Sky News has reported that:
Former health secretary Sajid Javid has warned that the NHS "won't survive many more years" without "fundamental reforms", urging the country to have an "honest debate" about the service.
I am quite sure Javid is opportunistically seeking to undermine the NHS, without explicitly saying he favours paid for models of care. But, I happen to agree with him. I do not think the NHS can survive in its current form and we do need an honest debate about it.
The fact is that since David Cameron promised in the 2010 general election that there would be no reform of the NHS the Tories have continually done their best to undermine it. The Lansley 2012 reforms were an absolute disaster, which even the Tories have had to admit. The subsequent reforms are , if anything, even worse.
The result is that we do not have a national organisation in England at least, healthcare is declining, and the service is failing. So of course we need a debate. But it is not the 70 year old model of healthcare that is failing, it is the trust based model of the last 30 years that is failing.
The model of trust based care has failed. It was intended to break up the NHS. It did. It failed to recognise the necessary integral nature of care and fractured it instead. And it has been a bureaucratic nightmare, imposing massive admin cost on the NHS whilst undermining consistency of service.
So, what do we need in the NHS in England? We need integrated regional health authorities responsible for all care and ancillary services in their region with paid GPs who actually work for the NHS on the frontline. There should be a focus on removing admin and paying staff appropriately. And there must be funding to make sure services can be supplied.
None of this is rocket science. It could be done. The only impediment to doing so is admitting that the government is accountable for what happens in the NHS when for thirty years this has been denied.
So yes, let's cut the crap out of the system, most of it put there by Tories, and focus instead on what is required. That's the reform that is needed.
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Spot on.
Thank you for another excellently pertinent article.
Might the “ Lansley Reforms”, and the like, be more accurately labelled as the “Lansley Changes”?
Maybe
Or the Lansley Deforms
Javid is doing the usual Neo liberal buck passing that makes the State look incompetent and a passive victim of changes in demand and demography.
A really good post.
The truth is that the the State knows about all these changes and extra demands but has chosen not to meet them because the politicians in charge happen to see things a certain way and want to turn fighting disease and care into markets from which to make profit.
Interesting read. The other problem with what Javid said is the other meaning of the word ‘trust’ – the whole basis of an ‘honest conversation’ has been destroyed by this govt and the surrounding think tanks and media entourage.
Yes – over 70 years Governments especially Tory – couldn’t resist reorganising the NHS – centralising/decentralising /regions/areas/trusts/internal markets/ internal integration etc. etc. McKinsey and co made millions ‘helping’.
It will be tricky to establish a single personal service provider/contact for service users – ‘patients’ – so that ‘having to re-tell my story’ multiple times to multiple people no longer applies.
So Richard it would be worth conceiving building the NHS from the user upwards rather than just from the top/regions down.
The impression is, that professional and quasi-professional / administrative silos have grown within the market/trust framework so that the user spends much time trying to communicate – often unsure who with.
A key problem is delayed diagnosis – after multiple tests by different specialists – done in series – over periods of up to a year. This can be fatal. In the diagnosis stage the system can seem languid, passive and slow and only springs into action after diagnosis, when it is almost too late.
This could maybe be replaced by a regional? multi-specialist diagnostic hub – with all the tests run in a day or even overnight until a diagnosis is achieved. There are small moves in this direction but to really be implemented, would require unprecedented collaboration between specialists and understanding by service users that travelling a long way and an overnight stay is better than being diagnosed too late.
It is terrifying to have Javid, Baker Sunak and co – the ‘lunatics in charge of the asylum’.
I am not sure I agree….who co-ordinates that and prevents another danger, which is over testing
This article reminds me of a speech by the late great Tony Benn that appears to be lost in the mists of time.
He relates the tale of a boat race between the NHS and a Japanese crew. Both sides tried hard to do well, but the Japanese won by a mile. The NHS was very discouraged and set up a consultancy. The consultancy came to the conclusion that the Japanese had eight people rowing and one steering, whereas the NHS had eight people steering and one rowing. The NHS appointed people to look at the problem and decided to reorganise the structure of the team so that there were three steering managers, three assistant steering managers and a director of steering services, and an incentive was offered to the rower to row harder. When the NHS lost a second race, it laid off the rower for poor performance and sold the boat. It gave the money it got from selling the boat to provide higher than average pay awards for the director of steering services.
Very apt. Probably more so now.
Good
We have to cut the management crap and retain the value it can add
Last Monday or Tuesday there was a Westminster Hall debate about aortic dissections, run by Pauline Latham, a tory MP, who had lost her son to aortic dissection 4 years ago. There were five or six MPs there. An observer was Whispering Bob Harris, who had had one himself.
