The NHS: Things That Need To Be Said E-Book

Iain Dale

• Herausgeber: Elliott & Thompson
• Kategorie: Geisteswissenschaft
• Sprache: Englisch

Seitenzahl: 78

Veröffentlichungsjahr: 2015

Beschreibung

The NHS is an institution close to the hearts of most Britons. People even profess to 'love it'. But it is now of pensionable age and, some would say, no longer fit for purpose. It isn't possible to reform the NHS until we accept that it cannot meet every demand made of it. We need to embrace the private sector rather than belittle or restrict it. This book does not seek to denigrate or dismantle the NHS, but to identify the issues that need to be addressed head on, whichever party is in power. It will make uncomfortable reading for some.Putting patient care and outcomes at the top of his personal manifesto for the NHS, Iain Dale slams the indecision and political dogma of successive health secretaries, but is firmly of the view that with £120 billion being spent on the NHS, it's impossible to take politics out of it. This is a must read for anyone who works in the NHS - or who uses it. It's time to say the things that need to be said.

Leseprobe

Contents

Introduction

1 Politics and the NHS

2 Private sector v. public sector

3 Targets, outcomes and a seven-day-a-week NHS

4 What is ‘national’ about the National Health Service?

5 The coming funding gap

6 Care and the patient experience

7 The challenges of population growth and demographic change

8 The challenges of personal responsibility

9 Still the NHS Cinderella: mental health

10 Transparency and the right to know

11 Diet and the nanny state

Conclusion

50 things which could make the NHS better

Introduction

Writing a short polemical book about the NHS when, inevitably, the readers of the book are bound to know far more about the subject than I do, is perhaps not the wisest thing for a political pundit and broadcaster to do.

Let me explain why I am writing this book. Each and every one of us uses the NHS. We have shared experiences, both good and bad. We all have opinions about what the NHS does well and what it doesn’t do so well. My motivation is not to write a book which contains all the answers to the NHS’s problems. That would be both stupid and impossible. Instead, it is to highlight some issues which are of concern to NHS users, the people who work in the NHS and those tasked with running it.

Any government wanting to get the best out of the NHS starts from a position where they know the NHS has huge amounts of public support. An Ipsos MORI poll in July 2014 found that more than half (52 per cent) of the public say the NHS is what makes them most proud to be British, placing it above the armed forces (47 per cent), the royal family (33 per cent), Team GB (26 per cent) and the BBC (22 per cent). Despite recent coverage of care failings and the increasing financial squeeze, we are prouder of the health service than we were two years ago, shortly after the Olympics (52 per cent now compared with 45 per cent then).

Furthermore, according to the Ipsos MORI Global Trends Survey, Britain is the second most positive country, out of nineteen, surveyed about the quality of their healthcare, with only Belgium rating their healthcare more highly. But . . . And here’s a very big BUT. The same survey found only one in ten of us (9 per cent) say that we expect quality to improve over the coming years, while 43 per cent think it will get worse. This makes us among the least optimistic of the twenty countries surveyed, and reflects concerns about the sustainability of the NHS in the future.

So that’s the context.

What I am going to attempt to do is identify some issues which I think will dominate the health agenda over the next decade. I want to challenge orthodox NHS thinking and say a few things which I think need to be said, but don’t always seem to form part of the current debate. And forgive me if I use a couple of personal experiences to illustrate some of the points I want to make.

In many ways, senior health professionals and those in government and opposition have much in common – even if that thought might fill the latter with a degree of horror.

The government is trying to wrestle with the demands of an empowered, knowledgeable twenty-first-century consumer base while NHS staff are all operating within a structure designed for a mid-twentieth-century command control system of healthcare provision.

There is another communality of interest – NHS staff all have a fair idea of what needs to be done, but no one in politics is courageous enough to articulate either the problems or the solutions. And, sadly, I do not see that changing either under any government we might have in the foreseeable future. No one is prepared to think the unthinkable, say the unsayable, much less implement the doable.

