Some home truths on the NHS
January 22, 2015
It is a brave politician who speaks openly and honestly about the NHS. That my colleague Charlotte Leslie has done just that this week – mere months away from a General Election – makes her contribution to the health debate both refreshing and courageous.
As a member of the Health Select Committee, Charlotte has observed at close quarters the acute problems the NHS faces in coping with rapidly increasing demand for its services. Placed ‘at the heart of our sacred taboos’, she has described political support for the institution of the NHS as a ‘religion’ that ‘prevents anyone from sensibly discussing solutions’.
In contrast to this candid assessment, we have Shadow Health Secretary, Andy Burnham, whose disingenuous posturing on the NHS is almost sickening in its hypocrisy. Having held the health brief in the last government, Mr Burnham is surely more aware than virtually anyone of the enormous challenges facing the NHS and of the institution’s staggeringly complexity.
As he well knows, the primary problem is not one of ‘privatisation by the backdoor’, ‘profits before people’ or ‘Tory cuts’. It is in truth one of near-insatiable demand and the difficulties an inflexible system has in coping with it. This demand issue was going to kick-in no matter who was holding the reins. We have a population living ever longer, a booming birth rate, an array of complex co-morbidities and the welcome creation of innovative, life-prolonging medical advances once disease has taken hold. In 1948 if you were lucky enough to reach retirement age, life expectancy was three to four years. A heart attack or cancer was essentially a death sentence. Today retirement often lasts decades with a significant proportion of that time spent being in ill-health, recovering from life-changing medical conditions.
Add to that a host of issues that have been a decade and more in the making, which will take equally long to fix. We are still reaping the dubious rewards, for instance, of the 2004 GP contract that disincentivised out-of-hours provision, a PFI-funded infrastructure investment programme that has left many hospitals with cripplingly huge annual debt repayments (some for decades to come) and a progressive recruitment crisis at A&E and GP level.
Since the very same Mr Burnham as Health Secretary paved the way for private providers in the NHS, and the current government has presided over a real terms increase in the health budget since 2010, we shall put to one side Labour’s primary, opportunistic criticisms. Arguably they are on more fertile ground when it comes to the concerns raised over the reduction in social care budgets at local authority level, as well as the robustness of mental health provision – two items which both have a significant impact on so-called ‘bed blocking’ in hospital units. Insofar as the coalition is culpable for adding to the list of NHS woes, however, its main mistake was to expend huge amounts of political capital on a reorganisation that very few people properly understood or were able to communicate effectively.
The Prime Minister’s initial instinct to let his erstwhile Health Secretary, Andrew Lansley, get on with the job and implement his plan to give GPs more control was admirable. As Shadow Health Secretary for six years, Lansley was fully immersed in his brief – a master of detail, confident that his policy wonkery in Opposition could be successfully translated into practical reform. But once in office, opposition to his supply-side plans was fierce and as MPs got deluged by email campaign after email campaign, the government seemed unable to answer in the simplest of terms what the reforms were all about.
As a result, they became pockmarked with messy compromise, drastically reducing their potency and effectiveness. But worse still, this episode has meant that any opportunity for sensible and open discussion about the future of the NHS has been taken firmly off the table for a decade. Politically, it is now simply too hot to handle. It is a great shame for I have in my constituency two outstanding teaching hospitals in Barts and St Mary’s Paddington, and after the initial confusion following the removal of Primary Care Trusts, we now see much better cooperation between GPs, hospitals and other care providers and improved surgery opening hours. Meanwhile the NHS as a whole recently topped the rankings for quality and efficiency when compared by the Commonwealth Fund to eleven other Western healthcare systems. Indeed what the NHS achieves in my constituency and beyond, week in, week out, is literally incredible. When the Health Secretary praises the hard-working doctors and nurses in the NHS, he knows they are performing miracles – nationwide over a million more people have been treated in this parliament than the last.
The dismal Lansley experience also revealed the powerful forces against change within the NHS, and the opposition that reformers face from those who spray around the word ‘privatisation’ to deter any discussion on efficiency. On this note, it is worth pointing out that if the Mid Staffs scandal had happened on the watch of a private provider, these same voices would have been calling for emergency legislation to hound out firms from the NHS for ever more. As it was, they took a vow of silence until Hinchingbrooke Hospital hit the headlines, allowing them to crow with delight that even mutual providers cannot be trusted with the NHS. It is worth noting too that in spite of the hyperbole about the loss of ‘our NHS’ to the profit-chasers, the state still provides 94% of its services.
The public forgets that bodies like the British Medical Association are powerful trade unions not the independent, dispassionate and professional observers they would have us believe. But such bodies know that they hold a trump card –any change in policy that they do not like can be warded off by browbeating the public that it will bring closures, a reduction in service or pressures on staff that put lives at risk. It is a tactic Labour deploys to great effect itself. It is difficult for reformers to explain succinctly the many reasons behind all that is being done to change and improve the health service. In contrast, the Opposition knows it can always condense any negative headline on the NHS down to three simple words: ‘Stop Tory Cuts’. Indeed such campaigns on the NHS are meat and drink to Labour campaigners. These are messages with which they not only feel entirely comfortable but provide them a reason to get out of bed on a Saturday morning and knock on doors!
In the face of all these challenges, debate on the NHS has essentially been shrunk to one about funding alone. But we are all colluding in a fundamental falsehood. As any Member of Parliament will tell you, there are two types of conversation about the health service – the public one, where talk of hard working nurses is accompanied by hasty promises of further cash, and the private one where NHS staff candidly admit that the current service is unsustainable and that we must urgently discuss future priorities, changes to the system, and our willingness either to provide more funding at the expense of other public services or tell the public that there is a limit to what the NHS can offer.
I hold out little hope that such a frank conversation will be brought out into the open in the next few months. As a result it is understandable that we wish to make the economy the central issue of this forthcoming election.
Regrettably I remain unconvinced that many of the NHS’s self-proclaimed champions care as much about patients as they do about preserving the integrity of ‘the system’. Insofar as we Conservatives wish to make the health service a campaign issue, it should be to contrast ourselves as a party of solutions, not of ideology. A party that focuses on caring for patients, not protecting the institution. In this vein, Jeremy Hunt’s placing of patient care at the centre of his vision for a twenty-first century National Health Service is something about which we must rightly be proud, whether in getting GP surgeries to open at times more convenient to working people or efforts to increase hospital transparency and accountability. The truth is, the NHS – like any institution – must innovate and adapt or it really will be in peril. Conservatives should place themselves ahead of that curve, not confine themselves to a game of one-upmanship over the cash.