Simon Jenkins in The Guardian
Archaic demarcations between GPs, consultants and nurses are wasting billions. These have to go
Protestors demonstrate during a doctors strike in Oxford. ‘The sheer scale of past NHS mismanagement has been staggering.’ Photograph: Dylan Martinez/Reuters
John Reid, then the Labour government’s health secretary, in 2004 offered GPs a deal that ended weekend and home visits. They could hardly believe it. He also leveraged their average pay to £100,000 a year. People said it would send thousands rushing to accident and emergency. The British Medical Association called the deal “a bit of a laugh”, and the King’s Fund later calculated it added £30bn in costs to the NHS with no appreciable benefit. But no one blamed the NHS. Everyone loved the NHS.
The attempt by Jeremy Hunt, today’s health secretary, to remedy part of Reid’s disastrous reform enjoys no such popularity. There is two-thirds support for the junior hospital doctors in their strike against weekend restructuring.
People may dislike other public services. They see the police as dodgy, train drivers as bolshy, utilities as run by crooks. But the NHS “saved my mum’s life”. So leave the doctors and nurses alone. Just give them money. Give everyone money.
Nothing dents this love. Day after day, the headlines scream of NHS woe. Last month half of all doctors said they offered a worsening service. Eleven thousand heart patients “die because of poor care”. The NHS wastes £12bn on a computer system that “does not work”. One in four hospital staff feels “harassed and bullied”. Three-quarters of them tell care quality commissioners that “patient safety is now at risk”. If the NHS is to the British, as former chancellor Lord Lawson said, “not a service but a religion”, the religion must be juju.
The sheer scale of past NHS mismanagement – of private finance and of procurement – has been staggering. It makes the Ministry of Defence seem a paragon of efficiency. When David Cameron at the 2010 election promised “no more tiresome, meddling top-down restructuring” and then did just that, I realised the NHS was more powerful than him. The beast had to keep reorganising or, like a shark, it would die.
The NHS’s carapace of love has to be its biggest danger. On Wednesday it was revealed that, despite last year’s Francis report on whistleblowing, not a single sacked NHS whistleblower has been re-employed or manager reprimanded. Instead doctors are eulogised for the “daily miracle of saving lives”. This is despite the OECD reporting that they save fewer lives per head than insurance-based health services in Germany, Switzerland and the Netherlands. Britain’s record on tracing cancer is dreadful.
Doctors are in the business of saving lives. It is their job. Firefighters are not “miracle workers” for putting out fires, or teachers for getting pupils through exams. Healthcare may benefit from fear of death and disease, and we are rightly appreciative of those who relieve it. But when other professionals such as social workers or carers of the elderly fail, they are publicly excoriated. Why is the NHS immune?
I have intermittently experienced medicine at home and abroad, in public and private sectors. I admit I feel strangely secure in the familiar NHS surgery, with its tired magazines and admonitory notices. It has a wartime air, like a Dad’s Army set, rendering it unpatriotic to complain.
But this is no joke when a friend dies of MRSA, or when a mentally disturbed child is left untended, or when, in my own case, the labyrinthine “referral” system between GPs and hospitals leads to dangerously delayed cancer diagnosis. When I challenged the consultant, he said the opinion of my GP on a particular test was “of absolutely no concern to me”.
Lax professional practices are bad enough in the law, but in medicine they can be fatal. Simple blood tests and check-ups which, in the NHS, take three visits and a month of waiting for results, in the private sector take one visit and 24 hours. A heart scan can take half a day off work in the NHS (and goodness knows what fee to the commissioning practice), but £295 and half an hour at Lifescan.
In the age of the internet and computerised testing, archaic demarcations between GPs, consultants, nurses, pharmacists and technicians make no sense. This is not a matter of ideology, but of restrictive practice. It must cost billions.
Britons love to swap horror stories about the foreign health systems. American care for the uninsured was, at least before President Obama, dire. But the American best puts the NHS to shame, as does care across most of Europe’s insurance or pay-and-reclaim systems. Insurance is not always a cost-effective basis for care, but the private sector delivers so many services more efficiently than the NHS.
John Reid, then the Labour government’s health secretary, in 2004 offered GPs a deal that ended weekend and home visits. They could hardly believe it. He also leveraged their average pay to £100,000 a year. People said it would send thousands rushing to accident and emergency. The British Medical Association called the deal “a bit of a laugh”, and the King’s Fund later calculated it added £30bn in costs to the NHS with no appreciable benefit. But no one blamed the NHS. Everyone loved the NHS.
