I generally avoid talking about Brexit, I don’t consider myself an expert, there are many more educated on the subject than I. what I can talk about is the NHS. with 24 years service I’ve seen a lot of changes over the years and managed many transformation processes. Like everyone else in the UK I am also a user of it as much as I’m an employee of it.
The brainchild of Aneurin Bevan, then Deputy leader of the Labour party in 1948, the NHS is now in the top five largest employers worldwide, it rubs shoulders with the US Department of Defence, McDonalds, Walmart, and the Chinese Army. We treat something like 1 million patients every 36 hours. It costs us approx. £2.4billion per week to do that. Those who are good at maths will have already worked out that this is about £125billion a year. That is some serious money.
The Health budget in 2016-17 was 19% of the national expenditure so the government of the day understandably want to make it as efficient and effective as possible. The single biggest problem that we the NHS face is that of constant demands for reform and scrutiny. We have no issue with scrutiny. We should seek to improve our game, but reform, dear gods, another one? The problem is that we never stop getting reformed. The NHS reals from reform after reform after reform, like a punch drunk boxer. staff constantly have to deal with reversed decision making that leaves them feeling uncertain and vulnerable. Not an ideal situation to be in when you have others to look after.
We spend millions on change every year. The costs associated with investigations and reports from Francis report, the Cavendish report, the Keogh report and the Berwick report etc, make your eyes water.
Right First time. That’s one of the many ethos’ of the NHS to which we aspire to, but sadly despite our best efforts, we occasionally fall short. We waste millions a year on dispensing medication that does not get used and has to be thrown away, supplies that are past their best before date gets destroyed despite still being in a sterile packaging. We lose hundreds if not thousands of hours on missed appointments, waiting lists though significantly better than two years ago are still pretty high for some services. more so when you talk about children and adolescent mental health services, because its funding is peanuts by comparison. Trying to get appointment with the GP is a nightmare and we the patient often feel like we are not listened to leading to frustration and anger.
We are often told the NHS has too many managers, yet the Kings Fund analysis suggests we have has less than is required for this size of company, particularly given the complexity of health care., Cost improvement savings are often born by the management teams rather than the front line services. Twice I have “taken one for the team”, and agreed to be redeployed to protect front line staff and services putting my livelihood on the line for sustained service delivery.
When we as customers are not happy we complain. When it comes to the NHS we demand that our MPs sort it out, who then demand reform, and around we go again.
What’s in it for me? Well, the flag ship service obviously is its critical care departments, including good old A&E. If you are critically injured you can expect the best possible treatment. The NHS will do its utmost in trying to save a life no matter the cost. After that, the NHS offers a bewildering array of services from regular health screening to palliative care, and everything in between. We have become all things to all people. It is the envy of the world, and we are proud to be number 1 in a list of the top 10 health services in the world. But it comes with a hefty price tag as I have already said.
Paying for it long term is a constant issue for the government, and the NHS. recently the NHS Confederation has said it needs an increase of five percent per year to meet the demands currently placed upon it, and none of the parties in the last election proposed those sort of numbers. That big red bus was nothing more than a figment of our imagination.
The House of Lords NHS sustainability committee in 2017 said we need a 2.4% increase just to stay in line with current inflation. Over the last few years we’ve had about 1 – 1.5% I think we got .4% this year.
So what is the answer? Well the simple answer is if we want a free health service like the one we are familiar with then we have to pay for it in taxation, possibly a further few pennies in the pound. We could reduce the amount of services we currently get for free, and pay for them through private health insurance, this already happens with dentistry, and most social care. Or we could just scrap everything except critical care. That would certainly put a lot more money in the government’s spending pot. But that does not help older people that have retired and have no money. We would see mortality figures rising sharply over winter. I believe the UK does want an NHS and it is prepared to pay for it, so we are stuck with option 1.
Long term funding not just for the next 5 years needs a consistent sustained increase to remain offering the services we currently are able to access. We have been cutting for so long that services are failing and failings at best mean long delays or appointments getting cancelled. At worst it could, and has led to failure of care that has had catastrophic consequences to peoples lives.
After all that what’s the conclusion?
Yes more money would be helpful, but that’s only half the story. we the NHS recognise that we are not perfect. Sadly we are prone to human failings, however we make every effort to learn from our mistakes and attempt to prevent them happening again. We should be accountable to the government for the delivery of public services but we need a buffer that protects us from the eb and flow of political manoeuvrings so we have time to make sense of the latest round of changes we’ve just gone through.
What really is not helpful is another reform. Please, no more. A cross party governance process that has a single vision and direction with some stability would give us a chance to consolidate the changes that are constantly being imposed so that we can develop and improve. Consider the NHS as an oil tanker, which you are asking us to manoeuvre like a speed boat. Go easy, handle it with care, after all its 70 years old you know.