Julia Manning, first published on Conservative Home, 2nd January
In the ‘Emperor’s new clothes’, everyone from the Emperor to his ministers to the townsfolk, not wanting to appear stupid, go along with the pretence that the Emperor’s new suit is fabulous. It takes a child to blurt out the truth that there is nothing there, but even then the Emperor keeps up the charade.
The question for the NHS in 2013 is whether our leaders will continue their collective denial that the NHS and Local Authorities cannot cope with current demand? The 1948 NHS emerged into a very different country to that of 2013. TB, diphtheria, scarlet fever, pneumonia and syphilis were the big challenges, no one bothered the doctor unless they really had to, there were few drugs to offer (salicylates for rheumatic fever, digoxin for heart disease, sulphonamides and penicillin) and giving bed rest was a major function of hospitals. There were more beds for the mentally ill than all other general hospital beds put together, and a fundamental part of the NHS Act gave the government executive control of all hospitals to allow effective planning.
The original aims of the NHS were to be a comprehensive service, available to all, free at the time of need and administered by centrally appointed, not elected, bodies. It was a transformational approach that pooled risk and dramatically reduced health inequalities. Over time, the comprehensive promise of the NHS has meant that its remit has expanded exponentially as new treatments have been developed (with new medicines and approaches keeping millions of people out of hospitals). Despite this the NHS has remained pretty inclusive but some controversial rationing has developed, based either on age, behaviour (e.g. requirement to stop smoking before surgery) or ‘low therapeutic value’ of a treatment. Charges were brought in after three years for some items such as glasses, dentistry and prescriptions and over time certain medicines have become unavailable on prescription, and many hospitals have become self-governing Trusts. The original NHS budget was about 3% of GDP; today it is about 9%.
In 1948 only 11% of the UK population were over 65 Years of age; it’s now about 17% and will rise to roughly 23% by 2030. In Europe as a whole it will be closer to 27%, but the UK is also predicted to be the most populous country of the continent. Meanwhile the latest figures show a drop in GDP spent on elderly social care from 7% to 6% of the welfare budget (of £111Bn) despite the rising numbers of elderly in the population, and reports over Christmas revealed that Germany (having the highest projected proportion of elderly within the next 20 years) has already started ‘exporting’ older people to cheaper care homes in eastern Europe.
The ageing population, costs of new technology and fossilised state of our professions all mean we cannot carry on doing things as we are. We need our politicians and health leaders to show the way in setting out what are the issues and genuine choices. Simply put, we need a culture change in which we are all involved with the following three key elements:
1. Much greater public involvement in health including
- Professionals letting go, seeing patients as partners and helping to shape a more appropriate workforce
- Public taking hold, involving themselves through more self-care, community caring and controlling their electronic personal health records
- Rewarding healthy behaviours
2. Transparency of data including
- Outcome data on treatments and detailed GP practice information
- Publication of NHS Trust losses and action plans to reduce fraud
- Public health information on food and drink
3. Refinement of expectations including
- Public discussion on national decommissioning, e.g. of procedures with low medical value and common medicines e.g. paracetamol
- A new Constitution with clarity on rights, responsibilities and redress
- Develop opportunities to adopt the latest technologies
The imminent report from Sir Robert Francis QC on the appalling experiences of patients at the Mid-Staffordshire Hospital will mean the NHS and elderly care is in the full glare of publicity from the start of 2013. Ministers and leaders must not shy away from the challenge of proclaiming, like the honest child amidst the Emperor’s court, what those patient’s families already know to be true: that the NHS and social care is not fit for purpose. Nor must MPs make any more false promises that the NHS can continue to be a totally comprehensive, free-at-the-point of use service giving everyone the best possible treatment alongside (of course) ‘saving’ their local hospital. We are not stupid. The Francis Report, painful though it will be, is the ideal time for Parties to start an honest conversation with the public: We need to be involved in our healthcare; they must provide the data; and together it is essential to review both how all necessary care can be provided through tax funding and where common sense efficiencies and opportunities can be found.