Leave or Remain, the NHS is in its death throes

NHSreality agree with Alice Thomson, who opines in the Times 15th June 2016: Leave or Remain, the NHS is in its death throes – Even the best hospitals are now struggling. We need a dedicated health tax or must switch to a social insurance scheme. It is a pity that Ms Thompson suggests nothing except co-payments or insurance. It is not too late to change the ideology but we have to debate it, and once overt rationing is accepted, we can then decide the most acceptable and pragmatic way to carry it out. The only philistines rejoicing in the death of the health service will be private capital.

There were scones and cucumber sandwiches for tea on the dementia ward, a weekly market on the lawn outside, health drinks in the café, smiling matrons and helicopters on the roof flying in emergency cases. When Rachel Sylvester and I were researching a series on the NHS two years ago the new Queen Elizabeth Hospital in Birmingham was the place we would have wanted to be treated.

The health professionals we spoke to agreed. With 8,500 staff, 1,213 beds (almost half in rooms of their own) and 32 operating theatres, this seemed like the future. It had the world’s largest single-floor critical care unit, Europe’s biggest organ transplant programme and the most advanced cancer and trauma treatments. Even its integrated IT system worked. If more than four patients complained about the food, an automatic message was sent to the catering staff. In many other hospitals the chief medical inspector, Sir Mike Richards, had found soiled sheets, blood on the floor, demoralised staff and dehydrated patients. The Queen Elizabeth felt different.

Yet now, even this hospital is struggling. A Care Quality Commission report into cardiac surgery at Queen Elizabeth was scathing about outcomes and management and the Trust went £4.6 million over budget last year. It has joined the majority of hospitals, ambulance and mental health trusts in financial arrears. The overall deficit of these trusts for 2015 was a record £2.5 billion.

So what’s gone wrong? I’ve talked again to some of the consultants, GPs, registrars, ambulance drivers, managers, nurses and heads of royal colleges. Almost all of them feel conditions have deteriorated in the past two years. Families have sent me heartrending emails about their children or elderly relatives who they believe have died because of mismanagement, overstretched resources and exhausted staff. Dame Julie Mellor, the NHS ombudsman, believes patients are met by “a wall of silence” if they dare to complain. A report from the King’s Fund
think tank has found that 65 per cent of NHS finance directors feel patient care got worse last year. However hard staff try, and the majority do, they can’t stop the overcrowded waiting rooms, queues of trolleys in corridors, bureaucratic blunders and rising waiting times for operations.

With four children, one of whom had meningococcal disease, and another a burst appendix, and two parents in their eighties with myriad chronic conditions, I’ve seen the creaking system for myself. It’s in its death throes. Of the eight series on public services written for this paper, ranging from education to prisons, police, immigration and the civil service, the NHS is the only one whose problems seem intractable.

Now both sides in the referendum debate are using the NHS for their own ends. The Brexiteers warn that only they can save the institution with an injection of £350 million a week, while Jeremy Corbyn insisted yesterday that a vote for Brexit would kill off the service. Tory MP Dr Sarah Wollaston, chairwoman of the health select committee, has veered from being pro-Brexit to pro-Remain as she tries to work out which side will do more to prop up the NHS. Both campaigns are using immigration, with Brexiteers insisting that foreigners are wasting NHS resources while Remain campaigners are insisting that the entire service relies on migrant workers. Both sides are wrong. A study by the University of Oxford last year found that higher immigration in an area led to lower waiting times because immigrants are younger and use less health care. On the other side of the argument, only 10 per cent of doctors come from other EU countries.

It won’t matter to the NHS what happens on June 23; either way, the institution is failing. For a while the threat of a junior doctors’ strike diverted attention from the more urgent debate but it is now obvious that the NHS is striving to do too much with too little money. There are a million more patients a year in A&E since 2010, hospitals are performing a million more operations and GPs are conducting 2.1 million more consultations a year.

It is easy to blame GPs, as I once did, for giving up out-of-hours services and putting the strain on A&E, but they are also floundering as they try to run small businesses while juggling more patients. It is obvious that more care needs to be done in the community to help the elderly and mentally ill but that is unlikely to happen. It is also true that there aren’t enough doctors and nurses, that many female professionals opt to work part-time and others are retiring earlier. In the last financial year, the NHS spent £3.6 billion on agency and contract staff.

The public could also shoulder more responsibility. Smokers cost
the NHS £2.7 billion a year and the obese £9 billion. We need to modify our behaviour.

Money is now the critical issue. The NHS has introduced efficiency programmes but by 2020 we will be spending only 7 per cent of GDP on health. That’s not enough. The French, Germans and Scandinavians spend 11 per cent and the US 18 per cent. A study last year by Imperial College found that death rates in British hospitals are already 45 per cent higher than in the US.

If we want to live longer, more fulfilled lives, we must pay for it. Whoever wins the referendum will have to consider European-style social insurance schemes, raising national insurance contributions or a dedicated NHS tax.

However hard both sides try to scare us, it will be irrelevant whether we are in or out.

The NHS on its way …

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.

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