The Titanic of health care

Comment from Melanie Phillips in Britain

Has there ever been a more bizarre notion of political responsibility? The NHS is currently engulfed by a deep financial crisis as it careers towards a deficit of between 600 million pounds and a staggering 1 billion. Operations are being cancelled. Hospitals and primary care trusts have frozen staff vacancies. Managers are even threatening to withhold tax and national insurance contributions because they don’t have enough cash to pay them. The service is descending into chaos. As result, the NHS Chief Executive Sir Nigel Crisp has walked the plank. The Government’s insistence that he took early retirement entirely of his own volition is frankly incredible. In fact, he very decently acknowledged responsibility for the service’s problems, as well as for its successes.

So a career beached in ignominy? Hardly. For Sir Nigel has been given a life peerage -- one of only a handful in the Prime Minister’s gift for public servants who have made a particularly distinguished contribution. For this failure to stop the NHS sliding into financial chaos, which has caused him to depart so precipitately from his post, Sir Nigel has therefore been rewarded with a Whitehall plum. Confused? In the surrealist and unending disaster epic that is the NHS, very little makes any sense. Unprecedented amounts of money have been hurled at the service by the Chancellor -- and yet we learn that, some four years on, the NHS appears to be going bust. So how can this have happened?

The immediate reason is that almost all this largesse has been swallowed up by salaries, pensions, drugs, IT systems and other commitments which cost far more than had been expected. As result, virtually no money was left for improving the actual delivery of services to patients, without what are euphemistically called ‘efficiency savings’ – or cuts to you and me. These were so vague as to be next to useless. So almost all the Chancellor’s extra billions disappeared into the mechanics of the system. Meeting the demands by ministers for more, better and faster treatment sent the service shooting into the red.

In a more honourable age, the Health Secretary presiding over such a shambles would have fallen on her scalpel. But here, surely, is the explanation for the ennoblement of Sir Nigel. His peerage was a sop to sweeten the bitter pill of being made the fall-guy for a politician who was determined not to take the rap. Sir Nigel should not have been sacked, because the job he was given was simply impossible. He was being expected to turn round a service which was being driven off the rails by the incoherence, arrogance and incompetence of Government policy.

What has happened has tested to destruction the old excuse that the problems of the NHS were due to lack of money. We now spend more on health care than the European average, but it has vanished into a managerial black hole. An unprecedented level of spending has simply produced an unprecedented level of crisis. This was entirely predictable; indeed, it was in fact predicted by many commentators. The government was warned that this would happen by Nick Bosanquet, the distinguished professor of health policy; it was warned by the influential Reform think tank; it was warned by the OECD, which said that such an enormous amount of money simply could not be processed efficiently in such a short amount of time.

The Government ignored all of them. Instead, it pressed forward with one ill thought-through and incoherent policy innovation after another. The reason Sir Nigel was unable to constrain NHS spending was that its managers were being driven to meet unrealistic ministerial targets -- in particular, the policy of reducing treatment waiting times. It was this policy which meant that more patients had to be processed faster, even though there wasn’t the money to do it. It was this policy which grossly distorted clinical priorities. It was this policy which shunted patients onto ‘ghost’ waiting lists -- which didn’t officially exist -- to artificially massage the figures downwards. And all this to provide the illusion of improvement, so that ministers could make an empty boast that would hoodwink the voters.

Now the Health Secretary Patricia Hewitt claims that only ‘a very small minority'’ of hospitals and NHS bodies have serious financial problems. One shudders to imagine what she thinks a large problem would look like. It should not have been Sir Nigel who resigned but the Health Secretary herself. The notion of ministerial accountability, however, seems to have gone out of the window altogether. Indeed one of the reasons for creating an NHS executive was to enable ministers to do precisely what Ms Hewitt has done -- to wash their hands of the mess that their own policies create. They keep the service under control so tight that it cripples it -- and yet they refuse to accept responsibility when things go wrong.

