Rescuing the NHS


The media would have us believe that, due to cost cutting, the NHS is in terminal decline when, in reality, it is thriving and has never had more resources.  Political spin aside, the real problems are that it is too big, too diverse, and over-managed. Suggesting that the NHS most needs the removal of political interference is hardly new.  The Bank of England has improved since Gordon Brown gave it independence.  It has not been privatised.  It remains a non-profit making public corporation acting, so far as it can, in the best interests of the country.  It would be inconceivable to make the BBC, also a public corporation, part of the Department for Culture Media and Sport.

Of course politicians should set the goals and priorities for the NHS and allocate the resources but continual interference in the way it is managed has demoralised staff and created patient dissatisfaction.  What qualifications do MPs have which can usefully applied to the NHS before other equally unqualified politicians reverse any changes as soon as they can?  The UK’s biggest organisation, by numbers employed, blows in the wind.

The NHS should have a long-term, not less than five years, charter setting out what it is aiming to achieve and the funds government will allocate.  Parliament should agree the mission but not how it should be achieved.  And NHS top management should certainly be held to account at the end of each charter.

The debates about “privatisation” exemplify why politicians should leave the NHS stage.  Left-leaning MPs claim that allowing anyone to make a profit, however small, in the supply chain raises the cost for the taxpayer.  This school of economics was once popular in Leningrad.  Now Russia, like everywhere else, recognises that even a public corporation cannot itself make everything it uses.  The Norfolk and Norwich Hospital does not take deliveries of iron ore to make their own scalpels.  The NHS should do for itself what it does cheaper and better.  When buying in services is cheaper and better, the taxpayer gains by so doing.  Whether someone has made a profit along the way is irrelevant.

Only local managers can do these calculations: they should be free (transparently) to buy in what makes better use of their resources and to do the rest themselves.

Secondly, prevention (health promotion), cure and care are three very different problems that need three solutions, not one. The NHS should focus on curing people and returning them, as soon as their health permits, to their normal lives or to state care if they and their families cannot cope.  Using curing resources for care is not just wasteful but ineffective, and even inhumane, as recent complaints about nursing and mental health institutions testify.

Moves are now afoot to bring care and the NHS closer together which is good in the sense of combining the two caring functions but bad in the sense that the managerially challenged NHS will not be able to cope with both roles. We should stop trying to cure the uncurable: the senile, and those suffering from dementia and many forms of mental health.

The National Care Service should be an independent organisation developing its own pride and professional standards.  The Hospice movement is a shining example.  It is noteworthy that general practice aside, the great curing institutions tend to shrink in number but grow individually as more specialities have to be accommodated whereas in care, the tendency is to move from large institutions to a multiplicity of small units closer to their communities.  Different problems need different solutions.

Finally, preventive health is in practice national publicity intended to reduce the net national cost by persuading us to adopt healthier life-styles.  Their effectiveness can be measured, and funded, by the reduction in the costs of cure and/or the benefit to the economy from our working productively for longer.  This role could be managed directly from the Department of Health or a separate quango but in either case, the performance measurement of the campaigns should be transparent.

Dear Politicians.  Please stop bickering over the NHS: separate its three functions and then leave it to the professionals.