Today’s media are full of stories of doom about the National Health Service. The Accident and Emergency (A&E) figures released yesterday for England show the worst performance in ten years for people being seen within four hours of attending A&E. In Wales, as the Tories like to repeatedly tell us, the picture is even worse.
So what’s going on? Is the latest NHS crisis (by the way politicians have been saving the NHS in every election for the last thirty years) just about A&E or is there a wider problem affecting the whole of the NHS?
The truth is, our beloved NHS is too monolithic to be managed properly and it has moved so far away from its original aims in the late 1940s; trying to do far too much with too little resource, both financial and human.
Where do we start? Well let’s look at the politics. Labour are fond of reminding everyone that they introduced the NHS and they are its rightful custodians. The Conservatives, always try to convince the public that they 'love' the NHS but never quite pull it off and the Liberal Democrats always promise more and more money for the NHS but never really say where that will come from. The truth of it all is that none of the big three political parties have clean hands when it comes to the health service.
But before I add my views to that of the doom merchants predicting the demise of the NHS, it’s probably worth pointing out that the experience for the overwhelming majority of people of the NHS is a positive one. They are treated, as I myself have been, quickly and cared for efficiently and with compassion.
But for the significant minority of people who do not have a good experience of the NHS, and any of us could fall into this category at any time, we need to look at how we can fix what’s going wrong.
There seems to always be a funding crisis
Despite protestations of ‘ring-fencing’ and investment doesn’t it always seem that the Health Service has a funding or administration crisis? The usual arguments of course are that there are too many managers administrating and pushing paper around on one thing or another. Well actually there are, and a whole industry has developed within the NHS where getting rid of them is neither easy nor cheap.
Quality of management
The quality of management is also questionable. The NHS IT project to, computerize (how very modern eh!) our medical records is a good example where billions of pounds were wasted on a valuable and ambitious idea by back-room staff that were simply not up to the job (employing consultants they didn’t know how to manage either). The project went in the dustbin along with a lot of tax- payers money.
Against this backdrop, there’s a lack of consultants, doctors and nurses, not just in A&E, but across the NHS as a whole. We’re simply not recruiting enough front-line staff and we’re not rewarding them with better conditions of service to retain the brightest and the best.
Paying back PFI contracts
There’s other places the money goes. Try the Private Finance Initiative. PFI was developed under a Conservative government in the 1990s and embraced and massively expanded under the Labour governments of 1997-2010. The terms on which PFI were entered into favoured the private sector. NHS trusts are now paying so much interest on repayments for new buildings and hospitals that their budgets can hardly cope.
A growing population
Population growth (mass migration/immigration) to you and me is the elephant in the room. Since 2004, four million people have entered the country and 675,000 children have come along in the same period. All of which have needed to use the NHS.
This has placed unprecedented and significant demand on health provision that cannot be sustained. In addition, tens of thousands of illegal entrants into Britain or overseas visitors with no health insurance make demands on the NHS that sees London and some parts of the country become an International Health Service. Politicians of all parties, with the exception of UKIP, do not want to discuss this but whether they like it or not it contributes hugely to the ongoing NHS crisis.
Lack of co-ordination
Then we come to the real problem. The lack of co-ordination and joined up management of primary care, secondary care, social care, mental health care and community care. All of which are managed by other agencies or bodies and all of which have had their budgets cut by as much as 40% since 2010. The NHS re-organisation that nobody voted for, but which took place in any case in 2010 did not help the matter of co-ordinated service delivery either. All of this means we have 'bed blocking' on a massive scale.
Lack of GP capacity
Finally, the lack of capacity within General Practice means it is now common for people to be unable to see their doctor for up to five days. So where do they go when they feel ill? A&E of course, even though they have not had an accident nor an illness that constitutes an emergency.
It's time for an honest conversation
In a nutshell, if we want an NHS fit for purpose in the 21st Century we have to all have an honest conversation about what we want and expect it to do.
We need a mass clear out of middle managers and administrators. We need to end PFI and to re-negotiate the existing terms of PFI with the private sector.
We need to limit what the NHS does for us and we need to recruit more front line staff and GPs with better pay and conditions and reward them well for working unsociable hours.
We need to control migration and immigration to levels that can be sustained and we need to ensure that any visitor to our country or non British national has comprehensive health insurance to cover their stay otherwise they are not admitted into the country.
We then need to ensure we have a proper strategy for the co-ordination of primary, secondary, social, mental health and community care needs - managed by people with a track record of running big business successfully. This strategy needs to be funded properly and supported with annual real term increases.
The NHS is too tempting for politicians to sort out. They want to use it as a political football but really all politicians should do is provide the funding. Parliament through a special NHS committee can provide the public oversight and accountability that is needed to ensure NHS finances are spent properly and appropriately and then let a small new generation of super managers streamline and run it.
Where do we find the money? Oh I won't go there, but those who read my blog regularly know exactly where the money can come from when we have tens of billions swilling around for all kinds of things.