The NHS is being destroyed by political vanity projects. It cannot go on being Westminster’s chew toy

The nonsense which party politics expects – 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

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The Independent Online

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.

Jeremy Hunt on NHS mortality rates

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.

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 Glasgow

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