NHS needs a new emphasis to bring it back to health
NO one denies the NHS is in crisis. Where there is not agreement is what to do about it.
I feel convinced, as do many others, that there may be those in the Conservative Party who are happy to let it “wither on the vine”, like NHS dentistry was allowed to do, so that it becomes a residual service as more and more people opt to go private. This would reduce expenditure.
It is true that we are constantly bombarded with advertising for private provision, and I know many people of quite modest means who were previously staunch supporters of the NHS but now feel obliged to pay for private provision because of inadequacies in the service.
You notice the private sector is keen to do fairly straightforward operations, but leaves the big ones, which require sophisticated equipment, to the NHS.
This does propose problems for the NHS, which trains the surgeons. The training is long and rigorous, but a key aspect of it is that a trainee has to train alongside an experienced surgeon, and then do “directly observed practice” before he or she finally qualifies. When more operations are done privately, this will become a growing problem.
Is it simply a question of more money? Yes, to fix an immediate crisis but in the long run “No”.
Is it another extensive reorganisation? The last one in 2012 was “big enough to be seen from space”, caused considerable disruption, ironically required more managers, and is now having to be unpicked.
The Conservatives thought the private sector would be more efficient, but competition prevented the different parts of the NHS working together. No one wants to go back to that.
I have been involved in the NHS in many ways as a lay member, and what has always struck me is the ethic of service and mutuality in the organisation. Staff are willing to work over and above what is required. Admittedly they have finally got fed up with seeing their pay effectively reduce every year because of inflation and have decided to take a stand. But the ethic is still there, and we lose it at our peril.
It was estimated that NHS spending had to increase by at least 2% in real terms a year keep up with the
aging population and advances in medical technology that meant new kit or medication. Tony Blair’s government just about managed this, but under the coalition and later the Conservative administration, the budget has only just about kept up with inflation. Hence the present crisis.
But long term rises in real terms are unsustainable, and the service needs a new emphasis. I am not talking about a wholescale reorganisation again, heaven forbid, but simply a different approach to health policy.
There are two long term approaches the NHS must adopt. One is to treat more elderly and infirm people in the community, so they do not have to go into hospital unnecessarily. The present policy of starving local authorities of money is preventing this as they provide much of the social care.
The second issue is to reduce the demand by trying to make people healthier. We suffer with very high rates of obesity in this country, for example, which are likely to cause diabetes or cancer when people age. Both are long term issues and require politicians to have the vision to think beyond the next election.
The NHS and local authorities have already realised that they must work together, and many innovative schemes have already been set up to give people who need care and support the ability to receive it in the community. Durham has been particularly good at this, but like all other local authorities faces considerable financial pressures.
The NHS has established a new system of Integrated Care Boards to enable to different parts of it and local authorities to work together. Sounds good in theory, but insiders tell me that in practice its approach is very “dirigiste” and centralised, requiring all groups to act in the same way, and stopping some good schemes to ensure uniformity.
Regarding making us healthier, insiders again tell me the original Primary Care Trusts, (PCTs) which brought public health, community services, GPs and local authorities together, was the best approach to this. It was junked in 2012. The PCTs had some notable successes, including reducing smoking and teenage pregnancies in the North East.
But most important of all was their “community based” approach to issues like unhealthy diet and lack of exercise, which can cause obesity.
They worked with social care to reduce falls in the home and ensured there were enough district nurses to keep an eye on people to prevent them going into hospital.
Charities such as Mencap and Deafened Support were involved, and groups set up to encourage walking, cycling and even running for those who had never previously thought of taking part.
There were community allotments and cooking groups to encourage healthy eating. The whole point was that to change people’s behaviour you must work with them, not “top down” as the ICB wants to do.
Reinstating the PCTs would not be a major disruption, but I feel it is the way forward for the NHS. Remember Nye Bevan’s quotation: “The NHS will last as long as there’s folk with faith left to fight for it.”