No-one could fail to be touched by the quiet sincerity of Bryan Webster's vain search for someone in the NHS responsible for the patient-centred care so much talked about and so urgently needed by his friend Patience (Medical Matters, 30 June).
He asks how could a system designed to deliver care and staffed by caring people so neglect his friend?
The rhetoric tells us that NHS is a "system" designed for delivering care. "System" it certainly is, but its design has its roots in the observ
ations of David Hume and Adam Smith that productivity can be greatly increased by the division and specialisation of labour.
This notion was the driver of the industrial revolution and has been taken as the "one right way" of managing all kinds of human activity systems. In brief, all the tasks that have to be performed are analysed, partitioned and allocated to appropriately trained and rewarded personnel.
This was the managerial philosophy dubbed "Fordism", appropriate to the mass production of motor cars but now being taken to almost surreal lengths by the designers of the NHS and of other state-owned service delivery systems.
Care for the patient is now so divided and sub-divided among the myriad of task-defined personnel, from consultants to ward maids, that each of them can see patients as presenting only particular features which are of interest to them and which deserve their specialised attention.
This system actually discriminates against anyone seeing the patient as a whole individual endowed with a unique combination of capabilities, needs and lifestyle. There is simply no need for anyone to perform such a role. Being a whole individual is not a medical condition, so regarding the whole individual is not a task that can be exactly defined. Nor can the outcomes of such an activity be measured.
This old industrial model adopted by the NHS after the Second World War was never an appropriate design for the care of people, simply because each person is unique. It supplanted a quite different way of delivering care which recognised patients not just as whole individuals, but also as members of families and social groups. This relied on the family doctor, whose knowledge and understanding was always available to whoever was providing care.
I guess the family doctor is the missing link between the patient and the care system that Bryan Webster was seeking and I believe the family doctor should be restored as the medic-in-charge and the familiar face that Patience needed so badly. He might even have brought her chocolate eclairs.
PROF FENTON F ROBB
North Street
Eyemouth, BerwickshireCongratulations to Bryan Webster. Sadly, there are many, many Patiences, and those of us who have had the misery of leaving a much-loved relative in the "care" of some of our NHS institutions will agree with everything he writes. Conditions are often worse than they might have been in Victorian Britain, with none-too-clean, malodorous wards, inappropriate medication which effectively sedates and takes away the will to recover, no dignity and no mental stimulus.
It is hardly surprising that many elderly people dread the thought of admission to hospital, seeing it as a virtual death sentence, and would rather take their chances of dying, in comfort and among people they know and love, in their own homes.
With the vast amount of money spent on the NHS each year, is this really the best we can do in the 21st century?
VIVIENNE M STIRLING
Craigs Grove
Edinburgh The full article contains 601 words and appears in The Scotsman newspaper.
