To those that use the NHS,

You will have no doubt heard about the pressures on the NHS just now. It is true, we are worried. We have begun this Winter under considerable strain - more than usual. And, I won't lie, we expect things to get worse.
1/15
#NHS
We have little capacity - both emotional or beds. We are short staffed, and on top of all this we have a pandemic to deal with.
I understand you too may be running out of capacity... to face even more calamity after a calamitous 20 months. You too must be worried.
2/15
Firstly, can I say, we are still here. We get up in the morning (or night) and come to work. We donn our PPE, roll up our sleeves and face the avalanche of patients, requests, relatives, battle-hardened colleagues, and a pathogen that we have lost many colleagues to.
3/15
But we are still here.
And if you arrive here at our door, we will do our very best to protect you and help you return to the life you enjoy, regardless of who you are or how much you earn.
But I will not lie to you. We can only do our best with what we have available.
4/15
What we have available just now is simply not enough. Not enough to provide the quality of care we are trained to deliver. Not enough to deliver the quality of care you deserve or have paid for.
5/15
You may have heard from some commentators (all outside looking in) that there are still enough beds for the 1000 additional COVID patients we must admit and treat everyday. You may even have heard the problem is the management of the NHS not it's resources.
6/15
These part-truths are somewhat more bearable to hear than the actual truth..
When resources are tight we must make difficult choices. When we have only two or three beds available on each ward, we have to prioritise who gets them. This happens over 85% capacity. Now at 93%.
7/15
We always decide based on clinical need, not on who can afford it or who knows who. It is the simplest part of my job in that way: the medicine decides, not the managers. But, how unwell someone has to be to gain entry to the current, rationed service is getting too grave
8/15
No doubt you will also have heard about the NHS being sold off to private companies. That, there is a concerted effort to defund the NHS and reduce the quality of care provided....to make you unhappy with the service and embrace a newer, profitable service.
9/15
I do agree with the choice: private versus public. There are arguments for each. But at the moment, the NHS is all we have. Private healthcare could not cope with one-tenth of the demands just now. And, IMO, failing to invest in our health service now, is unforgivable.
10/15
Today the budget will announce a nearly £6bn investment in the NHS. Please look at the details. It is not to benefit those sicker patients, who need more nurses, more beds, more GPs, more access. I am quite sure it won't even help reduce the waiting lists.
11/15
Over half the money will go to industry for new technologies and new diagnostic machines, which while potentially useful, will not make our health service safer or actual treatments more accessible.
I fear we may be heading toward a repeat of the Test and Trace failure...
12/15
...£37billion spent outside the NHS, to provide a service that failed to provide any significant benefit for the public. A lot of public money, your money, spent without a coherent, clinically justified plan.

The entire primary care budget for England is £12bn.

13/15
Our focus must be on the national crisis. Bed capacity is lower than before the pandemic started, there are less frontline staff, less GPs and diminishing investment. Private sector isn't ready and we need a functioning health service.
14/15
So, what to do?
Make some noise!
On any platform.
Demand your right to have your money spent directly to secure access to basic healthcare.
Demand better focus from our representatives.
This is my noise.
Simply put, WE NEED YOUR HELP...so we can keep helping you.

Sincerely,
Daniel
15/15
Here are some organisations and people who are fighting for better care:
@drbobgill @JujuliaGrace @NHSMillion @doctor_oxford @ShaunLintern @ReicherStephen @trishgreenhalgh @guardian @SallyMi83941850 @DrSimonHodes @EveryDoctorUK @AntonEmmanuel2

Will add more later...
Can't believe it took me so long to find this campaign #YourNHSNeedsYou & yournhsneedsyou.com

Thanks @PeterStefanovi2 and @stephenfry for sharing.

