Poor old NHS; every time it gets given priority status, it gets a drubbing. With each proclamation by the politicians that resources will be protected, or that the political priorities will be maintained in relation to its preservation etc., it gets hit by another public expectation that it can’t meet.
Having worked with the NHS for more than a decade, I have utmost respect for its founding principles, but if ever there was a time to look at the NHS being placed in an arm’s length political process it is now, in the almost inevitability of a hung parliament, born of the fact that electoral reform is way overdue.
The first-past-the-post system is a redundant relic of past tribal alliances by the electorate and it is only the political elites that have a vested interest in keeping it. We still find that the good old NHS is used as a political football, with people constantly stroking it or arguing it would be threatened if votes go to the opposition of any colour.
When Ukip raises the possibility of some form of alternative financing, the others immediately sabre rattle the threat of privatisation in the hands of “those wacky Ukippers”, but of course let’s face it, the NHS has been held to ransom through the Private Finance Initiative that, under a Labour Government, effectively mortgaged its future, nullifying the argument that the Tories are attempting to privatise the NHS, if one looks at the amounts of money involved in pure fiscal terms.
We are told people are living longer, we have an ageing population, and people avoid carefully the impact of population growth and immigration, because static populations do not produce a growing market, which will counter other people’s vested interests in the community.
The NHS vacillates between the threat of privatisation through to allegations of want and wastefulness, as six-figure managers are in the ascendancy, while care assistants, the hallmark of a compassionate society, live in comparative hardship.
The very quest for Foundation Trust status by many services has resulted in such poor internal planning there is a workforce shortage that has to be met by the private sector, through temping agencies at exorbitant prices that offer whole new career tracks and are defined by former NHS staff who exodus to the private sector to treble their income.
This is the problem of political imperative and ideology before pragmatism and sound management practice in an organisation that needs to be managed, not politicised.
Then we have the constant impact of the media bringing into awareness yet other areas of unmet need. In the last couple of weeks alone, it has been mitochondrial transplants to remove certain illnesses from babies, tinnitus, the health and social care divide, bed blocking and of course queuing ambulances, almost a weekly news item now.
We heap so many expectations upon this besieged institution, we forget to look at some of the structural underpinnings behind our complete abdication of responsibility towards the service.
Take the food industry and years of “E” numbers; cross species animal feeding practices leading to BSE; poor labelling; and marketing campaigns to get people to buy three when one would do.
Then there are scores of fast food chains and the nutritional value of many vegetables being 5% of what it was at the turn of the 20th Century. We wonder why people now have obesity and other problems. This combined neglect of regulation within the food industry and the requirements of individuals to take responsibility for their own girth has seen the growth of the “bariatric” medical specialism.
Then there is the real elephant in the room, the demands upon accident and emergency departments and ambulance services. We live in a “want it now” society and one in which we have to live forever and never get sick.
Consequently, with any sniffle for which we can’t immediately get a GP appointment, something it is arguable we should not do anyway, many people rush off to accident and emergency.
Then we have mental health services. There are some people who are profoundly and enduringly mentally ill and they will need help over a significant period of their life.
However, there are many people accessing “Talking Therapies” now, whose problems come about not because of underlying “mental health problems”, but because they need decent jobs or decent housing or not to be exploited so that they build up debts with payday loans to the point they are suicidal.
Of course biomedical and psychological interventions will remove all of these things, put one brick on top of the other, train and gainfully employ somebody and give them a decent APR. But, of course, we don’t address these things when the citizen can be simply treated by the NHS.
With an ageing population, why haven’t we predicated the baby boom was going to be upon us by now? Why didn’t we produce innovative housing that had a community feel to it, that could best use a limited number of carers across a large community of people who themselves could interact with one another, rather than being warehoused in maisonettes in isolation to one another?
Equally, why can’t some administration conclusively decide to resolve the health and social care divide and give the whole thing lock, stock and barrel to health so it is a single system responsible for the whole process? For God’s sake, don’t give it to local authorities who can’t even mend holes in the road!
The problem with the NHS is that it is a large institution that produces many management challenges. It also produces ideological challenges between the optimal ways of delivering a health care service that is free at the point of source to a large population.
All of these issues, however, pale if the structural prerequisites of a society are not in place in such a way that results in a health care system having to be deployed because of a lack of planning within our society for the social functioning, wellbeing and economic prosperity of its population.
The NHS has become the “sin eater” for inadequate public policy, it is full to bloating with this phenomena and one can hear it retching on a daily basis between constant re-organisations. It’s just not fair.
Let’s look at one final point; this myth that the NHS is free at the point of access. It’s a great principle, but the stark truth is the NHS is not free of the point of access, it is simply the patient concerned does not pay at the time. Every action within the NHS has a cost to it and there is a consequence when its resources are squandered or used ineffectively. Perhaps we should levy charges for people who turn up in A&E when it is not an emergency.
As for hospital outpatients, the “did not attend” rate in some cases involves high percentages and maybe it’s time for sanctions against those people who ask for a service and then don’t use it. I sat waiting for a relative in an NHS clinic recently. Over 180 consultant appointments had not been attended in the previous month.
Given the deployment of clinics, I reckoned that was around about 1.25 times the equivalent consultants per year, with a cost of in excess of £250,000.
By all means, keep the NHS free at the point of delivery, but we all need to be aware that there is a real cost associated with this and we should ensure we bear down quite firmly on wastage as part of the social contract with the population. Ultimately, without some effective measures, we will all pay more and get less.
In the final diagnosis, it’s about time the politicians stopped using the NHS as a football, weaponising it or otherwise and started looking at some of the real underlying social predicates of ill health in our community, like the vested interest in the food industry for one, which have been conveniently accommodated because we all want “jobs and growth” first, then we worry about the ethics of an industry second or perhaps third, or fourth…
Without some serious sensible political input on this, I feel the NHS may be on life support for a long, long time before the country ultimately realises its approaching terminal condition was avoidable.
David Cliff is Managing Director of Gedanken and Chairman of the Institute of Directors’ Northern Sector Group.