But although the Government won’t admit this, Ms Hewitt’s own job is also impossible. This is because the NHS is simply unmanageable. Since the mid-seventies, government after government has tried to reform it. Yet every one has made things worse so that the service merely lurches from crisis to crisis. The reason is that it is simply too big. According to some measures, it is the third largest employer in the world. In England and Wales it employs around 1.3 million people, or around one in every 40 people. It is just not possible to manage such a monster from an office in Whitehall.

The bitter irony is that the very premise of the NHS is proving its undoing. Taxpayers’ money is spent on the nation’s health care by ministers -- who thus inevitably tell the service what to do. And what that means is that no government can solve the NHS crisis, because government itself is the problem. Instead of a health service funded by the Treasury, therefore, the solution has to be a different model of funding altogether. The fairest and most efficient alternative is a form of social insurance as practised in Europe, where waiting lists are virtually unknown. Patients purchase healthcare from providers of their choice, with the state guaranteeing levels of provision covering the poorest in society.

Our NHS is a shibboleth because people assume it is the only system that is fair. But this is simply untrue, as anyone who has seen the often shameful way that it treats those who are both poor and elderly can testify. The present system is already a lottery which will become dramatically more unfair as the population ages and new treatments become available. Cancer care alone is forecast to cost an extra 15 billion pounds by 2011. The consequent rationing will become unendurable and unsustainable.

Sir Nigel has gone, but there is no sign that Ms Hewitt has the faintest idea how to address this crisis. She’s still talking about bringing down waiting times to 18 weeks. But as Professor Bosanquet says, this policy – which has not even been properly thought through – should be abandoned before it causes yet more distortions, chaos and patient distress. In the longer term, radical thinking is required. The NHS is the Titanic of health care. Rearranging the deck-chairs yet again will not save it from sinking.






MORE DESPERATE SHUFFLING OF THOSE DECKCHAIRS

"Patients with some serious conditions could be treated at home rather than in hospital in order to try to cut the number of emergency admissions. The Health Secretray Patricia Hewitt is expected to announce the move as part of Government plans to tackle the NHS cash crisis. Ms Hewitt is said to be preparing plans to encourage people with conditions such as asthma and heart disease to be cared for at home by community nurses. The Department of Health believes the measures could save the cash-strapped NHS up to 400 million pounds a year, according to a BBC report. But the Tories accused her of trying to get "healthcare on the cheap" and said the plans would threaten patient care.

Ms Hewitt said: "If we could cut these unplanned emergency admissions by 30% and patients would have improved lives and hospitals would be able to plan their services better. "The potential savings from those PCTs (Primary Care Trusts) that have many more emergency admissions than the average is almost 2.5 million pounds per PCT."

Shadow health secretary Andrew Lansley said the Government should "let professionals get on with the job of determining how patients are cared for". Dr Beverly Malone, general secretary of the Royal College of Nursing, said: "We are very supportive of care moving from the hospital to the community. "But right now there are not enough nurses in the community to take care of these patients. District nurses are already working flat out."

Source





1,000 staff to go from just one British public hospital

A cash-strapped hospital is to cut up to 1,000 jobs in a desperate attempt to reduce debts of more than 15 million pounds. The University Hospital of North Staffordshire in Stoke warned around three-quarters of the redundancies will be compulsory. Some 370 nursing and midwifery posts are expected to go. Pat Powell, the hospital representative for leading trade union Unison said: "The hospital claims the job cuts will not affect patient care, but we feel they will inevitably affect services."

Hospital chiefs said they were "saddened" by the cuts but the move was essential to address their huge deficit. There are already strict controls in place on recruitment to vacant posts. Managers said they planned to improve efficiency. Antony Sumara, Chief Executive, said: "I am deeply saddened that we now find ourselves in this position. "However, I firmly believe we will be a very strong trust, able to go forward confidently and provide first class services for our patients and good working conditions for our staff."

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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