Too often we think of NHS services in isolation.
Take the current debate over A&E. The focus has been on what is happening in these units rather than how it fits in with the entire system.
But in many ways the NHS is like an engine.
It is made up of many different parts. If a problem develops in one area, it is likely to have an impact on the whole.
Each part either has to work harder to keep the car moving or if the strain becomes too much it breaks down.
The problems being encountered in A&E are proof of that.
Visits have risen by 50% in England in a decade and this winter A&E departments have started spluttering.
But to get a full picture of what is happening you need to look at the whole system.
Rises in demand are being seen everywhere in England.
GP consultations are up by a third since the mid 1990s.
Some of this workload has been passed on to hospitals with referrals for non-emergency care at one point during the 2000s rising by 15% a year. This in turn has prompted increasing restrictions being placed on referral processes in recent years.
The gasket has gone – it’s just that the media and politicians dont see it.
The clear choice is upon us – rather more quickly than I thought. I always predicted implosion after a period of run down. This is now being followed by scapegoating and covert rationing, and will be followed by further reduction in choice and standards and eventually restructuring by knee jerk rationing – but at the last overtly. Without the philosophical debate about what should not be available to patients (different service unavailability for different people?) and what patients should have autonomy over, there will be great discontent. Our politicians have a duty to open this debate but they are ducking the issue…. See the post/entry “everything for everyone for ever”…
None of us want to say something is unavailable, but if we wish to continue to have a service for those things we really fear, then we need pragmatically, reluctantly, but quickly to exclude those things we don’t fear. We have already allowed the following areas to be partly rationed out of the Regional Health Services (Remember there is no NHS):
Out Patient physiotherapy
Second cataract operations (in some areas)
Choice (in Wales)
and I could go on.