Latham was asking what the government was going to do to make sure that someone in every ED knew how to recognise aortic dissections. A tory MP, himself a doctor who used to work in EDs, said there was such a test and he remembers using it when he was working in hospitals. He was getting mixed up between ADs and AAAs. There are tests for men over a certain age for AAAs, but not for ADs.
The reason Pauline Latham’s son died was because the dissection was not recognised and he was sent home.
If you look on the NHS website there is no mention of aortic dissections, even though Pauline Latham runs a charity which works to disseminate information about them to the NHS.
There are more people dying of them each year than road traffic accidents, over 2000 a year before they get to hospital.
So what chance does a divided NHS have of trying to join up good practice?
In the north, there is one hospital that deals with them, the Freeman in Newcastle. They take people from Teesside up to the Scottish border, and across to Carlisle.
Not sure what is going to happen with the new ICS and ICBs, the latest incarnation, although the north east ICS covers much of that area.
Just writing about aortic dissections because I know about that area, which is why I watched the debate. Government will think about it.
If you want to know what is happening in your area read this, and write to your ICS.
https://weownit.org.uk/end-nhs-privatisation-save-lives
The trusts were suspect right from the start. The Tories admitted that introducing trusts would be the first step on a longish road to privatisation, but denied that that was why they had introduced them. Even if that were true, the trusts were still there for another government that did indeed want to privatise the service.
Call me a leftist neanderthal, but all we really need is a competent regional bursar making investment and spending recommendations, and periodically putting them up to an elected board of clinicians for review and decisions. Billions would be saved, and even if everything went wrong there would be still be sufficient savings to put it right.
I would do the same thing for education too.
Hear hear!
Here in Wales the “internal market” has been abolished. Most health care is delivered by the (regional) Health Boards. There a few Trusts left, notably the Ambulance Trust. GPs, pharmacist and opticians still exist (of course) and offer NHS services. Some charges exist. All prescriptions are free. Hospital parking is free (for all). Things are not perfect. But the system appears better than England’s.
Agreed
I deliberately talked England
It’s almost as though Tory politicians have a different understanding of the word, ‘reform’, to the rest of us. Here’s how dictionary.com defines ‘reform’:
“noun
the improvement or amendment of what is wrong, corrupt, unsatisfactory, etc.”
No mention of privatisation, profit or shareholders in there. Or political manoeuvreing, or quid pro quo, for that matter.
Does anybody have a copy of the Tory Dictionary so we can see which other words they misunderstand?
I can only imagine what the entries for ‘honesty’ and ‘integrity’ would be!
Thanks
Totally agree. No-one is addressing this elephant in the room which is that the NHS crisis has been caused NHS privatisation by stealth since the internal market came into being in 1991. Bring it back into public hands and restore it to its former glory is the way forward.
This.
My ex used to work as a trainee nurse at at the time they privatised the laundry service at their hospital. Basically it was contracted out with the clause that they were obliged to supply x amount of laundered bed linen. If the nurses needed to use more, the hospital had to pay a surcharge for anymore than the contracted amount, and they often ran out during busy times so had to increase the amount. This meant that they had to pay through the nose for extra linen each day. How can this be be better value for money than keeping it in house?
It would be interesting to look through NHS accounts to see what difference there is in cost of services between when they were in house and privatised, I’m fairly sure the sums would be eye watering. Given that some maintenance companies are charging £10 to change a light bulb (a mate of mine was laughing about the extortionate charges said company he worked for was charging them, they sound like mighty).
It seems to me that all the Tory reforms have allowed is a layer of corporate profiteers to be slotted in to the NHS. This is why we see it haemorrhaging money and services collapsing as it is being bled dry by these parasites.
Further evidence of the government, via the BBC trying to mislead the puiblic:
https://www.bbc.co.uk/news/uk-64005274
(Hospital bosses) said patients should be safely discharged wherever possible (ahead of ambulance strikes).
Does anyone in this country believe that hospitals are not already doing their utmost to safely discharge patients wherever possible.
Since the UK seems to be adopting Australian policies these days (https://www.prospectmagazine.co.uk/world/australia-outsized-influence-british-politics) perhaps the next thing you’ll see is the government playing little Johnny Howard’s trick of subsiding the rich and moderately well off to buy private health insurance, thus boosting a frequently foreign-owned “industry”.
The rationale will be the public system can’t cope with demand and/or we just can’t afford it.
Australia still has a fairly reasonable public health system, but unless it’s urgent you may have to wait a very long time to get surgery or see a specialist if you can’t pay to go private, and many things that used to be free or very low cost you now have to pay for (oh and that’s with our new Labor neoliberal-lite government).