Saving the NHS
BRIGHTON: How on earth did it come to this? The party that promised to save the NHS from privatisation and is on course to have trebled its budget finds itself under siege for, you guessed it, privatising the NHS and making cuts.
The answer is clear. Labour came to power without a strategy for running the health service, and the strategy it has now adopted appears to many of its own supporters to contradict much of what it said to get into power. Then it attacked the hated Tory internal market. Now it has re-introduced a version of it (albeit one that ministers insist is fairer and less destructive than the old one). Then it attacked the invitation to private companies to work in the NHS. Now it says that private companies are vital to delivering the values of the NHS. Then it promised to - and later did - build new local hospitals. Now it has accepted the emerging consensus in the medical profession that the NHS needs fewer, bigger, more specialised hospitals.
The reason this happened is because in opposition the party's intellectual firepower was all directed at policies where Labour was seen as politically vulnerable. As one of those involved put it to me at the time, "what do we need a new NHS strategy for? We're 33 per cent ahead of the Tories on health." Another confessed that if you look at the siting of new hospitals, they tended to be in Labour constituencies (incidentally, I'm told, that the last Tory government did exactly the same - favouring its own seats for capital spending).
The result - a strike this week and a possible conference defeat next week in protest at the privatisation of NHS logistics. Meanwhile doctors are talking of running candidates against Labour at the election in protest at hospital closures.
The question now is how the government will react. Tony Blair is more convinced than ever that his reforms are the only way forward. He points to the gap between the performance of the NHS in England with that in Wales, where similar reforms were resisted. Gordon Brown though has long been privately critical of the rhetoric of reform which demoralises staff and leads the public to doubt that the NHS is delivering.
Last week before a speech to the TUC dinner he issued a press release including a quote in which he gave his full backing to the Prime Minister's NHS reforms. In the end it was a statement he never made, choosing instead to declare - to union applause - that the NHS would never be privatised.
The question that has not been convincingly answered is whether Prime Minister Brown would simply change the rhetoric or the policy as well.
I'm 
Comments
"Gordon Brown though has long been privately critical of the rhetoric of reform which demoralises staff and leads the public to doubt that the NHS is delivering."- Of course Brown makes this point, over 20% of the British electorate is employed by the state. IMO Brown has got this the wrong way round, the public sector is there to provide a service to the public as a first priority. If debating the issue of reform might lead to a better service being provided, then surely that is more important than the sensitivity of public sector employees.
If you are at the Lib Dem conference at Brighton why the blog about Labour?
I look forward to your blog during the Conservative Party conference, maybe, just maybe, we will see some comments about their policies or even the lack of them. What I don't want is for you to change to much, I couldn't take it if you were even slightly critical of Mr Cameron.
There has to be a judicious balance between state and private treatment. Politics should never creep in where medical treatment and hospitals are concerned. Health is far too important an issue for murky politics to interfere. The government in power should always have its priorities right. Health is a very important pillar and citizens expect the very best. If patients on the NHS have to wait for hospital beds or for specialized treatment, they should have rights to have paid treatment in private hospitals or clinics. That should be the bottom line.
I have no idea if it is precise but a number of web sites including those of the NHS and their main union claims the NHS to be the third largest employer in the world. And that doesn't include Scotland!
Well if so this means that we need more staff to run medical service for 55 million than the Germany needs to service 84 million. Not only that but Germany has more doctors, nurses and critical care beds per head of population that we do and strange to say has better healthcare outcomes on almost all measures that the UK!
The only conclusion possible is that our NHS is appallingly organised, overstaffed with bureaucrats and whatever with far too few doctors and nurses.
A point I keep making Nick that this government knows how to tax and spend but hasn't a clue how to deliver.
"I have no idea if it is precise but a number of web sites including those of the NHS and their main union claims the NHS to be the third largest employer in the world. And that doesn't include Scotland!"
-John Galpin.
John, that figure is correct. The total number of staff employed by the NHS is 1.3 million. The other two are the Chinese Army and Indian Railways.
'The only conclusion possible is that our NHS is appallingly organised, overstaffed with bureaucrats and whatever with far too few doctors and nurses.
A point I keep making Nick that this government knows how to tax and spend but hasn't a clue how to deliver.'
Or perhaps the Germany healthcare system is semi-privatised and has been for a long time?
Nick Robinson has captured the debacle of Labours NHS policies beautifully.
Expensive, ever more management consultants, ever more massaging of figures. Meanwhile local hospitals are laying off staff.
No real reforms are occurring. Commerce replces care, management consultants are more respected than medical ones. Expensive stand apart facilities and projects siphon off NHS money whilst local hospitals and surgeries are run down.
Labour has spent a fortune on NHS and achieved unimaginable damage as a result. The damage looks set to get worse as Blair and Hewitt head the NHS reforms ever more quickly towards the iceberg.
