We know the NHS’s ills, but must be bold to find a cure
EVERY TIME I hear anyone say
”,Iam reminded of the National Health Service which celebrates its 70th anniversary tomorrow.
To my certain knowledge, we have known for 40 years what is wrong with it and have done nothing effective about it.
For all that time we have known that, however dedicated the staff, they are not cost-conscious. We have known of great disparities in costs – and the prices paid for goods and services – between areas, confirming inadequate management.
In her review of 1988, Margaret Thatcher recognised a trio of problems – how to finance an NHS providing treatment free at the point of delivery while coping with an increasingly ageing and therefore illness-prone population, and the almost exponential advances in medical science and surgery. They are still with us, exacerbated by unbridled immigration.
For 40 years, the British Medical Association and health unions have objected to reform and health authorities have consistently overspent and then blamed the government of the day for bed closures, waiting lists and cancelled operations.
Local government, the police and Labour leader Jeremy Corbyn all play the same game. They are all bottomless pits, demanding more money with menaces, regardless of how efficiently it is spent. – the only conclusion I reach is that it is going to require a bold, popular and tenacious Government to sort it out.
I am afraid the present Government – torn apart as it is by Brexit – is not even at first base in spite of Hunt’s recognition of the near-divorce of health and social care. Certainly, Theresa May has appointed a Conservative Policy Commission and is in the market for 1,000 bright ideas.
This may be progress but it is not the response I was looking for.
She needs a concentrated highpowered inquiry on NHS reform to report in plenty of time for the next general election.
Meanwhile, I offer an overall objective and a six-point agenda for any no-holdsbarred inquiry. The simple objective is to fashion an affordable NHS that consistently delivers high-quality services to patients, rich and poor. My agenda is: 1. Structure: Is the current set-up too big, too complicated, too bureaucratic and too divorced from economic pressures?
2. Mindset: How can the apparent bureaucratic hold over the NHS be broken so that patients, regardless of income, always come first?
3. Financing: How is it to be sustainably funded – whether by grant, personal insurance, charges for certain services and for abuse of the system, tax reliefs for those who opt for private healthcare, or a combination of these things?
4. How can we run public and private health systems alongside each other without pre-empting public health resources?
5. Who should be in charge of the delivery of services: medical or executive staff? Shouldn’t executives be the servants of medics whose Hippocratic oath takes precedent over managerial whims?
I do not have any easy answers. Mrs Thatcher’s review came up with 12 papers and 18 bright ideas but not much changed. So the last item on the agenda must be:
6. How can we make reforms that improve matters stick?
In the meantime, we must recognise that after 70 years we cannot go on as we are. Generally speaking, if you are seriously ill, you are well looked after.
But that begs the question of how we treat the rest and how we might minimise serious illness by improving the fitness of the population and so prevent the need for medical treatment, thereby saving precious resources and money.
In short, we need a serious “Keep fit” plan for Britain. Perhaps that is the only thing that will stop us asking “What has changed? – ”– and heralding a new dawn for a noble concept.