Not only patients will need a miracle – the UK Health Trust Boards and CCGs need to go to Lourdes

Frank Field in the Guardian Tuesday 23rd February 2016 appreciates there is no miracle cure: The NHS is our national religion – but there’s no miracle funding cure – It’s time for a Bevan-type reform of health finances – the public would make greater NI contributions into a ringfenced mutual organisation to secure the NHS’s future

Not only patients will need a miracle – the Trust Boards and CCGs need to go to Lourdes. Voters are not committed in droves – they are more and more cynical. This is the result of numerous honest conversations with GPs and Doctors and Nurses throughout the system. Mr Field has it wrong. Its wishful thinking only.. And the miracle cure does not exist. One of the worst areas is Paediatrics, where the drop out rate is very high.

The NHS is the one postwar act to which the public are committed. It has become, in Nigel Lawson’s indicative phrase, Britain’s national religion. That is why politicians invariably play safe, knowing that the gods can most easily be assuaged with offerings of money. Yet the gods are getting more and more demanding and we live in an age of public austerity.

It must be doubted if the government believes its own rhetoric on safeguarding the NHS budget in real terms. NHS inflation is higher than the government calculates, the older we get as a nation the greater our health demands, and modern technology feeds that demand. So is the solution simply more money? The answer is an emphatic “yes”, but in assuaging the gods we need to change fundamentally the politics of health.

Here is where the public’s view of national insurance contributions could come to the rescue. The public do not regard an increase in NI contributions as a tax increase. A few of us pushed under New Labour for a broader funding of health and welfare by making NI contributions progressive and shifting these costs onto this new revenue base. Paying in before drawing out is the bedrock of what voters see as fair.

The financial catastrophe into which the NHS is beginning to tumble (already a record number of hospitals have tipped over to emergency loans from government) will slowly begin to shut down parts of the NHS as we know it. Maybe at that point, or before – if it wants to look smart – the government will open up discussions on a new funding basis for health and extend that to social care. It might even get away with the current NI contributory base, but peace at this price won’t last long.

Now is the opportunity for an Aneurin Bevan-type reform of NHS finances. Last year, I proposed the creation of a new NHS mutual organisation that debates with us, (the potential contributors), and the government, a rolling financial budget for the NHS.

The election came and went, with none of the main parties pledging anywhere near enough extra cash to meet the projected shortfall in the NHS budget. Hence why it now finds itself having to find an additional £22bn of savings by the end of the parliament. If these savings are to be achieved, voters are likely to have experienced a marked deterioration in their standards of care. The need for reform, as well as a buoyant new source of revenue, has therefore become doubly urgent.

Voters have made it clear that they are willing to make an additional financial contribution to the NHS. In 2002, when Gordon Brown put a penny increase on NI contributions the public cheered him. They may have been less enthusiastic had they known that a little under half the money thereby raised was siphoned off to other New Labour pet projects. Perhaps with this in mind, their willingness this time round to make an additional contribution is contingent on any new monies being used to drive an ongoing programme of reform that delivers a 21st century health and social care service.

Voters will not entertain the prospect of writing politicians a blank cheque to prop up a failing health service. Nor will they tolerate ever greater sums being transferred from other budgets as a quick fix to try and prevent the black hole in the health budget from growing. Having a mutual body that ringfences NI contributions for health and social care, and also presents us with what a modern health service costs, could see the NHS through the next 20 years. Agreement lasting four parliaments would be no mean achievement.

NHS doctor vacancies are 7.8% in Wales

Kailash Chand in GPonline reports29th Feb 2016: GP crisis: Ministers must listen to NHS staff and tackle the workforce crisis

Pennington manches LLP solicitors comments 2nd March 2016 on NHS staff shortages – the impact on maternity care

Paediatrics workload deters doctors, suggests BMA

Severe shortage of GPs is reaching crisis-point in Derbyshire – only 37% of GP training places filled – due to political rationing of Medical School places 10 years ago, and the shape of the job

Only 52% of doctors completing foundation training chose to enter specialty training

Helen Jacques in BMA news reports 12th Jan 2013: Royal college reports attrition and dissatisfaction among paediatrics trainees

One in 10 trainees in paediatric medicine drops out by specialty training year 3 (ST3), and over 40% have seriously considered leaving the specialty, the Royal College of Paediatrics and Child Health has found.

The findings come from a pair of surveys conducted by the college.[1] [2]

A cohort study of 354 paediatric trainees (81% response rate) who began training in the specialty in 2007 found that 11% were training in another specialty or working in another career.[1] This indicates an attrition rate of 5% a year between ST1 and ST3, the college said.

Half (51%) of the trainees no longer in paediatrics had moved to a career in general practice, and 13% had left medicine. Nevertheless, 71% of respondents said that they were happy that they chose paediatrics as a career.

A second online survey of 2037 paediatric trainees, representing a response rate of 56%, found that 41% had seriously considered leaving paediatrics.[2]…..

Victoria Bishoff in The Mail 22nd December 2015 reports: NHS won’t pay for £60k miracle cancer drug, but your insurer might… we reveal those that will

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This entry was posted in A Personal View, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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