Is the NHS safe in politicians hands - GP magazine

IS THE NHS SAFE IN POLITICIAN’S HANDS?
BY DR PAUL CHARLSON

A taxation funded NHS is always going to be a political issue.
Taxpayers expect the Government to spend their money wisely. It is not surprising that politicians feel the need to prove that this is happening. Has the culture of British politics changed? Has the rise of political spin created a problem that did not previously exist? I would argue that it has.

The Government learned through focus groups that waiting times were a big public concern. Rightly it chose to tackle this issue.
Parliamentary announcements were made that by a certain date waiting lists would fall to a certain length. The Department of Health was directed to make this happen. The Chief Executives of the Strategic Health Authorities were given an ultimatum to make sure waiting time targets were met. If they did not there would be “consequences” . With such pressure to succeed each Strategic Health Authority CEO spoke to each PCT CEO. They were given an ultimatum make sure waiting time targets were met or there would be “consequences” . PCTs had to succeed in reaching the waiting time targets. Managers were recruited and many meetings took place. It soon became clear that the task would not be easy. Doctors were recruited to work at disproportionately higher costs to clear waiting lists. Patients were shipped to distant hospitals to have operations at higher cost. Centres were set up quickly despite disquiet from local clinicians about standards to clear the backlog. Money was diverted from other medical fields to those, which had targets. Toenails were removed rather than major operations because they were quicker to do and reduced waiting lists more effectively. In some places managers drove round to patients houses to hand deliver letters of appointment in order to get the patients in before the March 31st deadline. Despite all efforts some targets were too ambitious. Managers rather than face the wrath of more senior managers resorted to a variety of tactics, which were later revealed in the national press as effectively “fiddling” the figures.

The result of this was that too many PCTs could tick the box “Target achieved”. This pleased the SHAs who could then tick their boxes , which in turn pleased the Department of Health because they could tell Ministers that the targets had been achieved. They could announce in Parliament to a grateful public that waiting lists had fallen and the money had been well spent. Of course Doctors and their patients saw evidence that things were not as they appeared.. George Orwell could not have come up with anything better.

Of course some patients have benefited but has this been the most effective way of managing scarce NHS resources?. Some years later despite record resources being poured into the NHS Primary Care and Hospital Trusts are heading for large deficits. We are already seeing the effects of this in the cuts to training budgets, front line staff and clinical activity. It is going to get worse. After 2008 there will be a drastic percentage term reduction in new money being given to public services including the NHS. Reform an independent think tank has calculated by 2010 there will be an £18 billion deficit in the budget.

The taxpayer, has been encouraged by political spin to believe that our Health Care system is the best in the world. Yet mortality figures for many major diseases rank us with countries such as Turkey rather than the USA and France. Despite this we seem wedded to our system and therein lays a problem. Any politician mentioning private enterprise and limitation of the NHS treatment has been shot down as some form of heathen. NICE has been overturned by public pressure applied to politicians. Yet we badly need to debate issues around the extent of a public funded NHS.

Despite the protestations of the health unions including the BMA, politicians have woken up to the idea that competition amongst providers will bring savings. The public don’t care where they get treated as long as it’s good and fairly local. Yet all main political parties cling to the idea of a public NHS as to argue against this would be political suicide.

David Cameron, the Conservative leader proposed only this week that whilst the NHS would remain public under his leadership an independent body would be set up to run the NHS. He also said that clinicians should be at the heart of decision-making. Andrew Lansley his Health Secretary even went as far as saying that he was happy that GPs earned on average £109K a year because they would earn it as the best placed senior NHS figures to run the service.

Gordon Brown has also spoken of an independent NHS body and The Prime Minister has long been a champion of private enterprise working within the public sector.

It is clear that politicians realise that they cannot go on trying to manage the NHS from Whitehall.
The hope is that with better clinical engagement, less central management and reduction in waste that the figures will add up. There is a strong possibility that sooner or later there will not be enough in the pot. The question then is whether to raise taxes even further, reduce the scope of the NHS by narrowing its provsion or seek additional funding from individuals as they use the service. This might require the introduction of medical insurance on a large scale. All of these options will be politically unpopular and only a radical shift in public opinion is likely to save a Government who introduces such measures.It will take a clever Prime Minister to shift public opinion faster than it will go naturally. It is the public who have tied the hands of politicians.


Perhaps the question should be “Is the NHS safe in the public’s hands?"