Others fighting for the NHS:

@MrMarkEThomas @PrivateEyeNews @BylineTimes @CarolineLucas

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More from @danielgoyal

26 Oct
The government's £6bn NHS investment for waiting lists is...

...too little,
...too late,
and raises further concerns about the priorities of this government.

theguardian.com/society/2021/o…
Firstly, don't be fooled. Investment into waiting lists are unavoidable. The restricted access during the pandemic mean a catch-up initiative was always going to be needed.

The first question: would more decisive leadership have led to less restriction to care and less backlog?
The second: how much have the years of underinvestment in the NHS worsened the problem?

The waiting lists have been growing massively under this government prior to COVID.

[source BBC - chart is over 10 years]
Read 16 tweets
24 Oct
Summary thread (for me too).

Clinical care for COVID-19 in the UK: shortcomings and lessons to be learned.

+

My view on what next...
Here, I summarise the threads I have written over the last couple of months.

It will tell part of the story of the UK's national response from a clinical perspective.

I have attached the previous threads only for those who wish more detail.
There are several critical failures in the clinical pandemic response, including:
1. The Herd Immunity Strategy
2. Reducing basic healthcare capacity
3. Bypassing primary care triage for non-clinical Covid triage
4. No Covid follow-up service
Read 23 tweets
22 Oct
The truth about the GP crisis...from a non-GP doctor.

I share this with you for 3 reasons:

1. To highlight the source (and fault) of the current GP crisis.

2. Because the primary care crisis is at a critical point and can be salvaged.

3. Public support matters.
We go back to March 2020, when all the health service staff were preparing for the arrival of this new, unknown pathogen. We were all nervous.

Those who expected to be right in the thick of it were:

Primary care - GPs, DN's, receptionists, etc
A&E (+ paramedics)
Medicine
ICU
For those who don't know, the typical pathway begins with the GP or Practice Nurse..

they assess, then either test and send home with advice, or send to A&E for further assessment...

if deemed 'unwell', they are admitted to medics.

That is what we were preparing for.
Read 20 tweets
21 Oct
Dear Prime Minister,

I will be brief.

Ideology has no place in a national crisis. You must do the first part of your job: protect the people. The second, promoting growth can only be done after you have been successful in the first - living being a pre-requisite for success.
I fear I am not getting through to you. Another way then. When the dust settles, and the true endemic level of SARS-CoV-2 is known, there will be a tally. There will be a count - with all the data, across all the domains that the many observers have collected.
The count will not be in your favour. In fact, when historians put pen to paper, the Johnson-era - on your current trajectory - will be remembered as a cautionary tale, a bookmark in history to teach those that come after you a simple fact: decisions are rarely binary.
Read 9 tweets
20 Oct
Covid-19 and Herd Immunity

What is the clinical harm associated with pursuing a herd immunity policy?

1/15

#GovernmentCovidCatastrophe
@IndependentSage @DMinghella @doctor_oxford @ShaunLintern @dgurdasani1 @trishgreenhalgh @Kit_Yates_Maths @chrischirp
@TheBMA #TeamNHS
Putting aside whether it will work or whether a Health Immunity Strategy (HIS) is ethically right...

What will be the CLINICAL harm to the UK public of allowing SARS-CoV-2 to spread without any mitigation strategies?
We know access to healthcare during a pandemic saves lives and prevents disability.

We know the greatest barrier to a "catastrophic loss of life" with HIS is healthcare availability @wtgowers @ChrisCEOHopson
Read 15 tweets
19 Oct
#COVID19 and '111'

Serious questions about the '111' Triage Service.

Is it fit for purpose?

@NHSDigital @DrGregorSmith @CMO_England @doclourda @CMOWales @FatmaMansab

dx.doi.org/10.1136/bmjhci…
Our study published today in the BMJ HCI examined the NHS '111' online triage tool.

Results include:

It could not reliably differentiate between mild and severe Covid-19.

It missed severe cases, advising such cases to say at home.
The study used 52 cases simulating various presentations of Covid-19 from seven national online triage tools.

Reliability was poorest for the '111' version.
Read 19 tweets

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