Somehow She avoids using the word rationing, but that is what she means. Co-payment knee jerk rationing is most likely if we have not had the debate about the ideology and philosophy.
Demands for more money ignore the basic need to make the health service more efficient
To listen to some experts, you would think the NHS is a runaway train heading for the buffers. Anita Charlesworth, an ex-Treasury high-flyer and one of the country’s leading health economists, believes a crisis will hit the NHS sometime in the next 18 months.
This week three health think-tanks issued a joint warning that the service is facing the toughest decade it has ever known. They say that even if managers achieve the extraordinary efficiency savings demanded of them, there will still be a shortage of money to care for our rapidly ageing population.
Even the competing promises made by our political leaders during the general election campaign to shower more money on nurses and hospitals has failed to solve the underlying problem. Another £8 billion a year won’t fix it. The system is in deep trouble.
Britons like to sanctify the NHS but the quality of what it does still varies wildly across the country despite repeated efforts to promote best practice in all regions. In the wake of the 2008 Mid Staffs scandal, which exposed callous neglect by NHS staff and higher-than-normal death rates among patients, we were assured that standards would rise across the service. We are still waiting.
A vicious circle has been allowed to develop where short-term fixes by managers when confronted by the need to make savings has created, not removed, inefficiency in a service notorious for waste.
Nurses are a case in point. There is an acute shortage of qualified nurses, because of our short-termist failure to invest in training enough home-grown ones. The gap can only be filled by foreign nurses, who need inducting, and by terrifyingly expensive agency staff. Spending on the latter rose by almost £1 billion last year. Yet temporary staff increase inefficiency and errors because they don’t know how individual wards operate.
The result is an increasingly unreliable and careless service. Almost every story I have heard recently is from people left reeling by inefficiency or indifference. The gulf between what they expect and what they experience is huge. The problem isn’t just money, it’s a culture that too often ignores patients’ needs.
A mother whose child waited almost a year for an appointment to diagnose her acute pains on walking any distance was told that orthotics — custom-moulded insoles — would solve her problem. Seven months later and after three consultations with a different temporary podiatrist each time, she got the insoles in the post. Crude, thick and ineffective, they couldn’t be fitted into any shoes except for wellington boots. There was no follow-up appointment. Her daughter still can’t walk normally.
A friend with breast cancer says her experience has been “Third World”. Terrified by the lump she found, she paid to see a private consultant the next day. He took scans, confirmed the diagnosis, and sent a fax to her GP so that she could be referred to an NHS specialist within the target of 14 days. A week later she discovered the surgery had binned the fax on principle. They only took referrals by email. The clock began again.
When she finally had an appointment, on the 14th day, the bored specialist could tell her nothing because although the scans had reached the building they hadn’t been uploaded yet. The letter giving a chemo start date never arrived. The hospital gave her a prescription for anti-nausea drugs that her local chemist couldn’t fulfil. Day one of the chemo was severely delayed because no one had told her to come for a blood test beforehand. Her friendly foreign nurse, scarcely English-speaking, muddled her with another patient and, until she corrected him, was cheerily planning to give her the wrong drugs.
Saddest of all is the man who died alone in the waiting room of a north London A&E this summer. I can’t guess whether the staff were harassed or indifferent, but nobody took the time to diagnose his burst artery before he collapsed.
It would be a tragedy if disdain and disorganisation like this spread through the NHS. Patients need a responsive, creative service, not a grudging monolith. Charlesworth argues that imaginative reforms are essential and possible within every hospital but that the culture of awaiting direction from the top paralyses innovation. Soon we will have to pay to put the service on its feet. In return the NHS must start building the agile, efficient culture that can guarantee its survival.