The health service is in need of a radical overhaul. But for this to happen there needs to be a political consensus that the status quo cannot continue and that urgent reform is essential
As the new Health Secretary gets to grips with the most sensitive brief in government, it’s a good time to consider attitudes to the reform of the National Health Service.
The titanic battles between the main political parties on the need for NHS reform indicates what is wrong with the politics of health in the UK. For many years now health policy has been an emotional issue and the NHS is always a hot topic in any national election campaign.
The NHS was perhaps the greatest achievement of the post-ward Atlee government and is seen by most people as a beacon of civilised society, where health care is free at the point of consumption and access is largely based on clinical need and not ability to pay. It is not surprising, therefore, that people have great faith in the NHS and are very reluctant to see any changes made to something they strongly trust.
However, the health service is now in need of radical reform for a range of reasons including both the clinical and economic. However, for this to happen there needs to be some sort of political consensus that such reforms are essential and that the status quo is not an option. Unfortunately, such a consensus does not exist and all parties seem more concerned with achieving short-term political advantage and point scoring.
It’s been clear, over many years, that when a political party (any political party) is in government they tend to try to promote some reforms and changes in the NHS, but when they are in opposition they fall back on policies which, by and large, comprise the following promises to:-
- Spend more public money on the NHS
- Employ more doctors and nurses (other health professionals rarely get a look in)
- Reduce the number of NHS managers/administrators
- Not close any hospitals however decrepit, unsafe and ineffective
- Not change anything
Not surprisingly, these sorts of policies are almost universally supported by health professional representatives and trade unions. This, coupled with strong publicity from the media, makes it incredibly difficult to achieve the level of change actually needed in the NHS.
In the UK parliament, the Labour opposition (in harmony with health profession representatives and trade unions) chose to oppose coalition government proposals for NHS reform in England attempting some short-term political point scoring. The government’s reform proposals had several flaws but also incorporated some sensible reforms. But the combined opposition of the Labour Party, NHS vested interests and, indeed, the Liberal Democrat partners in the coalition resulted in an emasculation of the plans and put an end to real reform for the duration of the current parliament.
In Wales, the publication of the Longley report on NHS reconfiguration in Wales was an opportunity to build consensus and take forward the necessary changes needed. Rather than support the Labour controlled administration in Cardiff in taking forward what are rather sensible reforms, the opposition parties in the Assembly preferred to undertake juvenile political point scoring by questioning the validity of the report and suggesting that maintaining the status quo was an option (which it isn’t).
Moreover, this sort of mentality often creates public opposition to legitimate reforms that are urgently needed to improve health care and thus makes them more difficult to implement. I recall an elderly relative of mine, awaiting surgery for an artificial knee implant, complaining because he was being referred to a regional specialist centre for orthopaedics rather than his local hospital.
‘It’s all to do with the cuts,’ he said. ‘It’s in the newspapers’. I patiently explained that it wasn’t to do with the ‘cuts’ (there weren’t any) but it was to do with the fact that such specialist centres generated better clinical outcomes than a local district general hospital and so would be good for his recovery. He thought about this for a while and then suddenly said: ‘No, I don’t believe that, it’s all to do with the cuts. We should fight it.’
The NHS now faces perilous times as a consequence of the financial and economic crisis in the UK. Since its formation in 1948, the NHS, overall, has received an annual rate of growth in funding that averages 3.7% and which between 2001 and 2005 averaged 7.1%. For the foreseeable future the NHS is likely to get growth in funding of approximately zero. Indeed, the NHS is expected to make large-scale ‘efficiency’ savings of £20bn over four years in order to find funds to meet growth in service demands largely as a consequence of the ageing population.
I am afraid the image of the proverbial oil tanker heading for the rocks appears before my eyes. For 60 years the NHS has consumed significantly increasing sums of public funding and now (almost overnight) it is expected to live on virtually no growth in funding. There is a cat in hell’s chance of the efficiency targets being achieved and it is very likely we will soon hit a major funding and political crisis in the NHS.
At that point, our politicians, of all parties, may regret trying to kid the public that the status quo is sustainable and that there is no need for reform.
Malcolm Prowle is the co-author of Public services and financial austerity: getting out of the hole published by Palgrave Macmillan