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The State Of The Nhs

December 10, 2004

The State Of The Nhs

Medical care in this country is failing to meet adequately the needs of the people of this country. Contrary to its cheerleaders’ increasingly desperate claims, Britain’s National Health Service is not the envy of the world.
Evidence enough for this proposition is in the number of British people w…

The State Of The Nhs

Medical care in this country is failing to meet adequately the needs of the people of this country. Contrary to its cheerleaders’ increasingly desperate claims, Britain’s National Health Service is not the envy of the world.

Evidence enough for this proposition is in the number of British people who choose (and pay twice over to exercise that choice) to have private healthcare. Many others choose to go abroad for their treatment. On the other hand we manage to provide “free” healthcare for every person who comes into this country with an acute medical condition, whether or not they have contributed in any way to the NHS. That is the nature of a system that is “free to all at the point of delivery”.

Sadly, with human nature as it is, people do not properly value that which is provided “free”. In spite of this I detect that many people increasingly feel cheated that after a lifetime of paying into the system they get short-changed when they would like to see some return for their money.

A great sadness for this country is the way that many of our brightest and best people are not being attracted to work in the medical profession as they have been in decades past. Similarly many of our best medical technicians are taking their skills abroad for better pay and conditions. What is to be done about it? All we ever hear is that money, money and more money is needed for “investment”. But no one seems prepared to accept the reality that the NHS is a financial black hole and that funding is not at the root of all the medical problems in this country.

There are too many anecdotes from all parts of Britain for us not to realise that cleanliness in hospitals has become a major problem; NHS dentistry especially here in London is virtually a thing of the past and patients wilfully misuse doctor’s appointments because there is no fee for turning up and no penalty for not turning up. None of these issues really concern investment but clearly many people believe money and money alone is the answer.

My contention is that it is not. Big is not always beautiful and medical care is at its best when carried out by motivated professionals who take a pride in what they do and receive the respect their efforts and expertise are due.

Take one example of the new developments in the NHS. Far fewer GPs are now able to offer a service which will see patients out of hours. So these patients present themselves at the local hospital’s Accident and Emergency (A&E) Department. The impact of that on the local health economy is immense. The cost to the taxpayer of each GP consultation has been calculated at £17. By contrast, each A&E attendance is estimated to cost £77. Throughout the country A&E attendances continue to rise while the policy of the NHS is to close many of them and rationalise. This clearly makes no sense.

Too much thinking on healthcare, across the political spectrum, is based on old political ideology. For the current government the issue lies with more and more funding because it was claimed that the NHS has been underfunded for decades. Yes but pre-1997 there was no superbug, MRSA, causing daily deaths in many of our hospitals. Nor was there a burgeoning administration management that is fast spiralling out of control and none of our universities had to close down science departments as a result of too few British applicants.

Now we are told that the extra taxpayer finance will provide a whole new world for NHS trusts and the foundation hospitals in particular. I would beg to disagree. From reports that I see there is great concern at the level of underfunding to handle the new GP contract. It appears that the government is imposing a number of exceptional costs on the NHS that are far in excess of the financial resources made available to the trusts. Some of these additional costs have already started to be incurred – they include the unfunded costs of the new GP contract but also the new consultants’ contract and the unfunded impact of the European working time directive.

Other costs, such as those associated with the government’s major health initiative, “Agenda for Change”, have also yet to bite and in the years to come, front-line services will also be forced to shoulder the burden of the NHS programme for IT.

There are so many statistics produced by the Department of Health and other parts of NHS administration that it is not surprising that success can be claimed in some areas. But few people, even in the NHS, are prepared to claim that the organisation is truly becoming more responsive to patients’ needs.

Here in London the latest figures show that the number of medical operations cancelled in the last year has increased by 16%. The figures are contained in a new Department of Health report. They directly contradict the NHS’s own Improvement Plan, which says, “Access to GPs, accident & emergency care (A&E), operations and treatment is improving with every passing year.” Year-on-year the number of cancellations increased from 2,237 to 2,606 with performance varying enormously across London with some hospital trusts reducing cancellations, while others dramatically increased.

The current hope lies with the government’s “Agenda for Change” and the positive impact it should have on the NHS. Yet it is clear that much of this has not been properly thought through. Different groups of medical professionals within the NHS say that it disadvantages them though there is less bleating frrom the administrators. Radiographers for instance say that their hourly rate of pay will fall; speech and language therapists are expressing similar concerns, but as yet no one seems to be responding from the government.

No one denies that there has been a massive increase in spending on the NHS in recent years but also few would say that there have been as many improvements as there should have been. Increasingly, patients and taxpayers are asking where the money is going and has gone. Today nearly 1 million patients remain on one waiting list or another. The length of time you wait for an appointment is the true cost of the “free” NHS. According to the latest figures from the Department of Health, average waiting times rose by five days during the period 1999 to 2004.

Patients are not seeing the fruits of the increased public expenditure on the front line. There may have had some success in getting rid of the longer waiting times, but at the cost of average waiting times rising. The massive increase in spending has only resulted in a five per cent increase in hospital treatments.

The reason, I believe, is that the money is being wasted. There has been a massive increase in targets, which has resulted in a growth in managers and bureaucracy. The number of new managers has grown at three times the rate of the number of new nurses and doctors. As a result, clinical priorities are being distorted.

We should allow the medical professionals to make the key decisions about patient care. Equally consultants must take responsibility in our hospitals – they cannot throw up their hands and complain about political interference or administrative meddling. If they want control of their day-to day professional lives, they must also manage budgets properly: once again the fallacy of “healthcare being free” works against the best interests of patients. Nursing must once more be regarded as a caring profession, not simply an element of the public sector workforce.

The medical systems in this country should benefit all who live here. Choice is an important factor. I believe that patients have the right to cleaner, better hospitals but I would also like to see taken away the right of people to misuse GP surgery appointments. Raising standards again in the NHS is a fight for all of us and is not simply about funding.