The positives of the NHS are enormous. I was in to have my prostate removed by a robotic assisted operation which was done in a state of the art facility. The thing about prostate cancer is that it is a very nasty killer if it is left unidentified until too late in the process and a perfectly reasonable problem to deal with if it is spotted early. I got spotted early and was on a screening programme that meant that when my scores went over a certain level action was taken in good time.
In a collective health care system there is nothing to discourage individuals from getting themselves screened. In an individualised insurance based system you risk putting your premiums up every time you refer yourself for a potential problem like cancer. Putting that more bluntly more people die of cancer if they refer themselves too late because they are scared of the cost. The NHS saves lives.
Because of this some excellent people are prepared to devote much of their lives to working for it. There is an ideal there that still inspires and it was lovely to watch new enthusiastic trainees being taught very skilfully, and with great patience, how to look after the patients on my ward.
What was less lovely was to watch exhausted experienced professionals literally running between patients and the complete lack of any margin for error or slack periods when the pressure eased off. Maybe I hit a bad night but patients will still being received into the post operative ward well after 10 pm and there were a series of crises including a patient death in the bed opposite me at 5 in the morning. Even very experienced staff need a degree of time for themselves when they have been delivering CPR and failing and then are contacting relatives and dealing with their grief. All the staff got was the need to move on rapidly to looking after the next person.
It took 4 hours to discharge me. A fifteen minute job. The delay was not because of any inefficiency of the staff. The simple reason was that it was impossible for them to cobble together more than 5 minutes at a time to devote to a routine and delayable job. Throughout the day there was real pressure on the time of each individual and they were battling with frustrations over the workings of simple pieces of kit like patient record computers.
If you listen to the weasel words of the enthusiasts for privatisation then the best way of dealing with all these pressures is to bring in more business expertise and to work more effectively. I have always been an enthusiast for business efficiency and I hate waste and disorganisation. I also believe that there are many circumstances in which the private sector is a lot better than the public sector – in the telecommunications industry for instance. But privatisation doesn’t work for the NHS for a number of important reasons.
Firstly, the service depends on the dedication of the staff to an ideal. Commercialise that and you risk the entire ethos of the service. There is simply no way that government can afford to attract people to work in health and care via financial incentives. People working in the NHS obviously want and need reasonable pay levels but a great many of them are basically there because they believe in the work. Destroy that and the cost will be enormous both financially and socially.
Secondly there is the difficulty in identifying which parts of the service to offer to private companies and of getting the contracting right. There are individual sections of any NHS hospital that you could package up and contract out relatively easily. Blood tests would be a good example. It isn’t that hard to draw a circle around that part of the service identify exactly what you want and offer it out in a contract.
But all you achieve by doing this is to hive off the easy and predictable parts of the NHS which the public sector is usually already running well. Instead of cutting costs you increase them by outsourcing the profitable jobs. You also increase the time spent on defining what service level you want, inviting bids, awarding contracts and checking those contracts are being delivered. You can’t solve a financial crisis by giving the profit making bits of your operation to private companies and focusing on doing all the hard, expensive and unpredictable things.
Health care isn’t like selling supermarket produce. There are peaks in need whenever there is bad weather or an outbreak of a particular condition. You need a degree of flexibility that can’t always be defined in a contract. Either a contract of employment or a contract with a private company. During an epidemic you can’t have too many employees saying they have done their bit and are going home or a contractor tell you that you didn’t pay for this kind of demand level so they aren’t required to deliver it.
Yet, each month a little bit more of the service is hived off. Each year there is less money available for each operation as tiny increases in funding fail to keep pace with the age of the population. Each day a new set of experienced staff decide that they can no longer put themselves through the personal pressures of work at the sharp end of an A&E unit or an emergency ward. Many of them come back on higher pay under a contract that means they carry lower responsibilities. Every year there is a new attempt at re-organisation which simply adds to the pressures.
There never will be a day when any government in the UK is brave enough to announce the death of the NHS. The Conservatives will always proclaim that they are the champions of it. They keep claiming they have allocated record sums of funding and real terms increases. In fact they have shattered the funding for the local authority care service and left the NHS to deal with the crisis. My mother spent 6 weeks in an NHS hospital bed for the simple reason there was no care bed available The NHS picked up the bill. They are being asked to make up the slack in the care system whilst also being provided with less money per operation. We are witnessing a slow and gradual destruction of the service. This is an ideologically driven choice and all the harder to resist for being done slowly and steadily.
The NHS desperately needs both extra funding and an opportunity to step back from continual re-organisation and just focus on running the service well. What we are seeing instead is an incredibly valuable service being steadily weakened.
We need to challenge the myth that the service is failing because it is a form of socialism. The truth is that this kind of service can only succeed if it is inspired by an ideal that we are all at risk of illness and we all need to club together to see each other through hard times.
I do not believe that the staff I saw working so hard this week would get much immediate relief from their pressures by an increase in funding and an end to top down re-organisations. But I do believe it would be a huge boost to their morale to get a message from someone in government that there is a determination to work with them and let them get on with their jobs with a little more support and a lot less interference.
The best first step towards doing this would be to raise income tax and use it to support the NHS. The staff are being pushed to the limits and it is time for the public to push back and tell its politicians that they value the NHS enough to pay up.