Absolutetly right. Before someone blames doctors pay for the financial woe which is forever exaggerated let me remind you that there is a predicted huge number of unemployed junior doctors next year while the legion of beaurocrats continue to rise and that the cost of the increase in wages is dwarfed by the disasters such as connecting for health (billions wasted) and choose and book. This government and patricia hewitt in particular is inept.
In response to Mr Galpin, Germany has statutory health insurance, not a health system under state administration, so there isn't a single health employer to match the NHS in size.
Health insurance costs in Germany passed 14 percent of an individual's salary recently, and in 2005 the public health insurance companies spent 鈧143.6 billion (about 拢96 million), so perhaps it should be better than Britain's given that the England and Wales health expenditure has only recently reached that level.
The founding fathers of the NHS must be spinning in their graves. From being an organisation formed to serve the citizens of the UK, it has deteriorated into a self-serving monster, controlled by Orwellian bureacrats. For some time it has been obvious that services, including hospitals, were being removed from the home counties, and especially from areas where the predominant residents were of white, UK-born origin. This seemingly reverse discrimination has been cynically practiced in the knowledge that the poplace will be more placid than that of 'ethnic' people and also that most would probably not be voting for the New Socialists. Not only are medical services vanishing from these areas, but also the job market is shrinking since the NHS is an employer of all manner of workers. The Minister of Health will deny these facts, but they are there for us all to see.
The NHS is indeed one of the largest organisations in the world, but not because it is inefficient - almost all other countries (like the US, France or indeed Germany, John Galpin) have many smaller private companies that provide healthcare. The UK, for better or worse, is unusual in genuinely (naively?) attempting a state run system.
Even more interesting is total spend. Britain in fact is very efficient in that it spends a lot less per head than many other countries for similar outcomes. This graph illustrates the point well:
The real question is: would we improve quality by spending more like other countries? And what on earth are we spending a larger share of GDP on than anyone else? Trident? Binge drinking? Does anyone know?
The problem with the "fewer, bigger, more specialised" policy direction for hospital provision, which is the one favoured by the Medical Profession, is that the chief beneficiaries of it are the Medical Profession and not patients.Health policy should always and only be about what is the best for patients, not some Doctor's career prospects.
All political parties seem to miss the one essential truth about the NHS, it has no clear objective. The NHS tries to be all things to all people, with 60 million potential clients it will always fail no matter how much money is thrown at it.
It would be much more sensible to define the remit of the NHS, by which I mean to layout which services will be provided by the NHS and which will not.
It is not really surprising that governments do not understand how to stay within a budget, unlike the rest of us they can simply ask for more. So for the benefit of the politicians out there, you stay within your budget by first buying the essentials and then, if there is money left over, you maybe buy a few luxuries.
I would like to see some more inventive thinking where public services are concerned. Here's an idea, rather than paying doctors and nurses huge salaries why not simply introduce a new tax rate for health care professionals. For example, if you are working for the NHS then perhaps you get a flat 20% tax rate, or an annual refund. Surely that is a better idea than inflating the NHS budget and having it swallowed up by pay increases.
The problem with the NHS is that in its initial concept, care from cradle to grave, free at the point of delivery, it is simply undeliverable when one takes into account our exponentially increasing expectations of what health care can deliver over the last 6 decades. And at the same time the marginal cost has increased enormously. Where public health is poor, as in the Third World, or 18th century Britain, enormous gains can be made by the relatively simple and cheap expedient of sanitising public water supplies. When the general level of public health is good 鈥 and in comparison to what I have just described, it is phenomenally good in the Western world, it costs much, much more to achieve comparatively less. Courses of drugs like Herceptin cost thousands of pounds.
What is more, we do not appreciate the costs. I recently had a CT scan of my kidneys. It took about 2 minutes, little longer than the time required for a simple X ray, and certainly just as painless. However, whereas the X ray might have cost 拢50, the CT scan cost 拢750. In the words of Michael Caine, 鈥淣ot a lot of people know that!鈥
The problem for democratically elected politicians, charged with ensuring such a service is provided, is that they cannot admit that they cannot do it 鈥 any more than their political opponents could. They perceive that to admit to it would be political suicide. And so, what is served up as health policy is actually a series of Wizard Wheezes, which will serve to demonstrate just how well the NHS is doing, while avoiding the uncomfortable truth that it can never be made to live up to our expectations. The hint of NHS unaffordability is always there 鈥 PRIVATE Finance Initiatives from Labour or PRIVATE Health Insurance top-ups from the Tories, but I have yet to see the Front Bench spokesman of any colour, who will openly admit to the reality that no amount of reform will ever be able to deliver the level of healthcare provision we desire.
What really gets the collective goat of those, who work in the NHS is when the reforms they are tasked to implement serve merely to produce indicators, which appear to show that, thanks to intervention by the incumbent government the service is improving in one particular way, while at the same time they are more than aware of how inadequate it is in others. It is dealing day-in, day-out with this sort of political cynicism that really saps morale.
