Tough choices ahead for the NHS – But we all have a role in making it work
As we head into the New Year we are warned of an impending winter flu crisis, set to be the worst for over fifty years and the public is being advised to expect delays and shortages to routine healthcare provision.
It is probably true to say, the NHS is perhaps the only public sector service that will impact every single person and that we all have a vested interest in having access to free healthcare at the point of delivery. However, in recent years, factors such as a growing population, rising life expectancy and an escalating expectation from our healthcare providers have led the NHS to become a monolithic organisation with an annual budget now amounting to around £147bn.
Health is always an emotive subject, not least because we all want to remain well and live out long lives, but there comes a point when we should, perhaps, stop and question if the current model is working and if we are getting real value for money from the investment.
Although the government has pledged to continually increase and ring fence the NHS budget, it still has to make significant efficiency savings. We are beginning to get some idea of how this may be tackled. Although I welcome efficiency changes it will not be easy. Historically, changes have proven to be extremely difficult to achieve for a public sector organisation as sizable and as multifaceted as the Department of Health. Ministers need to be patient as well as tenacious if they want to see true reform take shape. It will take a lot longer than anyone realises, certainly longer than a single term in office to see realistic change occur and real resolve when making sweeping changes to a service involving millions of public sector workers and a highly demanding general public.
I suspect there will be a significant resistance to change, particularly from the Unions and strike action is already being muted. If there are to be redundancies, I do hope the front line is the last to be affected as I have always been of the opinion that the public sector employs too many managers whose roles, in many cases, are not really full time or even needed. Far too often, NHS managers, in justifying their positions, introduce pointless, unnecessary policies and strategies which tend to just get in the way of the clinicians trying to do deliver the actual healthcare. Cutting bureaucracy will hopefully help, but only if it is done properly and so long as any ‘changes’ to working practices are made with the focus on service improvements rather than box ticking bureaucracy.
Healthcare procurement is complex and in parts inefficient, so it is important to caution against hasty procurement policies that target savings in one area, but may increase costs in another. Also, when seeking operational savings the NHS must temper enthusiasm for sweeping changes that may appear to offer large scale cost savings, but may well cause wide scale disruption which will impede delivery of services and end up actually costing more. Reducing the number of A&E departments is a good example of this.
The NHS is making much about patient choice being at the heart of its change agenda. While noble in cause, it is difficult to see how this can be achieved in practice. A patient choosing the hospital and surgeon of their choice sounds similar to a parent selecting the best school for their child’s education. A surgeon, like a teacher, can only treat so many people in any given period and the reality is, we can’t all be serviced by the leading professor. I suspect what people really want, and need, is access to good local services with the minimum of delays. Perhaps a greater focus on this, rather than patient choice, would result in better healthcare outcomes for all?
I have much sympathy with those tasked with trying to provide demanding public services in the face of stretched resources. All departments seemingly agree cuts and savings need to be made, so long as it’s not one they have a vested interest in. So what we tend to get is departmental squabbles rather than meaningful reform.
Since 1948, this country has enjoyed free healthcare at the point of delivery and it is something we have grown accustomed to. However, we have also perhaps become a tad complacent too. It is often the case, with products and services provided for free, that they can start being taken for granted and given neither the value nor respect they deserve.
While the general public, quite rightly, demands a first class NHS, it can also help make it a more efficient one too. For example:
According to the NHS, patients missing appointments cost the health service almost £1bn last year. Also, non compliant patients, i.e, those who refuse to complete their treatment regimes, fail to take medicines or do not use specialist equipment provided to them, costs the NHS millions each year. It is estimated, that unused or wasted medicines alone costs around £800 million a year. To put all that into perspective, that’s enough to fund an extra 47,000 nurses or 14,000 doctors or tens of thousands of routine operations, such as hip replacements
So, when the government tell us we are all in this predicament together – we are. Only by working together can we all get out of it.
This article was first published in the Newcastle Journal Newspaper 4th January 2018