Fundamental dishonesty. Let’s abandon our broken NHS and move on – The only solution to the health service’s problems is a continental-style insurance scheme

Over management and bureaucratic targets have distorted surgery and General Practice. It is “fundamentally dishonest and “No one is willing to admit publicly what so many inside the service privately understand..” Mr Hunt is the current Billy Liar, but he has had many predecessors..

Melanie Phillips in The Times 12th April 2016 opines: Let’s abandon our broken NHS and move on – The only solution to the health service’s problems is a continental-style insurance scheme

The NHS is in crisis. Yes, it’s always in financial trouble, but now it finds itself in the critical care ward. It’s running a combined budget deficit of more than £2.3 billion with three quarters of hospitals and other providers in the red.

Dame Julie Moore, the respected chief executive of the University Hospitals Birmingham trust, was asked last week to explain why the NHS was in such difficulty. A lot of it, she believed was down to leadership failure and incompetence on every level. “We’ve created a culture of people who are terrified of making decisions because you can’t be held to account for making no decision but you can if you make a decision,” she said.

Much of the blame lay with previous governments who had centralised power, leaving many of her colleagues “waiting for a command from God on high” instead of taking the initiative.

What Dame Julie describes is typical of highly politicised bureaucracies. In the NHS, this entails a culture of fear from the health secretary downwards. What are they all so frightened of? In essence, that the veils of illusion surrounding the NHS will be torn away and it will be seen to be the failure that it is. Yes of course there are dedicated staff doing magnificent work. Nevertheless, a recent study by Imperial College found that death rates in British hospitals were 45 per cent higher than the best performing country, the US.

Last year, the Patients Association reported that in most hospital trusts there were patients waiting longer than the NHS limit of 18 weeks between referral and surgery. In some, there were too few nurses to properly feed or care for patients.

The fiction has to be maintained that healthcare is getting better all the time. This is to mask the fact that the NHS’s core aim — to provide all with the same level of state healthcare free at the point of use — is an impossibility. It creates an inexhaustible demand for funding.

The NHS in England spends £116 billion per year. It’s still not enough. Hospitals are now being told to shed staff to dangerously low levels. This was entirely predictable.

As a panic response to the Mid Staffordshire scandal three years ago in which hundreds of patients endured appalling standards of care, the health secretary vowed that staffing levels must rise and to hell with the cost. Clearly, there would be a day of reckoning. That day has arrived.

Measures designed to deny reality go back to Margaret Thatcher. Even she was not prepared to declare the NHS unfit for purpose. Instead she decided to run it like a business. This merely piled on new layers of dysfunctional management. Today the service boasts no fewer than 16 directors of “transformation and corporate operations” alone.

Targets, the bureaucrat’s principal means of demonstrating improvement, create a plethora of perverse incentives. A report by the Nuffield Trust found that thousands of patients are dying because the focus on high-profile conditions has distorted the way NHS surgery is organised. Waiting lists and cancer care are measured nationally which means that hospitals structure surgery around them. Yet elderly patients admitted in the middle of the night with a burst appendix or gallstones are not measured, and often get poorer treatment.

No one is willing to admit publicly what so many inside the service privately understand. The result is that successive governments, swearing undying loyalty to the NHS, have quietly shuffled off responsibility for it to the market.

Some of these privately provided services are notably better. The issue, however, is the way this is fragmenting the NHS. Private health companies tend to do what is straightforward, leaving the NHS with the more complicated and expensive stuff.

The point is that this is fundamentally dishonest. The government pretends the NHS is delivering, while stripping it of coherence, responsibility and accountability so that it is no longer the thing it purports to be.

Ministers cannot admit this because the health service is one of the few remaining institutions of which voters feel they can be proud. As the former chancellor Lord Lawson once observed, the NHS is “the nearest thing the English have to a religion”. They believe the choice is between state control, which channels compassion, and heartless private health insurance.

Not so. In Europe, social insurance schemes predominate, covering even the poorest. They provide choice, accountability and, crucially, patient control and leverage. Even at their most basic level, their standards are far higher than the NHS.

Countries have many different types of social insurance but the common feature is that people pay into a scheme that covers healthcare provision for all. Because purchasers can choose to leave one scheme for another, competition drives up standards. Paying for care is thus viewed as both equitable and value for money.

All healthcare systems are having to grapple with the insoluble problem of inexhaustible demand. Surely, though, the public should be credited with some intelligence. The NHS model has expired. It has ceased to be. Time to ’fess up, end the deceit and move on.

How to kill the goose and create a shortage of 10,000 GPs – Patients kept waiting as new doctors shun GP jobs

It was the best job in the world – for me 1979-2012 – but now there are not enough of us to cover the country

Kill the QOF (Quality Outcomes Framework) for GPs


This entry was posted in A Personal View, 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.

1 thought on “Fundamental dishonesty. Let’s abandon our broken NHS and move on – The only solution to the health service’s problems is a continental-style insurance scheme

  1. Pingback: Health insurance and the future of the NHS – Approval from the Prof at the Health Consumer Powerhouse | NHS reality. An NHS soapbox. Speakers' corner for the NHS.

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