Friday, January 12, 2007

What future for the NHS?

Remember how Patricia Hewitt said "This is the best year for the NHS ever!" last year?

I doubt she will be repeating that remark.

The question is what is going on in the NHS and will it survive? There was this article in the Daily Telegraph today where it was reported that BMA chairman James Johnson said there was only one year to save the NHS, as it was in financial crisis.

Well, in part the financial crisis is created by the vast wage bill of the NHS, and in particular the increases in pay for GP's and Consultants. You can read what the Independent has to say about it here and here. Then there is the hidden cost of PFI. Apparently spending on the NHS is about to be triple what it was in 1997. It seems clear to me that what ever else you may think might help the NHS, extra money is not it.

As an example a friend of mine works in the local hospital's mortuary. A Consultant from that hospital who used to do post mortems now no longer needs to, as she earns the extra £15,000 per year anyway, so at greater expense they have to get a consultant down from London to do them. So no money saved. As the Independent article says, GP's now get 63% more than they did 3 years ago, but now only need to work 9 to 5 Monday to Friday.

We have had Can Gerry Robinson fix the NHS? It was an interesting series of programs. The main issue is not funding but how things are done. I used to work as a domestic in my local hospital, when I was studying for A levels. I can confirm that the way some things are done in the NHS are bonkers. Gerry found entrenched practices that made no sense and did not help run the hospital. He managed to get waiting times down in the Children's unit from 8 weeks to 2 with out spending a penny.

It seems to me that a lot of the NHS is organised the way it has always been organised, or the way the person who barks the loudest wants it to be organised, rather than in the best way possible for patient and tax payer. Part of the reason for this is that the service is "free" that is that some of the people running the NHS think they are doing you a favour. Well, I have got news for people like that, it isn't. I pay tax, to pay for the NHS, and if people are being treated with MY money I expect them to be treated well.

It seems clear to me that hospitals can't be centrally run, they need good and effective management on the ground. I'll give an example. Missed appointments cost the NHS lots of money every year. Is this feckless patients or a feckless service? Well, it is a bit of both but in my view more of the latter than the former.

If you have an appointment for some clinic or other you get an appointment time. When you turn up you find that everyone else at the same clinic has the same appointment time, you you have to sit around waiting for ages to see this or that doctor, or nurse, then go and queue for a blood test, come back, see some one else and eventually go home. In the mean time you spend a lot of time waiting about. If you had to drive, (in rural areas you have to) your car is needlessly blocking a car parking space, and in any case your employer is wondering where on earth you are.

There is no need to organise things in this way at all. It seems to be organised for the convenience of the clinicians, though it does not seem that convenient for either the clinician or the patient.

Even modern hospitals are not designed to be cleaned. If they were then you would have as many floors clear of any obstruction you that larger cleaning machines could be used. Instead of which dirt traps are all over the floor.

It just takes a little communication, some common sense and will to do these things. Unfortunately there is little good feeling in the NHS which has had to face 9 reorganisations is as many years all parachuted in from the top.


Innocent Abroad said...

None of what you say would be any surprise to Aneurin Bevan, who accepted that the price of a health service free at the point of use was a health service run in the producer (doctor) interest.

I am not aware of any health care system which combines affordability with consumer sovereignty. Whilst we can all agree that we wouldn't start from here, that's of limited help in devising policies to meet the double whammy of an ageing population and year-on-year increases in real prices as new drugs and therapies unroll at ever increasing speed.

I daresay politicians of all parties would love to "do a Railtrack" on all those PFI partners - bankrupt the b*ggers and buy it back in-house for £1!

Benedict White said...

Innocent, I agree it would not be a surpise to him.

There are two problems. Firstly it is actualy very hard to run an organisation that large just from the top. Just because some one says some thing will be so does not make it happen. Secondly there is the interests of the doctors.

I do not actually think the NHS is run in any bodies interests at all. It is just there. The changes needed are small, here and there changes. How to get that to happen of course is another matter.

AS for PFI, that will be a millstone around the tax payers neck for years.

Timothy said...

PFI is a big part of the problem*, as is a bureaucratic-lead contract culture, which sees units work to the contract rather than their full potential.

However... We are now in yet another winter without the full-blown beds crises that were a regular fixture of the Tory years, and the early Labour years, before the extra money kicked in.

A lot of money HAS been wasted, this is true, but the money has ALSO improved the service at the same time.

There is a dangerous perception growing that the money has JUST been wasted, which isn't true. There are a lot more nurses and doctors than there used to be, even though the number of contract-writers has grown at a faster rate.

I feel it's important not to overstate the scale of the problem, as that would lead to people despairing of any solution. I worry that a similar mood is engulfing the discourse surrounding Global Warming.

Essentially, the NHS works. There have been some maddeningly stupid decisions made in recent years, but most of the top-down reorganisations have made the situation worse rather than better. It would be good if the NHS could be left alone to get on with the job, but I doubt that benign neglect would look good in today's political culture.

* By problem I mean the reason things have not got as much better as they could have done.

Benedict White said...

Timothy, I see we agree about some things.

On the winter beds crisis, there are a number of reasons why it is not there, which I will come to in a minute. There are less beds in the NHS now than there were in 1997, in fact over 10,000 fewer.

We don't get the winter beds crisis for a number of reasons none of which have anything to do with spending on hospitals.

Firstly a lot of old people with long term conditions have been kicked out to be cared for in the community, or more likely in a nursing home.

Then there is the flu jab. This has only been possible in recent years but seems to help.

Winters have been nothing like as cold in the last 5 years as they were in the mid 1990's (positive effect of global warming)

and then there is the winter fuel payment.

The thing that concerns me though is the amount of money wasted in botched schemes. You and I both agree the NHS is important and taht these schemes have been botched. My fear is taht some one could use the failure as an excuse to give up, when it ought to be a reason to fire ministers.