The attempt by Jeremy Hunt, today’s health secretary, to remedy part of Reid’s disastrous reform enjoys no such popularity. There is two-thirds support for the junior hospital doctors in their strike against weekend restructuring.
People may dislike other public services. They see the police as dodgy, train drivers as bolshy, utilities as run by crooks. But the NHS “saved my mum’s life”. So leave the doctors and nurses alone. Just give them money. Give everyone money.
Nothing dents this love. Day after day, the headlines scream of NHS woe. Last month half of all doctors said they offered a worsening service. Eleven thousand heart patients “die because of poor care”. The NHS wastes £12bn on a computer system that “does not work”. One in four hospital staff feels “harassed and bullied”. Three-quarters of them tell care quality commissioners that “patient safety is now at risk”. If the NHS is to the British, as former chancellor Lord Lawson said, “not a service but a religion”, the religion must be juju.
The sheer scale of past NHS mismanagement – of private finance and of procurement – has been staggering. It makes the Ministry of Defence seem a paragon of efficiency. When David Cameron at the 2010 election promised “no more tiresome, meddling top-down restructuring” and then did just that, I realised the NHS was more powerful than him. The beast had to keep reorganising or, like a shark, it would die.
The NHS’s carapace of love has to be its biggest danger. On Wednesday it was revealed that, despite last year’s Francis report on whistleblowing, not a single sacked NHS whistleblower has been re-employed or manager reprimanded. Instead doctors are eulogised for the “daily miracle of saving lives”. This is despite the OECD reporting that they save fewer lives per head than insurance-based health services in Germany, Switzerland and the Netherlands. Britain’s record on tracing cancer is dreadful.
Doctors are in the business of saving lives. It is their job. Firefighters are not “miracle workers” for putting out fires, or teachers for getting pupils through exams. Healthcare may benefit from fear of death and disease, and we are rightly appreciative of those who relieve it. But when other professionals such as social workers or carers of the elderly fail, they are publicly excoriated. Why is the NHS immune?
I have intermittently experienced medicine at home and abroad, in public and private sectors. I admit I feel strangely secure in the familiar NHS surgery, with its tired magazines and admonitory notices. It has a wartime air, like a Dad’s Army set, rendering it unpatriotic to complain.
But this is no joke when a friend dies of MRSA, or when a mentally disturbed child is left untended, or when, in my own case, the labyrinthine “referral” system between GPs and hospitals leads to dangerously delayed cancer diagnosis. When I challenged the consultant, he said the opinion of my GP on a particular test was “of absolutely no concern to me”.
Lax professional practices are bad enough in the law, but in medicine they can be fatal. Simple blood tests and check-ups which, in the NHS, take three visits and a month of waiting for results, in the private sector take one visit and 24 hours. A heart scan can take half a day off work in the NHS (and goodness knows what fee to the commissioning practice), but £295 and half an hour at Lifescan.
In the age of the internet and computerised testing, archaic demarcations between GPs, consultants, nurses, pharmacists and technicians make no sense. This is not a matter of ideology, but of restrictive practice. It must cost billions.
Britons love to swap horror stories about the foreign health systems. American care for the uninsured was, at least before President Obama, dire. But the American best puts the NHS to shame, as does care across most of Europe’s insurance or pay-and-reclaim systems. Insurance is not always a cost-effective basis for care, but the private sector delivers so many services more efficiently than the NHS.
Doctors' strike turnout much lower than last time, says Jeremy Hunt
People love to defend the NHS – and attack private provision – through those deadly twins, prejudice and anecdote. The state’s anonymous hospitals and complex staffing systems can be glorious, but they are equally wasteful and demoralising. It is not just Hunt that is driving NHS staff at all levels into the arms of agency contractors, and costing the taxpayer a fortune.
I have never understood why so many self-inflicted “health needs”, such as sports injuries, drunkenness and overeating, should be charged to the state. Some fire brigades are charging for careless callouts. Mountain and lifeboat rescues often request “contributions”. Free at the point of delivery has long been a proud boast of the NHS. But that is policy, not papal doctrine.
The drug companies always made sure “free” did not apply to NHS prescriptions. With demand rising exponentially, supply of care must be rationed by something: if not by some form of payment and insurance, it will be by queueing and quality.Last year it emerged that more than 300,000 patients waited in ambulances for more than half an hour just to get into A&E.
Something is clearly snapping. One day, charging will assuredly come. The maddening thing at present is that it is unnecessary. It is not the NHS that needs reform but the concept of “seeing a doctor” or just getting care. The NHS may not be very good, but it is cheap to the nation. If it got tough with its labour practices and demarcations it could be even cheaper – and far better.
There is nothing wrong with loving the NHS, but it needs to be tough love.
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