This one’s for you if…you are worried or interested in the future of the NHS
It is easy to think, with the constant barrage of bad news stories in the press, that the NHS is on its knees. That it is not fit for purpose. That it won’t survive the crippling co morbidities of a population that is ageing, increasingly obese has more complex needs than ever before. Add a dash of neoliberalism, that the effects of smoking and obesity are the responsibility of individuals not society as a whole and you might begin to think it’s time for a new system. A few years ago, I now admit with shame, I probably would have agreed.
The whole purpose of this blog is to celebrate the power of reading. The power of learning, engaging, debating and changing your mind. Politicians out there- it really is possible to change your mind based on expanding your knowledge- you should try it some time.
Books such as this, so excellently written by McCartney, make you realise the value of the NHS. Make you realise that a huge proportion of its workload comes from a lack of responsibility by other areas of society. The alcohol industry. The smoking industry. Austerity’s effects on social care. Lack of follow up by private healthcare organisations. Worst of all? Lack of evidence in policy making. McCartney talks us through a list longer than a long person’s arms of policies put in place for political gains which end in money down the drain and no improvement for patients.
One particularly nonsensical part of the way the NHS is currently run is as follows. Targets are set. If a hospital doesn’t meet them, they are fined. (Regardless of the possibility that missing the targets could be due to insufficient funds/staff). Staff also have to write reports on the missed targets. So the hospital/trust which is doing badly is left with an increased workload and reduced funds. From which point they are supposed to improve their rate of hitting the targets?!
I like to end on a high. So how can we ‘save’ the NHS? Let’s realise that problems like obesity occur because we live in a highly obesogenic society- communities lack safe and accessible places to exercise, the nature of our society encourages us to sit on our backsides for an unprecedented proportion of the day, and shops offer us food that is ridiculously calorific, with unbelievable levels of sugar, and put the ‘bad stuff’ on promotion. Let’s encourage politicians to use evidence when debating and implementing healthcare policy. Let’s try the insurmountable task of holding them to account when they don’t. Doctors work day in day out using evidence to provide high quality care for their patients. And I don’t think it’s unreasonable to expect the same from those in government.
Warning: the following content may be infuriating.
Aneurin Bevan 1946 House of Commons “Medical treatment should be made available to rich and poor alike in accordance with medical need and no other criteria. Worry about money in a time of sickness is a serious hindrance to recovery, apart from its unnecessary cruelty. The essence of a satisfactory health service is that the rich and poor are treated alike. Poverty is not a disability and wealth is not an advantage.”
Mid staffs crisis and understaffing- trust was told to save £10million and a CQC report “found a shortfall of 120 whole time equivalent nursing posts”. “The nurse [working in mid staffs at the time] described how managing other nurses placed her under pressure to lie in the records, having been told that if they didn’t meet the targets, heads would roll and A&E would be closed, with everyone losing their jobs” p32
“Social inequalities aren’t caused by laziness, or by people choosing to have a poorer quality of health. Instead, they arise from circumstances partially or completely out of poeple’s control, which have small, cumulative effects on their life chances, possibilities, directions and, ultimately, quality of life and time of death. Caring for relatives, going to an overstretched school, having a lack of good childcare, living in an area of greater pollution- all these add together and translate into inequalities becoming deadly.” p55
“In the US, a regular non means tested income to disadvantaged Native Americans was associated with benefits to children that was still detectable a quarter of a century later.” p56
“if everyone drank responsibly the alcohol industry would lose 40% of its sales and some estimates are higher. In formulating its alcohol strategy, the Government must be more sceptical about the industry’s claims that it is in favour of responsible drinking.” p62
“In 2013, I read a report by PwC purporting to show that technology in the NHS could save money. I found out that the report itself had cost £75,000, yet it was fatally flawed..making entirely non evidence based statements suggesting that large quantities of patients could be safely managed at home rather than in hospital.” p142
“Recurrent reforms from the 1990s onwards have been predicated on the belief that money is the best motivator for change. This had resulted in too much medicine- treatment by rote rather than because it matters to you, the individual patient. The seams of vocation and ethics are pulled at by the incentives which request compliance, not the interrogation of suitability for the individual.” p199
Kenneth Arrow, Professor of economics, “I live in Silicon Valley, where there are loads of startups- at least half of them fail. That’s normal; it’s part of a competitive system. It’s a problem if it happens in a medicsl system, because it interrupts care, and it’s deleterious to an ongoing relationship; it’s bad for people who were getting that service. But the fact that they fail is the way the market system works. Next time around, they’ll guess their costs better. But if you are right in the middle of medical care and the supplier goes broke, you have adjustment costs. It’s not the same if I’m buying fruit and they go out of business- well, I can go to a nearby store…I’m so surprised that a country that has contained its costs and achieved good healthcare should be worried.” p88
Paraphrasing US journalist H.L.Mencken “For every complex problem- such as how best to organise medical staffing at weekends in the NHS- there is an answer that is simple, clear and wrong. This needs unbiased minds and clear statistical understanding not an election manifesto promise to be driven through no matter the cost.” p93
NHS always picks up the tab. Circle tendered for a 10 year contract to run a hospital and pulled out after 3 citing that demand for A&E had risen. “the NHS can never transfer the operational risk of running a hospital, leaving the taxpayer exposed should the franchise fail…Additionally, the National Audit Comittee pointed out that under the terms of the contract, Circle would be responsible for only some of its debt- the taxpayer would be ‘left exposed’ to pick up the rest. Not only that, the chief exec was given a generous redundancy package and left to work in another NHS role.” p149
“We need our NHS to be run on evidence, moral value and humanity. We need to ask for the right evidence, out evidence before policy, make no policy without cognisance of the evidence and always consider the harms.” p210
“We also need the option of rejecting short term political policy making in favour of making mature cross party decisions drawing on evidence and expertise, freeing the NHS from the legacy of damage through the short-term need for political parties to claim successes for themselves or blame failure on others.” p231