You don’t have to be seriously ill to realise the NHS is in trouble. In fact, ironically, some forms of serious illness would preclude the realisation. I’m sure that, as I type, delirious patients on trolleys in superbug-infested corridors are among a tiny minority of British citizens oblivious to the healthcare crisis. Let’s hope they get the treatment they need to bring into focus the desperate surroundings in which they’ve somehow got the treatment they need.
Research published last week in the medical journal BMJ Open says that two in five GPs are planning to quit their jobs within five years in what has been dubbed, perhaps in celebration of Passover, an “exodus of GPs”. Though in this case, the plagues will come after they’ve left.
The flaw in the research is that there’s no control: what’s the percentage of the UK’s overall employed population who are planning to quit their jobs within five years? It’s going to be quite high: everyone within five years of retirement, plus everyone from other EU countries who suspects they’ll have to (or will want to) return home, plus everyone who dislikes their job.
Because that’s what you say if you dislike your job but need the money: “I tell you what, I’m definitely quitting within five years.” You want to assert that this isn’t how life is going to be and yet you know you won’t quit now. And quitting within a year seems a bit close and scary. And quitting in 10 years seems too remote and dismal. So “within five years” is a nice, vague, woolly resolution to change.
So let’s assume that among those who, say, work for McDonald’s, the number who imagine quitting within five years is higher than two in five. But also that among those who, say, live their childhood dream of earning their living directing live opera or managing a large acreage of ancient woodland or being leader of the opposition, fewer than two in five envisage moving on in so little time as half a decade.
If you average that out – and since there are probably more in the former group than the latter – I wouldn’t be amazed if the overall rate of people with jobs saying they want to quit within five years isn’t also about two in five. I’m just guessing. I haven’t had research commissioned by a careers advice website or anything. But I don’t sniff Britain and get waves of job satisfaction pheromones coming off the workforce. And I live in London, where the streets are paved with oligarchs’ discarded onyx worktops and we’re all so rich we don’t hate immigrants.
Then again, GPs’ annual earnings are on average about £100,000, a salary that usually militates against dissatisfaction. Which makes the two in five figure more worrying again: it’s a well-paid job, and a worthwhile one, and it’s not physically dangerous, yet 40% of the people who do it want to stop. The unavoidable conclusion is that it’s horrible. Like Egypt under Pharaoh.
This report is just one recent example of troubling news about the health service, which also includes nurses balloting for strike action, a cluster of “avoidable” infant deaths, the number of people waiting more than 18 weeks for surgery “set to double” and new cancer drugs being ruled too expensive. Despite Trump, Brexit and Syria, the NHS is clinging to its share of column inches as doggedly as Mel B’s love life, and is just as bleak.
It’s clear that a solution must be found before the whole thing collapses into an enormous heap of rubble, crutches, wheelie drip-stands and little cardboard dishes of vomit. Well, it has been! Last week came news of a campaign, pioneered by Nottingham university hospitals NHS trust that aims to get patients out of bed, dressed and walking around. Obviously, in a sense, the whole NHS is supposed to be a campaign to do that. But the difference with this scheme, referred to as “End PJ Paralysis”, is that it aims for patients to do it before they’re necessarily better.
The premise of the scheme is that lying around in bed feeling sorry for yourself becomes self-perpetuating. So staff are encouraging patients to get dressed, move around and in general act like they don’t feel terrible. At a time when the NHS is under unprecedented pressure to free up beds, this is a refreshingly direct approach. “Get out of that bed!” say the staff. The patient does. The bed is freed up. It’s much more efficient than waiting for them to die in the bed, at which point you have to send for a couple of guys and a trolley.
Instinctively I believe this idea works. We’ve all done it: just decided we can’t be ill, either because there’s stuff we have to do or because we’re fed up of the sweaty sheets, the daytime TV, the endless Lemsip. By getting up and pretending everything’s normal sometimes it becomes so. You get distracted from the symptoms and by the time you remember them, they’ve receded or disappeared.
This idea has much in common with alternative medicine. In that field, because patients are listened to, given time and respect in a comforting environment often involving a CD of wind chimes, they frequently feel better despite it having been proved that the actual treatment doesn’t do any good. It’s an effective mood-changer for someone who doesn’t feel 100% but is basically fine.
“End PJ Paralysis” is doing the same thing in a different way. It’s the “Pull yourself together!” to reflexology’s “I’m so sorry to hear that” and is much less costly in time, staffing and vaguely oriental-looking indoor water features. Like homeopathy, it absolutely cannot fail unless accidentally applied to someone who happens to be actually ill.
Some people’s recovery will be helped by greater pressure to get dressed and move around. But can we be sure patients will succumb to this pressure according to whether they’re really up to it, rather than because of their own personality – their instincts to obey authority or deny the seriousness of their condition?
The principle that people who have been hospitalised should restart normal life as soon as they can is already well established. So it’s suspicious that a campaign exclusively pushing the idea of getting up and going home should coincide so precisely with the NHS’s dire shortage of money. It feels like a treatment it’s financially convenient to prescribe.
‘End PJ Paralysis’ is more symptom than solution | David Mitchell
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