Is the NHS really a national service? Matthew Eason doesn’t believe it is, highlighting current issues within the organisation that we should be focusing on.
When you think about it, the NHS is a misnomer. It cannot truly be called a “national” service when there are such wildly different standards of care and treatment across the country. There is a postcode lottery for healthcare in this country.
One of the main reasons for this discrepancy is the flawed system that was introduced by the Coalition government. The Health and Social Care Act of 2012 scrapped Primary Care Trusts (PCTs) and Strategic Health Authorities (SHAs) and replaced them with Care Commissioning Groups (CCGs).
There are undeniable problems with the NHS and social care, but the creation of CCGs has been a terrible mistake. Handing control of hospital funding to GPs was not the right choice.
It is quite right that we should want the NHS to provide the best possible service at the best possible price. However, demanding hospitals try and cut, or limit spending is not always the best way to save money. Firstly, cuts will always eventually lead to a reduction in the quality of service if political forces demand that the range of care provided is either unchanged or expanded. Secondly, with an ever-expanding population and the increasing cost and range of treatments, it is evident that NHS expenditure will need to rise, unless fewer treatments are offered.
Of course, this does not mean that the NHS cannot be made more efficient or effective. Nor does it mean that we should accept discrepancies in care and standards between different areas of the country.
Every new government seems to think they will be the ones to “fix” the problems of the NHS. However, this is not the way to improve the NHS. The NHS cannot be brought to the pinnacle of world healthcare providers when it undergoes a radical overhaul every 3-5 years and has constant meddling and fiddling in the intervening periods. The NHS cannot deliver proper care if the ‘How’s? And Why’s?’ of healthcare are always in flux.
Devastating changes simply will not work on a sprawling; some might say bloated, organisation like the NHS. We need to see a commitment by the main parties to allow an evolutionary approach to maintaining the NHS. We need a proposal that would see the required small changes properly settled and implemented without compromising structures that already work well. We need to change when necessary, not change for change’s sake or because you want to be seen to be doing something.
Under the current system, the demand for savings has led to dangerous and short-sighted policy decisions. For example, “minor” surgeries like cataract operations have been restricted in many areas. It may save costs in the short term, but it creates problems like an increased risk of falls which in turn can lead to a much more severe injury.
Not only does the decision to restrict “minor” operations like cataract removal risk patient health, but it also does not save the NHS money in the long term. Any injury caused by the complications of not having “preventative” surgery will have to be covered, and usually, for more significant expense than the initial “minor” operation.
Whilst making the NHS cost-effective is a worthy and essential goal, we must never lose sight of the fact that being cheap does not always save money. The right level of funding will lead to more staff and better patient care.
It would not do to discuss the travails of the NHS without mentioning the problem of recruitment and retention of doctors and nurses. It has to be said that paying healthcare professionals a reasonable salary is vital in maintaining staffing levels and boosting morale. A sensible salary is of far greater importance than discounts on gym membership or in supermarkets.
However, there is a deeper problem that is being ignored. There are obvious problems with the education of new doctors and nurses. For example, if we have a lack of staff, we should be increasing the numbers of training places available and loosening the restrictive academic requirements.
Academic achievement is no guarantee of capable doctors and nurses. Other requirements should be considered, such as being personable and having a genuine drive to help and care for others.
Of course, academic ability is important, but increasing numbers of students are treating medicine and the related courses as any other sort of degree. They don’t necessarily end up going into or staying in the profession. If almost 50% of F2 doctors do not continue into a clinical career in the NHS, there is something drastically wrong with both the selection process and the courses. We need trainees who will stay the course and are fully committed to dedicating a significant portion of their lives to healthcare.
Additionally, the courses themselves have become more focused on academia and less on practical experience. It means that newly qualified doctors and nurses are unprepared for starting work. Doctors and nurses who, once the realities of a medical career set in, leave the profession as it becomes too much for them, and they are not willing or capable of buckling down. Brainpower and theoretical knowledge are both useless if they cannot be applied effectively and professionally in pressurised situations.
We should not be satisfied with a health service that rates in the bottom half of OECD comparisons of health system performance. We can certainly do better than just throwing money at the NHS.
Politicians must recognise that the NHS is a flawed organisation. The long-term solutions are not continued wholesale restructuring or short-term bodges aimed at appeasing the media or ending negative publicity. We must ensure meaningful and effective reform through a conservative, evolutionary approach. An approach that will get treatment and care right by returning to national treatment standards and funding plans. A system that allows for improved staffing levels, increased trainee numbers, new criteria for trainee selection and properly funded salaries and pensions.