Reposted from Open Democracy - Our NHS LINK, author Dr David Wrigley, under Creative Commons terms LINK. No changes have been made from the original text.
Be careful of what you wish for Mr
Cameron and Mr Hunt. This one could come back and bite you very hard indeed.
“We can become the first country in the world to
deliver a truly 7-day NHS”, David Cameron used his ‘first major
speech’ of his brand new Conservative majority government to tell us.
It sounds appealing - but does it stand up to scrutiny, or
is it just more spin from the former spin doctor?
With 5 years of unconstrained power ahead of him, Cameron will
now be expected to deliver on this key Tory manifesto promise.
If Cameron really wants to achieve a 7-day NHS he needs a 7
point plan.
1. Get the 5 days right
first.
If the government wants to make the NHS work safely and
efficiently 7 days a week, then it might be a good idea to get the 5 days of
Monday-Friday working well beforehand. At the moment the NHS is in dire
financial straits – and its demoralised
doctors, nurses and other healthcare professionals are leaving or retiring
early. What was the adage Cameron likes to use – fix the roof while the sun is
shining? Well the
sun isn’t shining much in the NHS these days - but you certainly need to
fix the roof Mr Cameron, and pretty sharpish.
2. Invest in your NHS
staff
Nurses got years of 0% or (at best) 1% pay increases during
the coalition years. They effectively ‘donated’
over £1.5bn a year of unpaid overtime to keep the NHS afloat amidst the cuts. They
were pilloried
for failures that were not of their making. Blamed for scandals that were
often due to hospitals chasing
Foundation Trust status at all costs, their eye only on the bottom line. Many
health professionals are becoming unwell now because they cannot give any more
to the job they love. The number of nurses off with stress soared
by up to 48% last year.
How are they going to feel now the government tells them
that in a 24/7 NHS it will be “archaic”
to pay supplements for working “unsocial hours”? Many nurses rely on these
payments to boost their stagnating income.
3. Get your workforce
planning sorted
Cameron claimed last week that “We are training and hiring
many more GPs right now”. But in fact one
third of GP training places are empty. And one
in three GPs plan to retire in the next 5 years, leading to a workforce
time bomb fuelled by 5 years of unpopular NHS policies and huge cuts (known as
‘efficiency savings’).
4. Sort out social care
and community healthcare
The huge cuts to local authorities has meant social care
being cut to the bone, with budgets being slashed by up to 35%. Many elderly
and vulnerable patients are being left alone or with haphazard 10 minute visits
from zero-hour contract workers who have to dash from client to client in order
to make any sort of living. These patients are becoming increasingly unwell and
needing more NHS care. Inadequate community healthcare services (district
nurses have been cut by 40% in 5 years) mean they languish in hospital beds,
unable to be discharged safely to the community.
5. End the dog eat dog
competitive market in the NHS
We are wasting
billions annually on administering an unwanted healthcare market where
providers fight each other for contracts and NHS managers spend their lives
refereeing and sorting this all out. No one (except the private health
industry) has asked for this. The money saved from scrapping this market system
could fund decent social care for all the elderly and vulnerable people in our
society.
6. Make all NHS services available 7 days a week
But tell us – as Cameron has so
far refused to – what it would cost. Doing it properly would cost billions. As
a GP if I see a patient on a Saturday or a Sunday I need the full range of
services available to me in order to treat my patients effectively. I need a
fully functioning hospital laboratory with blood collection services twice a
day over the weekend. I need access to NHS physiotherapy for my patients with
urgent musculoskeletal problems. I need access to health visitors to refer
children needing their input. I need access to a fully functioning radiology
department offering x-rays, CT scans, MRI scans, ultrasound and other
investigations.
7. Beware of the unintended consequences
Increasing the NHS to a full 7 day
service will increase demand – and therefore cost. Cameron’s promised ‘extra’
£8bn would merely plug one small gap in the black hole opening up at the centre
of the Department of Health. To stretch already overstretched services more
thinly will lead to a poorer service in coming years – and no doubt, the electorate
to blame the government for a failing NHS. Cameron may have already said he
will be leaving Downing Street before 2020, but is this really the legacy he
will want to leave for his successor?
A 7 day NHS service is attractive
to patients and attractive to politicians seeking votes. But no other western
health economy has managed to provide it, as Cameron said himself. With the NHS
already struggling many really doubt this government can do it properly. I hope
it won’t be imposed on already beleaguered NHS staff and they are forced to
provide the 7 day service against their professional advice.
2 comments:
Interesting to hear that its GPs which start to pipe up. This is a professional group who operate outside of the NHS as self-employed or businesses since 1948 and have had their salary's consistently rise above anyone else within the NHS. It should be noted that the Organisation for Economic Co-operation and Development report our GP's are the best paid in the whole of the Western World.
When the CCG's were created GPs managed to edge out the allied health professionals to attain majority status and have been quietly and steadily increasing the award of contracts to private sector providers. Last year it has been estimated that between 33 - 40% of all new contracts awarded by these GP run CCG's went to the private sector. Whilst research by the British Medical Journal found that 1 in 3 GP's on CCG's have interests in private healthcare providers either helping to run them or holding shares.
Its certainly not in the interests of GP's to run wider more flexible services but it is for the public.
NHS England reported that 10.91% of people could not get an appointment with a GP last year and the public health committee said that 1 in 10 of these went to Accident and Emergency instead. Which in turn puts pressure upon other services and can contribute towards the perception that 'services are failing' and in turn require privatisation to 'sort them out'.
Granted the author of this article GP David Wrightly highlights in point 5 we need to end the competitive market, but for starters we need his profession to give up their independent contractor status which contributes towards inefficiency and an inability to plan services properly. Perhaps then, if we had every service that the NHS is reliant upon (Including GPs and Big Pharma) under public ownership - economies of scale could ensure public money being frittered away as profit could be invested into services.
7 day NHS is a good thing, in many ways the CCG are already making it happen
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