescribed on incomplete information. On top of this the NHS has a history of locking itself into contracts (but not just for drugs) for longer than the term of the patent, meaning they do not buy competitively and consequently waste huge amounts of money.

 

Medical reps used to be a big part of GP-Land, they’re not any more. There are now very strict rules on what they can and can’t do and even giving out branded pens and highlighters is against the rules, which is a shame because our stationery bill has shot up. The medications available are largely controlled by NICE and the Health Board so a rep is really barking up the wrong tree if they think that the GP is able to approve use of a drug. Equally, I have the pleasure of working with a few of the most cynical GP’s I’ve ever met and any sales ‘patter’ tends to fall on very deaf ears until some real academic research is produced. Such is the extent of the decline of the reps that we no longer see them here.

 

You’re right about the concerns over incomplete research information, it’s a far from ideal scenario. Equally as a contractor to the NHS I can only re-assure you that things are being tightened up on what feels like an hourly basis.

 

Having said that, I believe we all need a wake-up call. We take too much for granted because the NHS is free at the point of use and many people, for one reason or another, do not even contribute towards their prescriptions. It has made us careless. We need to remember it is OUR money and not to be wasted.

 

However, GPs too have a responsibility. I mentioned anti-biotics in an earlier post. Through unnecessary prescription and patients failing to finish the course, we can expect the emergence of a super-bug that no current anti-biotic (and I think there are no new ones in the pipe-line) will cure.

 

And the chap who was prescribed Viagra - what on earth was the GP thinking to allow this repeat prescription to go unchecked? Unless he told the GP he was working as a gigolo, (and I'm making an assumption on what condition it was used to treat) there were certainly grounds for a patient review.

 

Our chap with the stockpile was regularly reviewed an had re-assured our Dr’s that the meds were going to good use and as there are just 4 tablets per pack it’s not out of the ordinary to suggest that they weren’t being used every month.

You’re right, GP’s do have as much of a responsibility as the rest of us over the usage of anti-biotics and I agree entirely on the risk of a super-bug.

 

Here’s the challenge they face, for most people they get a cold/cough/sore-throat and visit their GP expecting to be prescribed anti-biotics. The GP refuses – the patient then goes to see another GP who, through either lack of judgement or not wanting to battle with the patient prescribes the requested anti-biotics.

 

The patient then stops seeing the better, stronger GP of the two in question and tells all of their friends and family that the new easy to win-over GP is ‘excellent’ and they then all start going to the new surgery.

 

Being a ‘Dr. No’ is challenging, so much pressure is placed on these better GP’s by the public and by less capable GP’s.

 

These people tend to be the same who then stop taking the medication as soon as they start to feel better, which would have happened even if they hadn’t been taking the meds. They put them in a drawer and as soon as they sneeze they start taking them again. All of the time the resistance to the medication increases until, eventually it’s rendered totally useless and we all die an agonising death from an untreatable infection.

 

The increase in litigation has something to do with this, there’s another post here where someone lost a very young friend to a most dreadful and aggressive cancer. However, in their description of what happened they explain that she presented to her GP with a sore throat and wasn’t given anti-biotics. It’s seen as a fault of the GP and of GP’s in general when they don’t prescribe something which, in retrospect wouldn’t have made any difference whatsoever. Such is the fear of litigation that this profession is one of a few that people have to pay out huge sums of money just to continue working in.

 

People decry doctors wages but I struggle to agree with them when seeing first hand the amount of pressure and expectation placed upon them, I can’t think of many other professions where someone has to pay £500 a year just to maintain their licence, almost £10,000 a year in liability insurance amongst many other registrations.

 

I don't think the Daily Mail or any other newspaper has made us believe that GP practices do not care for their patients. We just have higher expectations, are better informed and are less likely to be fobbed off. What's wrong with that?

 

Nothing is wrong with high expectations, we should have them, I know I do.

 

I think it’s down to being involved in your own care and showing an interest, I mentioned on another post how finding something on wikipedia doesn’t mean it’s right and I maintain that. But, by researching and discussing it with your Dr it means you’re both invested in your care and I’d advocate that we all do the same.