The reason for fewer more specialised centres has nothing to do with doctors careers.The European Working Hours Directive is increasingly biting into heath care. Junior doctors rotas in the past were built on very onerous on-call rotas. The hours were long, the pay was unbelievably bad, but learning on the job was often very good. Consultants were paid for a basic week of 33 hours and they were not paid at all for any time over this and also not a penny for being on-call. Their hours were also long and the picture of the golf-playing medical consultant in reality existed almost nowhere
( especially not in the provinces ). It was merely a picture which politicians tried to retreat to, rather than dealing with the real problem of an underdoctored service which was being patched up by overlong, poorly paid hours.
Now the EWHD is increasingly lowering the hours which anyone can work - and failure to obey it can result in very high fines for NHS Trusts. The result is that the undermanning situation has become uncovered. Small Trusts cannot afford the staff numbers to maintain all services and all on-call rotas. The result is they must either reduce services, close, or amalgamate with bigger units to keep service provision. This government trauls the third world to asset strip its medical work forces and then when this doesn't work tries to off-load the problem onto private enterprise
( the op-while-u-shop philosophy ).
Private enterprise is in business to make money and who can blame them. They may perform a few loss leaders for a while to get their business going but to balance the books and make a profit they will siphon off the small inexpensive health problems where quick money can be made. Anything else will be sent back to a run down NHS service or alternatively the public will be asked to provide top-up fees because the job can no longer be done at the money the state is providing. Just look at what has happened to dentistry over the years. Slowly the vast majority have been pushed into private practice and look what that costs.
Fundementally both main parties want to be shot of the NHS. They don't want to ask the public for the realistic taxes which it will cost to run a state NHS properly- because it will make them unpopular and the public might take their jobs away. The public on the other hand have too long allowed themselves to be kidded that you can have something for nothing. Everyone needs to grow up. What is just about to be inflicted on people will be the worst of all worlds. A pofit motivated private system taking easy work for easy profits and a run down and demoralised NHS rump taking the remaining expensive work which it will not be able to afford to do properly. Do something to stop it now - before its too late.
A couple of corrections regarding size of the NHS as an employer...
- unfair comparison with Germany, as their health system is not a single employer
- NHS employs less than Wal-Mart. Wal-Mart has 1.8 million "associates" world-wide, with 1.3 million in U.S.. Therefore, at best NHS is 4th.
- However, debatable as to whether NHS is a single employer. Yes, there are standard terms, conditions, and salary scales across the NHS. But, from the Inland Revenue perspective the employing organisation is the local NHS Trust, Primary Care Trust, or Strategic Health Authority.
Sorry to be a pedant!
Nick refers to "the emerging consensus in the medical profession that the NHS needs fewer, bigger, more specialised hospitals".
But there quite simply is no such emerging consensus in the medical professsion. It's a managerial and political creation, which lacks clinical support.
Nick doesn't usually parrot this kind of thing. The danger in doing so was instantiated almost immediately in Matt Davis' comment that the supposed consensus is a careerist conspiracy imposed by clinicians in their own self interest. In fact, doctors think it's against their interests AND their patients' interests.
Adding to the woes of the NHS is the "postcode lottery" regarding treatment. Why is it possible to have a somewhat "luxury" procedure in one place but not another? The treatment spec. is spread too thinly. There should be a basic entitlement laid down for all, everywhere. Beyond that, NHS money should not be available for things, say, like tattoo removal or IVF. These cannot be classed as an illness or disease that could affect the health of the whole population. On the subject of IVF I am curious as to why so much IVF is necessary? Isn't it fair to say that the difficulty evident in performing our raison d'etre, in the UK at any rate, is caused by environmental and/or diet factors? It is those factors which should be addressed otherwise couples increasingly will need an increasing amount of painful, lengthy and costly artificial means. There certainly was not much difficulty in encouraging natural human reproduction 30 or 40 years ago!
Also, I think that food served to sick people in hospitals could be simplifed, to both patients' and the hospital's financial advantage. How come meals suitable for people in physically demanding jobs is prepared and served to those who need much less, and simpler to digest, food? It is no wonder that so much food is wasted in hospitals. I have seen platefuls of over-complicated "dense" food served up to patients often too-strongly flavoured and smelling, often congealed and unappetizing, often in daunting portions and difficult to eat. Managers seem to be incapable of imagining what the feeble digestions of bed-bound people are able to manage.
I would like to know which school of acting he went to?.
If he does go with a tear in his eye it will be a tear of joy at the thought of counting the millions he will be getting from his book and the millions from a grateful USA who will insure a fully paid lecture circuit for services rendered, a few choice well paid directorships,it goes on and on.
The question is how much will he give to his debt ridding party that he leaves behind?.As for us we just have to hope our wives don`t get breast cancer unlike the Blairs we can`t afford to buy herceptin.
Labour have kept to the principle of the NHS "from cradle to the grave"it`s the speeding up off "to the grave" that I have a problem with.