A catastrophic funding black hole with £22bn to be saved by 2020; increased waiting times for tests and treatments; opaque plans about how to make things better. The NHS is in crisis – and deep winter, the flu season, has yet to arrive.
The NHS needs more money, no doubt: we spend less of our GDP compared to many of our European counterparts. Out of the original 15 EU member countries, we are 13th for healthcare spending. https://www.kingsfund.org.uk/blog/2016/01/how-does-nhs-spending-compare-health-spending-internationally But there is no point spending more on healthcare if it is wasted.
Take the Health and Social Care Act. Andrew Lansley’s monster has meant millions for commissioning, contracts and administration – and for NHS instability. The Act opened the door to competition and private companies have increasingly moved into the NHS. But markets in medicine expect failures, and account for it. Circle’s takeover of Hichingbrooke Hospital in 2012 resulted in early withdrawal from the contract and the taxpayer paying for much of their losses. As the public accounts committee put it “no-one has been held accountable for the consequences”.
GP practices, taken over by private companies, are going bust: a combination of increased demand and a shortage of doctors led to contracts being handed back early, with all the associated stress for patients. Where was the evidence that the competition introduced by the Health and Social Care Act would be better for the NHS? It didn’t exist. This was a political vanity project.
As for Labour, it was entirely clear even during their era of their PFI that the funding method it was an unaffordable, expensive way to build the NHS – costing far more than public lending would have. The rebuild of St Barts Hospital cost £1.1bn, but repayments will run to more than £7bn, with an annual repayment this year of almost £144m. That Trust is running a budget deficit of £90m. In this climate, when savings are made it inevitably involves staff cuts – despite good evidence that more nurses make the NHS safer. We are setting up the conditions for another Mid Staffs.
There are numerous examples of such wasted political policies. Take dementia screening, instigated by Jeremy Hunt, who shamed doctors for allegedly not diagnosing dementia often enough. But later data showed that dementia rates were falling, and the screening test that GPs were incentivised to carry out (they were offered £55 per new diagnosis) was highly inaccurate, creating many distressing false alarms. This wasted millions of pounds, but also doctors’ and patients’ time, which would have been better spent elsewhere.
Or “seven-day services”. This was a fantastic soundbite for the Conservative Party manifesto. But the seven-day system was also unclearly defined, part cause of a bruising contract dispute with junior doctors. Neither was the step shown to improve death rates, or even be affordable for the NHS as it stands now.
The nonsense which party politics expects from the NHS – from futile “health checks”, to private sector treatment centres, to the millions spent to open GP surgeries on Sunday afternoons only to be greeted by empty waiting rooms – are the death knells to an NHS free at the point of use.
The worst jobs for your health
The worst jobs for your health
1/10 10. Surgical and medical assistants, technologists, and technicians
Overall unhealthiness score: 57.3 What they do: Assist in operations, under the supervision of surgeons, registered nurses, or other surgical personnel and perform medical laboratory tests. Top three health risks: 1. Exposure to disease and infections: 88 2. Exposure to contaminants: 80 3. Exposure to hazardous conditions: 69
2/10 9. Stationary engineers and boiler operators
Overall unhealthiness score: 57.7 What they do: Operate or maintain stationary engines, boilers, or other mechanical equipment to provide utilities for buildings or industrial processes. Top three health risks: 1. Exposure to contaminants: 99 2. Exposure to hazardous conditions: 89 3. Exposure to minor burns, cuts, bites, or stings: 84
3/10 8. Water and wastewater treatment plant and system operators
Overall unhealthiness score: 58.2 What they do: Operate or control an entire process or system of machines, often through the use of control boards, to transfer or treat water or wastewater. Top three health risks: 1. Exposure to contaminants: 97 2. Exposure to hazardous conditions: 80 3. Exposure to minor burns, cuts, bites, or stings: 74
4/10 7. Histotechnologists and histologic technicians
Overall unhealthiness score: 59.0 What they do: Prepare histologic slides from tissue sections for microscopic examination and diagnosis by pathologists. Top three health risks: 1. Exposure to hazardous conditions: 88 2. Exposure to contaminants: 76 3. Exposure to disease and infections: 75
5/10 6. Immigration and customs inspectors
Overall unhealthiness score: 59.3 What they do: Investigate and inspect people, common carriers, goods, and merchandise, arriving in or departing from the US or between states to detect violations of immigration and customs laws and regulations. Top three health risks: 1. Exposure to contaminants: 78 2. Exposure to disease and infections: 63 3. Exposure to radiation: 62
6/10 5. Podiatrists
Overall unhealthiness score: 60.2 What they do: Diagnose and treat diseases and deformities of the human foot. Top three health risks: 1. Exposure to disease and infections: 87 2. Exposure to radiation: 69 3. Exposure to contaminants: 67
7/10 4. Veterinarians, veterinary assistants, and laboratory animal caretakers and veterinary technologists and technicians
What they do: Diagnose, treat, or research diseases and injuries of animals and perform medical tests in a laboratory environment for use in the treatment and diagnosis of diseases in animals. Top three health risks: 1. Exposure to disease and infections: 81 2. Exposure to minor burns, cuts, bites, or stings: 75 3. Exposure to contaminants: 74
8/10 3. Anesthesiologists, nurse anesthetists, and anesthesiologist assistants
Overall unhealthiness score: 62.3 What they do: Administer anesthetics or sedatives during medical procedures, and help patients in recovering from anesthesia. Top three health risks: 1. Exposure to disease and infections: 94 2. Exposure to contaminants: 80 3. Exposure to radiation: 74
9/10 2. Flight attendants
What they do: Provide personal services to ensure the safety, security, and comfort of airline passengers during flight. Greet passengers, verify tickets, explain use of safety equipment, and serve food or beverages. Top three health risks: 1. Exposure to contaminants: 88 2. Exposure to disease and infections: 77 3. Exposure to minor burns, cuts, bites, or stings: 69
10/10 1. Dentists, dental surgeons, and dental assistants
Overall unhealthiness score: 65.4 What they do: Examine, diagnose, and treat diseases, injuries, and malformations of teeth and gums. May treat diseases of nerve, pulp, and other dental tissues affecting oral hygiene and retention of teeth. May fit dental appliances or provide preventive care. Top three health risks: 1. Exposure to contaminants: 84 2. Exposure to disease and infections: 75 3. Time spent sitting: 67
We can do this better. The question is whether we are willing to let go of short-term party political vanity projects. We need a mature, long-term consensus on evidence-based healthcare policy. The NHS cannot go on being Westminster’s chew toy.
The public sccounts and health select committees are both very good at scrutiny – but after events, and with too little power. Organisations such as the National Institute for Clinical Excellence are capable of independently assessing evidence too.
So, what will it be? An NHS which suffers from overspending on things we know simply don’t work, or aren’t tested properly? Or politicians who believe in the principles of the NHS and seek expert advice on evidence, beyond party divisions, to ensure that “free at the point of need” remains its defining principle?
Margaret McCartney is a GP in GlasgowReuse content