R.I.P. FREE HEALTH CARE

Tell the truth, Prime Minister: that If you won’t inject billions more into sinking hospitals, it’s...

A culture of fear stalks Britain’s hospital wards

ALL is calm, stable and safe with the NHS, if our Ministers are to be believed. That is the reassuring message they tell us, week in week out, as the Health Secretary did last Tuesday at the Conservative Party conference.

But unhappily that is not the case. For the health service is facing very stormy weather and unless we put in place some radical solutions, I believe there is a real danger it will sink.

The NHS is close to bankruptcy, morale is low and a culture of fear stalks its wards.

Right now, hospitals across the country are being told to do more and more for less and less. Treat more patients, keep more services open 24/7, have evershorter waiting lists – all the while making £20billion of savings by 2020.

Ministers want voters to believe it is all possible. But the truth is that, try as hospitals might, it is not. Despite the heroic efforts of both medical staff and managers, we cannot do everything on the budgets we have.

As new figures from the financial regulators show, hospitals are struggling to give the care they should be providing within their means. Eight out of ten NHS trusts are in the red, having racked up a combined deficit of almost £1 billion in just three months.

We have been squeezing the lemon for ‘efficiency savings’ for years. But it is getting to the stage where there is nothing left to squeeze. At the same time, we are being told we must have more doctors and nurses on our wards or face being castigated as unsafe.

The Government’s big idea is to offer the public even more of a 24/7 NHS, but there isn’t a chance of that happening when our hardpressed and loyal staff are struggling to deliver what we are meant to be delivering within our means.

I applaud the intention of providing more services 24/7, but how are we going to afford it?

I think there’s a risk that the public’s expectations are being raised, without a realistic chance of us meeting them.

The stream of letters from Ministers and officials is unremittingly negative: ‘You mustn’t do this, you mustn’t do that.’

Junior doctors feel they are being undermined by the clumsy negotiations over their contracts, which they fear will leave them working unsociable hours for less. This is causing many to consider their options, with the talk in mess rooms no longer being of how to progress their NHS careers, but to which country they are going to move.

Medical staff fear being put behind bars for making a single, serious, but honest mistake, thanks to a series of troubling cases where individuals face criminal prosecution just for doing their jobs.

All this is utterly demoralising and, unless Ministers want jumbo jets full of NHS doctors trained at vast public expense flying off to Australia or the US, it has to stop. Hospital chief executives, unable to square the circle of flat finances and rising demand, are already voting with their feet and quitting the NHS in droves. Thirty-three trusts currently have no chief executive, leaving them effectively rudderless.

Someone has got to tell the truth: if there is no further injection of money, we are going to have to run and fund the NHS in a very different way.

If we don’t, the quality and safety of NHS care will suffer.

Hospital bosses now face an impossible choice: maintain staff numbers and ignore the finances, or cut staff at the expense of patients. Currently many are choosing the former, but that cannot go on indefinitely.

Hospitals will have to cut the number of nurses and medical staff because however hard they try they cannot break even.

In the short term, patients are going to have to wait longer for outpatient appointments and pre-planned operations like hip replacement and cataract removals, because we have to prioritise emergency care.

In the longer term, things will get worse as the number of older people with complicated health problems continues to rise.

I believe the Government has to make a clear decision if it wants to maintain the safety and quality of the NHS.

Either it puts more money into the system to maintain the health service as it is now – with every service free to all. Or it asks people to contribute their own money for certain aspects of their health care.

THE Prime Minister has to have the political courage to be totally straightforward with the electorate. He has the chance to preserve and develop a successful NHS for the nation, and I strongly urge him to do so.

Of course, the NHS must continue to provide essential care for free, for everyone. But can it continue to offer the most expensive drugs and some non-lifesaving treatments on this basis?

So far this year, dozens of very expensive drugs have been cut from the £340million Cancer Drugs Fund after reviews found they were poor value for money. That’s a start. But the fund is just a fraction of the £12billion the NHS in England spends annually on expensive branded drugs. A wider-ranging review is needed, looking at whether we can continue to afford drugs that are ten times more expensive than ‘generic’ versions but only marginally more effective, if at all.

Can we afford them when we cannot provide proper home care to thousands of vulnerable old people with dementia?

However, I also passionately believe we can take hugely positive steps by harnessing the force of the 32million Britons who volunteer every year.

To that aim, I want to set up a ‘HealthForce’ of volunteers who would be trained to help care for elderly and frail individuals before, after and even during their stays in hospital.

Trained coordinators would help care for them at home, physically and using technology, to reduce unnecessary hospital admissions and ensure they could be discharged from hospital speedily, so freeing up beds.

They could also help on hospital wards themselves.

In India, patients on wards are cared for by both nurses and families, as I saw on a recent trip to Jaipur. When I was chief executive of Marie Curie, we had queues of trained volunteers coming to work in hospices for the terminally ill.

There is no reason similar approaches could not be used in the NHS. Such a system is already being trialled at King’s College Hospital in London and could be rolled out to every hospital in the country.

HealthForce would reduce use of scarce state resources in social, primary and hospital care.

Cynics might dismiss me as an optimist. But they should remember the London Olympics, where volunteer Games Makers played such an important part, and more recent initiatives like Dementia Friends, which now has 1.3million taking part.

The NHS is currently facing huge risks, but with those risks come enormous opportunities.