 

Sometimes Dr’s have to tell us things we don’t like to hear. Smoking will most likely kill you, so will being overweight, drinking too much, not eating the right things or exercising. It’s not the Dr’s fault if these things catch up with you – they don’t pour the drink, order the KFC or light the cigarette yet I see so many people who get offended when a Dr suggests a lifestyle change as a part of treating the many conditions that we see as a result of the modern lifestyle.

 

I think such reliance is placed upon the fact that modern medicine will fix all problems that we forget our own responsibilities in keeping ourselves healthy. Recently we’ve been sending people who need knee and hip replacements to an exercise programme if they’re obese. We’ve actually seen a decrease in the number of operations being required as people lose weight, build muscle and place less strain on their ailing joints and bones. They feel better as a result and if the op is still required then they’re physically fitter and better able to deal with the risks of major surgery. It’s win – win but people don’t like being told that they may well hold the best part of the cure to their own condition. Yes a new knee will help – but losing several stone, learning some healthy eating and exercise techniques and changing your lifestyle may well mean that you never need to be exposed to all of the risks associated with someone effectively cutting your leg in half and then filling the gap with titanium.

[Sali]

It will always be that we only discover how good a service is when we or somebody close to us comes to use it.

 

I saw a health system badly co-ordinated, inept, apathetic and often cruel. Of all the people I came into contact with (and there were many over a number of years) only two doctors struck me as competent and caring - and one of those left mid-way.

 

I suspected it then and have since seen articles on 'referral management schemes' supporting my theory, that the GPs were reluctant to refer the patient to hospital for investigation because there was a financial gain for them not to do so. The patient then became so ill that it was necessary to admit them to hospital via A&E (one of the reasons I feel that they are inundated). The hospital, keen to free up the bed, rushes the patient out of the door before they are fully well and with no definitive diagnosis or planned treatment. The revolving door of this foolish system spins again and the now deteriorating, pain-wracked, distressed and weary patient is re-admitted to hospital - and that brings a financial benefit to the hospital. So, the incentive is clear. Money. Always money.

 

The GPs did alright out of the last government's deal for them to work less and get paid more. Yes, probably things were not fair before, but the BMA took advantage, in a 'Bob Crow' like way, of incapable politicians and their ill-informed advisors, to get their pound of flesh and then some. I don't think either party in these negotiations stopped to consider or even cared about the impact on the patient.

 

I know my experiences are not everyones. I realise that there must be some good, professional people in the system, but they were not present when two of my relatives suffered pain, indignity and then died too early.

 

I heard on the radio this morning that Mid-Staffs hospital is likely to be fined for allowing a diabetic patient to fall into a coma and die. What's the good of that? I want those who failed to be disciplined, struck off and/or imprisoned.

 

You state that you can't think of many other professions where someone has to pay £500 a year to maintain their licence and £10K in liability insurance. I can't think of many other professions where the careless and incompetent get away with maiming and murder.

[rebel11]

Had an appointment a couple of weeks ago. Had to wait 3 months for the appointment, had to wait 3 hours on the day, the Doctor was late because he arriving from another hospital, there were about 15 people waiting to be seen. It took all of 10 minutes to see me as I was one of the last to be seen. Complaint to the Trust.

[speedfreek]

Get a phone call Friday your appointment for next Friday can't be done because of a meeting.

 

I have a truecall device which auto records all calls in and out so have just played it back.

 

How about Monday the 25th? Okay says I.

 

Turn up today and Monday the 25th repeated twice in the conversation really meant Tuesday

 

The letter stating Tuesday was on my door mat when I returned.

 

Do I have any faith whatsoever left in the NHS? Let alone this new team!

 

Tomorrow is going to be fun!

[mr_mastiff]

Get a phone call Friday your appointment for next Friday can't be done because of a meeting.

 

I have a truecall device which auto records all calls in and out so have just played it back.

 

How about Monday the 25th? Okay says I.

