Background
It's sad to see the cherished institution which is the U.K's National Health Service reported so regularly in the news for all the wrong reasons.
At the same time its crucial role in supporting the U.K.'s economy has never been more apparent and newsworthy. At the moment there are regular headline-grabbing accounts of disagreements between scientists, Ministers and ex-Ministers over health policy at the Public Inquiry into the Government's handling of the Covid pandemic.
And then there is the big debate about all sorts of related national issues (1) including record waiting lists reaching 7.5 million this summer and about so many NHS staffing posts being unfilled. And as an indication of how serious the waiting is in Northern Ireland, it is reported (2) that in November 2023 there are almost 429,000 of its people waiting for a first hospital appointment as an outpatient, with over 83% waiting for more than nine weeks.
Set against these issues, the daily frustrations of citizens queuing to get an ordinary appointment with a GP, important as they are, seem like a low priority.
The organisation's well-documented problems along with issues of understaffing and under-funding take on an extra layer of seriousness in Northern Ireland where there is no regional Government operating to monitor the health of its economy and its citizens. One party's protest about a Brexit deal, which most people and the four other parties rejected at referendum, works against the express will of the people, against the public interest and to the detriment of the region's reputation and well-being.
Older issues have become more critical and new ones are not addressed as political responsibility is abrogated. Take these examples.
Neurological failure
In 2018, the National Health Service witnessed Northern Ireland's largest recall of patients. More than 5,000 patients whom the consutant neurologist, Michael Watt, had treated for stroke, Parkinson's disease and multiple sclerosis were recalled. The chairman of an independent inquiry concluded in June 2022 that the governing Health Trust's "failures ensure that patterns of the consultant's work were missed for a decade."
Indictment is another word. Following a medical tribunal's finding that his professional performance was "unacceptable," Mr Watt was finally "struck off" in November 2023.
The process continues its weary way. Reports (3) that the police are opening an investigation into his clinical practices form the latest highlighting of a bad news story for our beleagured National Health Service.
Women's health - cervical smear testing
Another example involves women's health and reveals substantially more recalls than Mr Watt's case necessitated. Some 17,000 women are being recalled for review of cervical screening smear tests following an investigation into their "accuracy" at a Northern Ireland Health Trust. Apparently, there were concerns about "persistent underperformance" of some screeners over 13 years. An Inquiry by the Royal College of Pathologists concluded that the women are "at risk of missed opportunities to detect and treat precancerous changes."
In mid-November 2023 the Trust opened clinics for repeat smear tests for those whose previous slide is either unavailable or had taken place more than 10 years ago. It seems that repeat smear tests cannot be offered to all 17,000 patients "due to capacity issues in the U.K. (4)." Coincidentally, on the same day the recall clinic started, it was announced that Ireland is on target to eliminate cervical cancer by 2040.
Dr Gabriel Scally, Professor of Public Health at Bristol University (and born in Belfast) has commented on the stark differences in approach to women's health between the two national governments. He says that this latest NHS scandal is symptomatic of a dysfunctional health system where women are being "failed" by a "completely out-of-date" screening service.
Unlike in Great Britain and Ireland where there is primary HPV (human papilloma-virus) screening, Northern Ireland uses a slower cytology-based system with slides being examined under microscope; and thousands of patients are subsequently backlogged facing six-month delays for a smear test result. Dr Scally describes the HPV test as very accurate in picking up the HPV that causes cervical cancer.
Abuse of vulnerable adults
The third example relates to the long-standing tale of alleged abuse of patients at Muckamore Abbey Hospital in County Antrim. A Public Inquiry into the abuse was established back in 2005, with hearings still continuing in November 2023. The Inquiry website states that "it wishes to hear from current or former staff or from a former patient, relative, carer or a member of the public who has information that will assist the inquiry."
The last report (5) which I read about the Muckamore Abbey Hospital case says that more than 70 staff have been suspended and dozens arrested at the facility - which treats people with severe learning difficulties and mental health issues. A separate police investigation into the abuse of vulnerable adults is also underway.
As the man says, you couldn't make this stuff up. These are very upsetting stories, to say the least. And in all of these examples, one party is disabling Stormont from taking part, with Westminster seemingly unable or unwilling to break the deadlock.
England
Nothern Ireland's NHS is not alone in having to face up to serious problems.
BBC2's Newsnight has reported last year (2022) about allegations of mistakes and a "Mafia-like" culture at England's busiest Health Trust in Birmingham. The programme now reports (6) that its investigation led to the launch of 3 Inquiries and the subsequent implementation of changes at that Trust.
Now in November 2023, the programme's NHS investigations unit has uncovered very similar allegations being levelled at the Royal Sussex County Hospitals. Staff have claimed that unheeded warnings and the existence of a toxic culture of cover-up led to numerous unnecessary deaths and maiming of patients. Police are now investigating. Sounds familiar.
New RCN Book
I conclude on a positive note.
A magnificent tribute to our nurses has just been published by the Royal College of Nursing Northern Ireland (7). A lavish new book entitled "Nurses' Voices from the Second World War The Ireland Connection" tells the stories of nurses from both jurisdictions across Ireland "who were willing to put their lives at risk caring for their patients on the home front and on overseas front lines."
This largely undiscovered (until now) and exhaustively-researched story reveals the harrowing background events where many nurses died in tragic circumstances at sea and even as prisoners of war.
It puts everything else, not least our contemporary concerns about the state of the world, in perspective. And it provides a salutory reminder - maybe one is needed - as to a big part of the rationale for establishing a National Health Service after violent and senseless global conflicts.
© Michael McSorley 2023
References
1. https://michaelmcsorleyeconomy.blogspot.com/2023/10/state-of-nation.html
2. BBC News 30 November 2023 Marie-Louise Connolly "Waiting lists: Woman waited for three years for telephone consultation"
3. BBC News 28 November 2023 "Michael Watt: Police to investigate former neurologist"
4. Irish Times 25 November 2023 "Shortcomings of cervical screening in the North revealed by review of smear tests" Seanin Graham
5. Belfast Telegraph 7 September 2023 "Muckamore Abbey abuse inquiry unlawfully requested medical records without notifying patients, court hears"
6. Alan Erwin BBC2 Newsnight 29 November 2023
7. "Voices from the Second World War The Ireland Connection." Researched by the RCN History of Nursing Network, collated by Margaret Graham and Seán Graffin. Proceeds to charity