1

Politics and the NHS

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Politicians treat the NHS as a political football, insisting on initiative after initiative, to prove that there really is ACTION THIS DAY, and yet consistently fail to plan for the long term. They seem to think that structural reform and targets will yield results – and sometimes, in the short term, they do, but who can really say that they can think of a single health secretary who has been able to plan for the long term – of either party? During the thirteen years of the last Labour government there were six different health secretaries.

The Conservatives under Margaret Thatcher and John Major did a little better and managed only seven in eighteen years. The coalition government has had two different health secretaries. So a health secretary serves for an average of a little over two years. Of the fifteen holders of this post since 1979, very few had any direct experience of health policy before they took on the job. So they spend six months reading themselves into the job and the last six months trying to save themselves from being sacked. This gives them each just a year to make an impact. A few years ago, the Adam Smith Institute published a report which opened that:

Secretaries of state and their junior ministers come and go with sometimes breath-taking frequency. But the one thing they all have in common is the desire to make headline-grabbing changes to advance their careers. As a result the NHS is besieged by a bewildering array of initiatives from one minister, only for him or her to be replaced by another minister with their own (often conflicting) ideas. Politicians tend to think that they can improve the health service by simply giving orders, or setting targets. But such measures always have perverse effects, distorting clinical priorities and encouraging creative accounting. NHS policy should be determined by medical priorities and not by political ones.

Bearing in mind that the NHS is one of the world’s largest organisations, this way of running it is utter madness. If IBM or Glaxo changed their chief executive every two years, their share prices would plummet and within a short time the company would be considered a basket case.

And so we constantly hear pleas to take the politics out of the NHS. Liam Fox, when he was Shadow Health Secretary, said it. Various Labour ministers have said it. Andrew Lansley said it. Jeremy Hunt actually believes it. But surely none of them can be so naive. Well, it seems the general public agree with them. A poll for the British Medical Association conducted by Ipsos MORI found two-thirds of the general public wanted the NHS to manage itself without the involvement of politicians. Another 46 per cent also said politicians should have low or no involvement in how the NHS is run. They are all wrong. We have to have democratic accountability in the NHS.

After all, the fact that the Health Service eats up £115 billion – a sixth (!) of public expenditure – means that the way that money is spent has to be made accountable, and that has to be through the political system. The trouble is that half of this sum has, according to the Wanless Report, gone on price inflation and extra pay – 25 per cent to consultants and 23 per cent to GPs.

Was that the right thing to do? Voters will be judge and jury on that point. It had to be a political decision, not one made by a faceless independent board. So any politician who calls for politics to be taken out of the NHS is likely to be doing it to get a cheap round of applause on Question Time and can safely be ignored. It isn’t going to happen, and nor should it.

That’s my view but, interestingly, the think-tank the Adam Smith Institute (ASI) begs to differ. Its briefing paper documents the bewildering and counterproductive range of political initiatives and interference which, it says, has wreaked havoc on our nation’s healthcare system.

The paper’s proposal is for a distinguished panel of health professionals to be appointed to run the NHS, to allocate its budget, determine its priorities, and operate it according to medical needs rather than political aims. A YouGov poll taken on the subject showed massive popular support for precisely such a proposal, with 69 per cent in favour and only 12 per cent against.

The NHS budget would be set by Parliament every five years, and increased each year in line with inflation. The ASI’s YouGov poll showed that this idea, too, enjoys widespread popular support, with 74 per cent in favour. The suggestion that ‘the NHS has become a political football’ receives 72 per cent backing.

Whatever the merits of the ASI’s proposals or those of the Conservatives, an independent NHS certainly isn’t going to happen when we have such consummate political brains in Number 10. Think back to the Gordon Brown government.

I’m told that the Deep Clean initiative wasn’t thought up in the Department of Health. It came direct from the Number 10 Policy Unit, who gave the Department of Health a few hours in which to consider how to make it work. It was duly announced by the prime minister, who made it sound as if this would be the only measure needed to eradicate MRSA and C. difficile from our hospitals. Indeed, when I heard about it, I too thought it sounded a deeply sensible measure.