 

Turn up today and Monday the 25th repeated twice in the conversation really meant Tuesday

 

The letter stating Tuesday was on my door mat when I returned.

 

Do I have any faith whatsoever left in the NHS? Let alone this new team!

 

Tomorrow is going to be fun!

 

Had the same problem! Three telephone calls ensure to that I turn up to my appointment at clinic 5. After 30 minutes of looking for clinic 5 I asked at reception who told me " Clinic 5 closed 12 months ago you need clinic 4 now".

finally reached clinic 4 to be told that my appointment had been changed to next week!. Received my first reminder telephone call tonight telling me to go to clinic 5. Received Letter telling of cha of appointment this morning!

[mkb]

I have absolutely no complaints about the NHS & the way it has met the needs of my family.

 

I have a degenerative, disabling disorder of my spine. To get a diagnosis I had consultations with my GP who referred me to the hospital. An orthopaedic surgeon ordered MRI scans, x-rays & courses of physio. He then referred me to a rheumatologist who prescribed me appropriate medication & instruction to my GP to continue/amend medication as my condition dictated.

 

I also have emphysema & again my GP referred me to a consultant in respiratory disease. He ordered lung function tests, spirometry & x-rays in order to ensure I was on the appropriate medication.

 

Over time my inhalers were no longer maintaining good airways so the respiratory consultant referred me to the Royal Brompton Hospital in London, a specialist hospital where lots of research is done as well as experimental treatments.

 

On my first visit there I had CT scan of my lung & tests to establish the exact condition of my lungs. The CT revealed a couple of nodules on both lungs so he ordered a PET-CT scan as well as repeating the CT.

 

These scans showed an active tumour in one lung & another in the other lung that didn't uptake any of the radioactive sugar so is present but not doing anything - yet.

 

I was given the choice of having the tumour removed by way of lobectomy but declined this. I was not forced to comply with what the doctors wanted to do. It was my choice to wait & see and the medics accepted that & agreed to monitor me.

 

I have had 4 monthly checks since then & the tumour has grown on each occasion so we are now actively exploring the possibility of cyber knife treatment or failing that, palliative radiotherapy as & when the appropriate time arrives.

 

Throughout this whole saga, my GP has been brilliant & always there if needed - our surgery runs a same-day surgery or a telephone consultation if it's just advice needed. Every hospital appointment has taken place on the day it was arranged for both for my spinal problem as well as my cancer.

 

I can arrange to read my GP notes by following the data protection procedures & I requested that letters from the hospitals are copied to me also.

 

The NHS is a brilliant establishment. Sure it has it's problems - what organisationn of that size wouldn't have - but it's always there for us when we need it & without it many millions of us would be in a much worse state than we are.

 

I cannot begin to imagine what this would have cost me if the NHS had not been free to users. I would be unable to get insurance owing to my existing disabilities & even if I could, what cost would that come to given the cancer diagnosis/treatment. The number of bankruptcies in the US or people going without treatment because they don't have insurance is frightening.

 

Constantly knocking it & the people that work in it simply serves to demoralise them & does nothing to improve things.

[Sali]

It's great that your experience, to date, has been so positive.

 

However, it would be absolute madness not to criticise a service because you fear that it may demoralise the staff.

 

Too many reports now have shown that the NHS (and so many other public bodies) - managers, nurses, doctors - routinely try to cover up their mistakes and failings rather than being open and honest with patients and bereaved relatives. Consequently there is no 'learning.' The impact of those damaged - and the ripples spread far - is incalculable.

 

 

When I read about nurses who worked at Mid-Staffs saying they would leave work at the end of their shift in tears, I couldn't help thinking how self-absorbed they were. Afterall, they CHOSE to work there. They got to leave at the end of their shift still breathing. So many patients, who suffered and died too early, only got to leave in body bags. If everyone had tippy-toed around the issues for ever (and they did in my view for far too long) we wouldn't have had the Francis report and its recommendations.

 

If the NHS were a private company, where it comes down to the survival of the fittest and smartest, it would be long dead.