Monday, 19 September 2016

Is it Our NHS or Their NHS?

I'll start with a little celebration. A senior finance officer from our local NHS presented to Bradford's Health and Wellbeing Board. Now if you'd made a habit of reading Twitter or The Guardian you'd be very worried at the content of this presentation - the pain, the stress, the cuts....AUSTERITY!

The officer opened with this (I paraphrase from my notes but it's close enough):

"The NHS has £800 million to spend across the three CCGs. This number is not going down but is rising. However, it's not growing at the pace we think we need to meet demand."
This, dear reader, is the truth about the NHS. When you see parades of nurses waving banners about 'saving the NHS', you're led to believe - it's implicit in the protest - that the health service is suffering draconian cuts when the truth is that the rate of growth for the NHS simply doesn't keep up with the growing pressures. And every report, each presentation we see from the officials of the NHS repeats the need for system change - words like co-production, self-care and prevention dominate the pages of PowerPoint flashing up on the screens. And this is great.

There is, however, another theme and it is this that explains the 'Save Our NHS' campaigns and the heartrending tales of cuts and awful austerity. It cropped up in today's presentation - the first three lines in the list of economies to be made were all about workforce efficiency, pay restraint and savings in administrative staff. It's not 'Our NHS' we're saving, it's 'Their NHS' - the anger about cuts and austerity is mostly a response to the NHS applying the same cost management practices that private business and, latterly, local government have used.

This isn't to say that all is rosy in the NHS or even that it is grossly overmanned but rather that a system predicated on annual increases in costs significantly above inflation is simply unsustainable. It's not a solution - as some seem to think - to create a hypothecated tax unless you plan on making the rate of that tax increase by 5% each and every year. The solution lies in stabilising the cost base and this, whatever those banner-waving NHS employees may say, means cost controls. And the NHS's biggest cost is wages.

What we're seeing with the NHS Action Party, with the doctors' strikes and with the sanctifying of all NHS employees, is an endeavour aimed at drawing the public into defending the interests of the health service's employees. For many this is right - these are deeply caring, highly skilled people - but it covers up the truth. The reality is that, without different ways of working including those involving fewer staff, the NHS is not sustainable. None of this is about privatisation, market forces or some sort of dark and evil Tory conspiracy to destroy 'Our NHS' - it's simply a necessary process aimed at ensuring that, so far is practical and possible, we retain that central idea of a health service free to all without favour at the time they need that service.

Here in Bradford the forward look at NHS finances tell us that, without changes to the way we work, there will be a deficit of over £200m by 2022/23 - this scales up to a national deficit of £20 billion. It doesn't require much analysis to conclude that this simply can't be met. So the result is that we have to make these cost savings and since over 75% of NHS costs are wage related, the biggest chunk of those savings has to come from staffing. The impact of strikes, protests and campaigns won't be that these reductions don't take place but rather - as with almost every campaign of this sort in recent history - with the resultant cuts being more extensive, more painful and more damaging.

If you want it to really be Our NHS then you need to start by rejecting the militant 'Save the NHS' campaigns and instead support a considered, rational and planned approach to reforming the NHS. This means better use of technology, it means partnership with the private, charitable and voluntary sector, it mean promoting the idea of healthy ageing and it means working with local councils to improve case - at home and in the community - for the elderly and disabled. It cannot mean supporting current structures, systems and staffing levels - if we do that we will be the losers as the NHS fails to meet our needs and the needs of our neighbours.



Marko said...

And getting rid of a management culture that vastly overpays itself compared with private industry. The salaries and perks are on another planet.

Nigel Sedgwick said...

A major cause for concern is expenditure on hospitalisation of the elderly (especially those with dementia), where they hospital stays are not really necessary or are significantly longer than necessary. This is sometimes as a prelude to the elderly person going into a care home for the first time, or needing several care visits daily in their own home.

The problem is that mainstream hospital beds are very expensive, typically as expensive per day as even the more expensive care homes are per week. This is primarily a problem with Social Services not being able to react to new personal need within an appropriate timescale. It is government expenditure on both the NHS side and the Social Services side, but currently handled to deliver much poorer value for money - as well as interfere with more appropriate use of NHS hospital facilities and funds.

I also note that, years ago, cottage hospitals were largely or entirely phased out. It seems to me that such cottage hospitals (or something similar) could provide transitional care for the elderly in a vastly more cost-effective way than can general hospitals.

Any views on the above from Simon would be much appreciated. Especially on whether this problem with the elderly is a large part of costs, and whether the 'cottage hospital' concept is being used or being considered for the future.

Best regards

Jim said...

The NHS is a job creation scheme and generous pension plan that happens to do a bit of healthcare on the side. The former is the important bit, the latter is entirely coincidental. If anything threatens the former then it will be opposed bitterly, regardless if whether it would improve healthcare.

As a little thought experiment, imagine the reaction of the NHS to a computer that could diagnose your ailments by just sitting in a booth, while it scanned you and took samples. Then prescribe the correct drugs/course of treatment. They would oppose it mercilessly, regardless of the fact it would revolutionise healthcare for the patient, but because it would mean massive job losses in the NHS.

Simon Cooke said...

Nigel makes an important point. Issues relating to old age are the main driver of additional cost in the NHS (put simply we're living longer) - dementia is one of these and is, compared to many other conditions, expensive to manage. Interestingly I was talking to Bradford's new Director of Health & Social Care who said she was an advocate of reintroducing convalescence homes as a staging post to returning home (as opposed to the permanent, house-disposing solution of a residential or nursing home).

James Higham said...

When you see parades of nurses waving banners about 'saving the NHS', you're led to believe - it's implicit in the protest - that the health service is suffering draconian cuts when the truth is that the rate of growth for the NHS simply doesn't keep up with the growing pressures.

We need to drive that into our brain and keep it there.

Anonymous said...

The convalescent home as a half-way house has much to commend it, if only for its ability to free-up beds in real hospitals for real medical treatment use.
But that would really be a subsidised 'medical hotel', where no active treatment was delivered, rather the post-hospital situation was 'managed'. In that case, there seems no reason why this should not be subject to a 'hotel charge', offering the patients a choice: either fix up your own care at home or pay us, say £50 a night, to deliver it here. As a half-way house to residential care-home, that would neatly slot into the charge equation at around half the cost of a full-time home-place.
The sacred cow of 'free at the point of delivery' would not have been slaughtered, as the critical medical care had already been delivered free, this about the choice of recovery environment.
And don't think no-one could pay - many of the next generation of healthcare demand will be those fortunate souls retiring on generous old company pensions (or public sector pensions ad infinitum), so they could pay if they wanted to, and it's still a choice, not compulsory. Go for it.