Dr Teck Khong: The social problems driving ill health

Dr Teck Khong, a GP and forensic physician, is a parliamentary candidate of the Conservative Party. In this Platform piece he urges us to 'forget right and left' and just get the country back on its feet.

I work in a typical NHS health centre, with occasional stints at out-of-hours centres, caring for people of all social classes. Some nights and weekends, I attend to detainees in police stations because they can’t sleep, or have a rash or cough but did not have time or bother to see a GP, or are withdrawing from ‘gear’, have minor injuries from drunken brawls, or gained a few more scrapes while resisting arrest for burglaries or “got a real bad shoulder pain” having crashed a stolen car. And, of course, there are those call-outs for allegations of police assault because the handcuffs were tight or those who assert they cannot be locked up because they “suffer claustrophobia in the cells”. Sadly, these cases now outnumber other forensic examinations such as psychosis, suspicious deaths, and suspects and victims of physical and sexual assaults.

While some drug addicts have jobs, many have never worked and those who are still in work are likely to be unemployed before long. Apart from their own destruction, their cost to society must run into hundreds of thousands of pounds annually – treatments that rarely work, thefts to buy their heroin which costs anywhere from £30 to £300 a day, unemployment/benefit claims, treatment of serious infections such as hepatitis and AIDS, their prison upkeep, cost to the criminal justice system, etc.

Then there are detainees who say they can’t speak English and “need checking over in case they have some weird disease”…. How did we ever end up footing those huge bills for interpreter services, Language Line and legal aid?

Over the past 24 years that I have been a police surgeon, there is a creeping sense of despair and a knowledge that matters are only getting worse. If you think this kaleidoscopic view of Britain today as seen from the wrong side of the law is only natural, think again.

One evening, I returned home to find my wife watching “Street Wars” on a television channel she doesn’t normally view. It showed a really nasty family on the Isle of Wight where members of all ages were terrorising neighbours with despicable acts of violence and destruction, even damaging the house they were living in. Like many of my colleagues, I often attend to people who suffer such thugs.

Recently, someone with belligerent new neighbours requested anti-depressant and sleeping pills but pills were not the solution. After several months and in desperation, she requested a letter to move away from a house that has been home to three generations. “Can you put in a strong medical reason, like stress or depression, as otherwise I won’t get enough points from the Council to get out of the area?” pleaded the young mother. Why have councils become insensitive? Why medicalise a social problem? Why put out good people to please and embolden the bad ones? Why does our society tolerate people who wreak misery on others?

But the whole picture is more than just about obnoxious people and their victims. At the heart of all this mess are bad policies. There are policies that prevent the police from doing their work properly, policies that favour the offender against the victim, policies that discourage self-advancement through industry and honesty, and so on; in short, flawed policies abound that de-motivate and frustrate. It’s about time we stop denying that there are limits to liberalism and realise that the survival of a society requires discipline and respect – at home, in schools, in the workplace and in public.

It’s about getting our priorities right; priorities of the majority based on what is intuitively correct and common sense. The majority stay outwardly silent not through acquiescence but through fear of castigation and censure. They have distrust that the instruments of law and the might of the establishment will malign and incarcerate them. Someone must speak out for them.

At one health authority which lacks a neurosurgical unit, patients with brain tumours, skull fractures and brain haemorrhage have to be transferred nearly forty miles to the next city for treatment, sometimes with considerable risks to prognosis due to the travelling time. Its Family Practitioner Committee (FPC) was replaced by six PCTs before a recent reorganisation into two PCTs. But do we need over 300 managers and administrators for one PCT to look after just 63 GP practices when the NHS cannot afford a neurosurgical unit? You can have several neurosurgical teams for less than the price of a PCT.

In one typical PCT covering a population of less than 300000, I found over 314 extensions for named staff members alone yet it was difficult to actually speak with any particular administrator. To manage cigarette cessation, it has one STOP Team Administrator, one Senior STOP Team Administrator, one STOP Admin Assistant, one STOP Manager, four STOP Advisors, one STOP Specialist Advisor, three Specialist Cessation Advisors, one Specialist Advisor - Pregnancy STOP Specialist (presumably, that’s because people who smoke during pregnancy are a different type of humans), and one STOP Smoking Specialist (Young People). Oh dear, they seem to have overlooked providing specialist STOP advisors for the Elderly. Presumably, smoking isn’t important after retirement. Do you know how much the entire cigarette cessation team costs in salaries, office space, back-up clerical staff, computers, etc? We haven’t even factored in the costs of the medicines, publicity materials, special classes and payments to pharmacists and GPs for running the programmes.

Those who say the treatment for stopping cigarettes is expensive clearly ignore the cost of their cigarettes! I say whoever pays to start smoking should pay to stop smoking. Besides, will power costs nothing. Cut out the bureaucracy and free up the cash for cancer care instead of waiting for dying patients to set up pressure groups or seek special considerations.

Check out the other appointments. In the marketing department, there is a Media Relations Manager, a Media Relations Assistant, an Information Analyst, a Senior Information Officer, a Director of Information, a Communication/PR Assistant, a Communications Officer, an Internal Communications Assistant, an Internal Communications Manager, an Interim Director of Market Management, a Patient & Public Involvement Manager, two Community Development Coordinators, and the Director of Strategy & Market Management. Does the NHS really need to spend money like this on marketing?

How can the government justify the vast numbers of administrators for nonsensical positions? Oh, there is the IT system which costs billions, doesn’t yet work properly and which is likely to lose personal information on a massive scale. These are the sorts of scandalous abuse of taxes where cuts in public spending are urgently needed.

Alas, as if that’s not bad enough, there are stultifying targets and measurements of the immeasurable. Medical training and clinical quality are suffering. Work contracts are repeatedly fouled up. And if you have bad teeth – tough! It’s easier to find hen’s teeth than an affordable good dentist; there is no such thing as a free NHS dentist. While administrations are getting bloated and ponderous, the people who work at the frontline such as doctors, nurses, police officers and teachers are losing their professional morale.

Clearly, this government is running out of sound judgement in virtually every department. You and I, the public, deserve much better.

But before any other political party is ready to govern, it must be prepared to stand up for the hopes and aspirations of millions of ordinary, decent people – those who care to work for their living, those who pay their taxes that subsidise the weak-willed and the scroungers, those who bother to bring up their children with values of decency and diligence, those who have chosen this land as their home and who are law-abiding, respectful and hard-working. We must also understand those who say we can’t have an open-door without being careful who we admit and we must act wisely.