“Each man is capable of doing one thing well. If he attempts several, he will fail to achieve distinction in any.” Plato

It is interesting that general belief appears to be that the NHS is an anomaly. A shining beacon of socialism with the rare quality of providing healthcare for all, regardless of income. In 1948, this was definitely true. In a post-war era, the founding of the NHS was a spectacular leap forward.

I found it faintly baffling in the Olympic Opening Ceremony, when we devoted a significant portion of the proceedings to the founding of the NHS. It underlines the national feeling of pride about our healthcare system, and an assumption that other countries are not as fortunate. This is false: almost every other developed country has a comparable system. Some are taxation based, some work on compulsory insurance, but the general principle of universal healthcare unrelated to income is now implemented across Europe and the developed world. 

It is the misconceptions about our healthcare system, both about ideology and practicality, that lead to the discrepancies of opinion between public demand and system reform. There is a general feeling that reorganisation and specialisation are undermining the ethos of our healthcare system. There is public disgruntlement about local hospital closures and apparent diminishing services in district hospitals.

I have completed almost a year working at Ealing Hospital, where there is much uncertainty regarding the future of various specialist services in view of the proposed merger with Northwick Park and North West London hospitals. Daily, I walk past protestors on the way into the hospital, campaigning for the A&E department to remain open, and for the retention of specialist services at their local hospital.

On the face of things, it appears to be detrimental to shut local services, but this is not the case. If you were to have a serious heart attack, your best chances of surviving would be to get you to a catheterisation suite, where a specialist heart doctor could inject dye and map your arteries, re-inflate areas of blockage with a balloon, and probably stent the arteries in order to ensure continuing blood flow. To be effective, this needs to ideally happen within 90 minutes of you first experiencing symptoms. This has many barriers, not least the amount of time it takes the average person to realise that they may be having a heart attack. Logically, to the public, it seems rational that getting to an A&E 10 minutes away will improve your survival rather than travelling an extra 15 minutes down the road. 

However, the precision and speed at which these services are deployed increase with every person treated. If you are blue lighted to the Harefield, a specialist cardiac hospital, then they will have seen hundreds of thousands of the exact same case, everyone will have a preordained role and, on average, they can get you from ambulance to catheterisation in 30 minutes; assessment, examination, and diagnosis all happen on the move to the theatre. 

Now take Ealing. Admission to A&E, running an ECG, taking confirmatory blood test and diagnosing a heart attack will inevitably take around an hour. We just don’t have the specialist set up. Additionally, Ealing doesn’t do out of hours catheterisation, so most people will sit overnight awaiting operation in the morning. Somehow, the extra 15 minutes doesn’t seem so bad. The cardiac team at Ealing are exceptional, they are perhaps the best functioning team in the hospital, however, there is only so much you can conceivably do in a district hospital, and there just aren’t the facilities for specialist treatment.

Specialisation of services is not a bad thing. Yes, it is incredibly frustrating for the cancer patients who have to attend multiple hospitals for treatment – radiotherapy at one, surgery at another, follow up at their local hospital. Yes, it is a pain in the ass travelling continually for medical treatment. But if the alternative to that is sub par medical care, I think I would do the travelling. 

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