Is not health and well-being universally a top priority for individuals, families, businesses, and a source overall for improving not just the UK economy and productivity but also lifestyle and happiness? Will the next Prime Minister and their Cabinet treat it as such?
TIME FOR REFORM?
“The NHS is BROKEN: does it need a radical rethink?” This headline in the Daily Telegraph of 23 July echoes a common theme in the UK press over the last few months, which is the critical condition of health and social care, reflected in the numerous areas of delivery where it is under extreme stress and arguably failing the public. This is not to diminish the performance of thousands of dedicated doctors, nurses and others who have gone extra miles in the care for patients. But is not the public now wondering whether the NHS as an institution is capable of delivering the services they expect and meet their needs, without substantial changes and improvements? Why is it that, on nearly every critical measure typically used to assess health services, the UK outcomes are near the bottom of the table of peer group nations? It is certainly no longer about shortage of funds relative to GDP at least.
In 2020 Sherbhert published an article about the NHS, acknowledging its many achievements but recording possible changes that needed consideration. If that was true then, how much more is it true today? But it is striking that neither of the potential Prime Ministers is recognising how essential an open public debate about reform and the adoption of wide-reaching measures may be necessary as a matter of priority, but instead promising always to give it enough money. Improving the NHS performance and its use of resources could uplift the UK and its economy. As ever, the political risk, the fear of the wrath of worshippers of the NHS deity and the media love for backlash against any suggestion of change which even questions the culture and philosophy originally behind the NHS, is stifling debate about the biggest elephant in the room. As ever, politicians only seek adulation for pouring money down the insatiable throat of the NHS, maybe demanding value for money but never evidencing its delivery. Both candidates need to show the courage to insist major reform is on the table.
Is health and social care not just the elephant in the room but perhaps also a Sisyphean rock which rolls back to crush the British public just as one thinks it has been cured?
DISGRACE, DEPRESSING DATA and DEMORALISATION
Judging by press reports over the past few months, arguably there is an almost systemic downgrading of healthcare services, a downward spiral in many areas. The reputation of the NHS has been hit by reports of scandalous incompetence or negligence. For example, the Ockendon report into maternity services of the Royal Shrewsbury & Telford Hospital NHS Trust, detailing the shocking catalogue of hundreds of needless baby deaths. In addition, maternity services at numerous other hospitals have been the subject of major criticism. Is there perhaps a wider cultural issue here?
The Times reported in May 2022 on a cover-up that shames the NHS, which involved doctoring of evidence by the North East Ambulance Trust in relation to the death of Quinn Evie Beedle in 2018. Concerns about dozens of other deaths resulted. Negligence claims against the NHS annually run into billions.
The Tavistock Clinic put hundreds of children at risk with its dangerous approach to treating trans-gender issues. Its closure is welcome, if long overdue. It took an independent inquiry initiated by Government, notably not by the NHS, to identify its failings. The Tavistock approach defies common sense. The NHS establishment opened it and endorsed its operation which is a scandal of medical incompetence.
Some simple data, facts and figures tell a dangerous story. For example, according to the Telegraph the average Category 2 (including possible heart attacks and strokes) ambulance arrival time is 52 minutes, the target being 18 minutes – is this an emergency service? 50,000 people a year are dying for want of effective treatment; GPs are seeing only 55% of patients face to face; a list of 6.6 million people are on treatment waiting lists and the prospect is an increase; case diagnoses are often far too slow with drastic consequences. The list goes on.
Cancer treatment illustrates the decline. “In broad terms England’s cancer survival is 10 to 15 years behind leading nations” said John Butler, clinical leader to the International Cancer Benchmarking Study to a Parliamentary Select Committee in September 2021. But even pre-pandemic in 2019 the UK was at the bottom of that league table.
In addition, large numbers of doctors and consultants are working part-time in the NHS, and NHS England is short of some 12,000 hospital doctors and 50,000 nurses and midwives. Shortages in social care workers are in 6 figures. Doctors and nurses threaten strike action over pay. And dentists are leaving the NHS in droves because NHS work is not financially viable, with perhaps 50% of children now unable to access an NHS dentist.
Allegedly, NHS bureaucracy has doubled since the pandemic. Report upon report refers to appalling morale and exhausted staff. But efficiency, bureaucracy, staff resourcing and morale, and healthcare outcomes generally are matters reasonably expected to be for senior management and NHS England to look after and suggest solutions. The recent report into leadership in health and social care by Sir Gordon Messenger represented a major opportunity for recommendations for services improvement but arguably was a damp squib. Did he fall victim to the UK pandemic of avoiding offending the Godly institution?
