The NHS is wounded by internal market and inspection culture | Letters

Here is an alternative our chronic impasse over the NHS (Report, 17 February): abolish the internal market, together with its draconian micromanagement and inspection culture. These are flawed and failed ideologies. In attempting to replace vocational motivation with commercial incentives we have all but destroyed the best of healthcare’s professional art, heart, spirit and intellect. Our profession’s impoverishment of morale is widespread and increasingly hazardous. The internal market is inviably complex and divisive. It has undone collegial trust and therapeutic networking, and has replaced these with dense, rigid institutional procedures and documents that are often known to be senseless, often corrupting. Increasingly I have witnessed just-legal feints and “creative accountancy” to deceive yet formally comply: redesignations to double-count, cherry-picking referrals for financial or statistical advantage, for example.

Our earlier, pre-marketised system worked much better. Older practitioners know this well; many patients sense it, often without fuller understanding. The government’s position is nervously defensive; the opposition is now too disarrayed to marshal the formidable counterculture to rid ourselves of this tumourous burden. The longer we leave it, the worse it will get.
Dr David Zigmond (GP)
London

• It is unfortunate that you didn’t reference the important role that health visitors play and how they are currently being cut in many areas across England (Report, 15 February). The coalition government correctly addressed the need to increase health visitor numbers in 2011, but since 2015 NHS statistics show their number is decreasing, caused by the scandalous cuts to public health budgets which are totally counterproductive to both improving the nation’s health and the cost-effectiveness of services. The government, and the prime minister herself, talks about the key importance of early support but the reality of their policies totally undermines this rhetoric.
David Munday (health visitor)
Stalybridge, Greater Manchester

• Join the debate – email guardian.letters@theguardian.com

• Read more Guardian letters – click here to visit gu.com/letters

The NHS is wounded by internal market and inspection culture | Letters

Wounded soldiers failing to receive the care they are entitled to

The Division of Well being has responded to the warning by saying that from up coming 12 months every single part of the country will have GPs specially educated to react to the bodily and mental overall health needs of veterans.

“Veterans are now entitled to priority accessibility to NHS care when their medical condition or care relates to their time in the Armed Forces, and we’re investing £22 million to help veterans bodily and mental health as well as funding 24 professional veterans prosthetics centres,” a spokesman explained.

“From summer 2015 there will also be a expert GP in each regional area trained in the physical and mental health demands of veterans.”

Prof Briggs has recommended that personnel serving complete-time are handled inside of 6 weeks and those who have retired from services are noticed inside twelve weeks. At the moment there is an 18-week waiting time target for civilians.

In a foreword to the report, the Duke of York writes: “This will boost care for all individuals and provide a extremely significantly much more constant strategy to rehabilitation. Without a doubt, some of my fellow Falklands veterans – often forgotten by the program – are living confirmation of the urgent want for this.”

Prof Briggs’s overview, acknowledged as the Chavesse report after Captain Noel Chavesse, a medical professional who was awarded the Victoria Cross twice in the course of the 1st Globe War for treating injured soldiers, is anticipated to discover:

·  There is nevertheless some lack of connection between the MoD and the NHS, particularly in rehabilitation. This results in a fragmented service and dangers serving personnel, reservists and veterans falling into “no man’s land”

·  When services personnel are discharged, the NHS gets to be the sole supplier of their on-going care. There is a threat that they will not acquire on-going care in a timely method

·  Variable and patchy rehabilitation signifies veterans might miss clinical consultations and get misplaced in the method

·  It is presently impossible for NHS systems to recognise serving reservists and veterans in order to ensure quickly tracked care for them

·  Both clinicians and veterans appear unaware of the Covenant and its implications for their care. As a consequence, veterans frequently neglect to inform the GP that they are an ex-serviceman and do not supply the GP with their discharge report.

Dr Dan Poulter, the well being minister, said: “Veterans are some of our bravest and very best and the entire country has a moral obligation to support them. By generating a specially educated GP available to each nearby region we are continuing to prioritise help for our veterans’ physical and mental wellness.”

Wounded soldiers failing to receive the care they are entitled to