Guest Blog: Gail Beer, Consultant Director, 2020health
“NHS bosses face sack for rationing by delay” by Rebecca Smith of the Telegraph and “Lansley Threatens Sack to NHS Chiefs” by Randeep Ramesh of the Guardian both appeared at the start of this week on the 14th November. While all the arguments were well rehearsed: the private sector was accused of sneaking in the back door; managers were criticised /defended; the population is being denied choice; waiting times are rising, Labour and the Conservatives continue to slug it out over in whose hands the NHS is really safe. I fear we are no further forward and yet another announcement will have limited impact on changing anything within the NHS. And today, commentators are playing with the latest waiting time figures as Lansley says he wants to stop NHS Trusts hiding those who have waited longer that 18 weeks.
The date the 14th of November is significant at it is 34 years ago that I started at St Bartholomew’s Hospital as student nurse. The NHS was, I seem to remember in crisis, and I was assured near collapse and would go under within the 10 years. The government were out of touch, did not care and relied on us, the professionals, to deliver care in the face of a lack of money. Plus ca change.
Happy Anniversaries aside, the articles raised several issues for me.
Are we clear that everyone who is on the waiting list should be? The waiting list reduction has really turned lives around and is something we should not lose, but we need to make sure everyone who is on it really needs to be on it. Indeed, are all the procedures necessary for our health, have we fed an expectation of an operation which may then be impossible to deny? Not only do patients remove themselves from lists, but they ‘Do Not Attend’ (DNA) and cancel operations. If you have ever worked in the acute sector you will not be amazed by the numbers. The NHS too cancels operations because it cannot cope with the heady mix of emergency medicine and surgery and elective care.
So here we are rationing elective care, the elderly are all backed up in hospitals with nowhere to go and seemingly no-one to care. Patients with long-term conditions are not universally cared for and maintained at home using new technologies but admitted to hospital. Surgical emergency patients are hanging about waiting for theatre time or senior review, all costing money we don’t have. How can we plan what hospitals and services we need where when we are not making best use of what we have?
Given all the above and our failure to manage it throughout all the NHS what is the point in choice? We cannot have elective care on demand, where and when we want it. We pay our taxes but we must do as we are told so why go to the though the expense of pretending otherwise? If our hospital provides poor care, if the services it provides are no longer viable and put us at risk we still have to go there. Choice does not exist in the way we are led to believe.
Finally, has the paternalistic NHS removed from the nation the responsibility for its own health? We eat too much, drink too much and don’t exercise enough, with some truly awful health statistics to boot. At the end of the day, we will all expect the treatment that is required after we have abused our bodies.
Happy Anniversary? No because until the public start asking ‘where does the money go?’ and starts letting those in charge hold managers accountable, and the newspapers stop damming every Secretary of State for either interfering in the day to running or not asking for responsibility, we are never going to have any kind of grown up debate about how we are going to cope in the future with all the pressures and likely demands on the budget.