Perhaps too it is important not to be beguiled into blaming the Covid pandemic for all current problems. However, it certainly highlighted the “just in time” lean approach to healthcare, with little slack for emergencies in the system, such as the limited number of hospital and critical care beds relative to comparable countries. It underscored too the lack of preparation for a pandemic apart from flu. While undoubtedly so many healthcare and social care workers performed miraculously, in general the institutional NHS and NHS England were exposed. The fact that the primary reason for lockdowns, and all the consequential suffering they caused, was to protect the NHS from meltdown is a salutary reminder of its frailty, which needs addressing. It will be important that in future the NHS is sufficiently resilient and adaptable that lockdowns are never required again for Covid or other reasons. The excessive glorification of the NHS during the pandemic perhaps is a regrettable impediment to change.
A special legacy of the pandemic is the number of working age people who seem to have left the workforce, at least for now, seriously affecting productivity and worker shortfalls. An article by John Burn-Murdoch in the Financial Times of 21 July analyses the effect of chronic illness in the UK, stating that, post pandemic, of the 500,000 people not returning to work, two thirds of those aged 15-64 cite chronic illness. But he states too that chronic illness predates the pandemic. His thesis is that ill people are having to wait too long for timely primary healthcare, and so illnesses become unnecessarily chronic. And chronic illness is making the UK workforce the sickest in the developed world. Notably he reports for example that in Spain post pandemic almost all workers have returned to work. Perhaps other countries’ healthcare services are more resilient leading to better care and less chronic illness?
WHAT COULD AND SHOULD HAPPEN?
Rafts of commentators and experts are saying that major changes are required, not always advocating the same ones, especially on how resources are directed and how the NHS is funded. There is however wariness on rearranging deck chairs with new structures but no real improvements in behaviour or culture. The NHS is not a religion and there must surely be no sacred cows. The NHS devours cash like a bottomless pit, a black hole. The recent much heralded £15 billion injection for NHS and social care will almost certainly simply be gobbled up with little showing for it, and maybe social care, getting a later bite, may only receive morsels and leftovers. Constant crisis management, even in this Summer when it is normally recuperating, means doomsday forecasting for winter (same every winter) and an NHS management whose main solution is that billions more of taxpayers’ money is required. Whilst there is no doubt that the NHS performs sometimes outstandingly, the conspiracy of silence around NHS problems must be broken. Perhaps the most necessary initial step is the declaration of an open no holds barred debate where no innovative idea is out of bounds. The gospel of “free at the point of delivery” must be rewritten.
France, Germany and the Netherlands, as well as others, have better healthcare outcomes in most key areas. The European Social Insurance systems provide healthcare to all, with Government contribution serious but limited. They ensure the poorest are protected. Might not some competition in the supply of services encourage improvements? An increasing number of people in the UK are resorting in frustration to paying for private treatment for fear of dangerous delay. The amount of money the UK applies to healthcare today as a proportion of GDP in its peer group is among the highest, but its results are among the poorest. Could the NHS do more to learn from what other countries do better, where they have more impressive outcomes than the NHS?
Should the NHS move its emphasis from reacting to sickness to a focus on preventative medicine? Apart from dogma and the gospel of “free” medical care, why is it so wrong for people to pay towards the health services they use, at least a modest contribution, with the poorest subsidised appropriately? That might allay the abuse of not turning up to appointments without proper notice, of which there are some 16 million instances a year, it is reported.
Obviously, some hospitals and GP surgeries are better than others: the best working practices, and the best managers, need to spread throughout the system, which is an easy win but depends on a culture of willingness to recognise shortcomings and to remedy them, not perhaps an NHS strength. Have some of the best innovations adopted in the pandemic been applied more universally?
Reiterating a regular Sherbhert theme, as was in the 2020 article referred to above: Perhaps the public has the biggest part to play in helping the NHS to deliver a service which meets their needs. For example, by not calling an ambulance or visiting A&E when unnecessary. A big part of the preventative approach will be down to the general populace altering their unhealthy lifestyles, and so using the NHS less often. Education of adults and especially children into sensible not harmful diets and achievable regimes of exercise, even in ways that save people money, is an easy priority to implement. Making the changes needed to wipe out obesity is a challenge and one not to be shirked See Sherbhert Article about obesity and the need for a national strategy. Each person can do this for themselves, with the least capable needing assistance. But its back to individuals taking responsibility and not demanding others solve their problems. However, creating an environment which is conducive to that is a role for government, businesses and other institutions.
Also, a culture of acceptance that hard choices need to be made in prioritising the use of medical resources needs to be embedded. The desire to live into absurd longevity even with little quality of life, simply absorbing scarce resources, may need tempering. The flabby government attempts to encourage people off junk food and drinks is deplorable, and this needs to be urgently gripped, and people persuaded of the merits. The way in which supermarkets in the past and now junk food purveyors and home deliverers attract and addict customers to a consumerism which is an act of grave self-harm is perhaps one of today’s most immoral poisons: it should be dealt with as such urgently.
Health and wellbeing are not just at the heart of economic success, they are critical factors to harmony and happiness. Fundamental changes to the NHS and social care, and lifestyle choices, are essential drivers of the country’s viability. Will the next Prime Minister and their Cabinet grasp the fundamental reforms required or duck the issue succumbing to the fear that besets UK politicians on this subject?
