The NHS is a victim of its success: people are older because they live longer.  You are old at 85 now, not 65.  The NHS provides much better care now than it did in the 1970s, when age restrictions on admission to heart units, and regimented care of the old in hospital, were the norm.  Tiny premature babies, and children with dreadful illnesses, now survive to adulthood and have their own families.  Health care workers are enthusiastic, skilled, and bright, eager to do their best for the patient, and are generally providing brilliant care across the UK, in hospitals, clinics, homes and surgeries.  How can we help them to continue their mission? Which party should they vote for?

Maybe it doesn’t matter.  All political parties, and most doctors, agree that the NHS should be a national, free service, funded mainly by taxation.  All agree it should be well-managed, well-staffed, joined-up, and provide excellent, safe and friendly treatment.  All see the difficulty of continuing to provide such a service in the light of new treatments, and the increasing frailty of the population.   The indications from the Tories and Labour are that they will concentrate on providing flexible home-based care, with more links between ‘care’ and ‘health’.  They plan uplifts to the health budget of a couple of percent, and some refinement of the organisation and management.  The detail differences are not worth going into.

I propose a few alterations.

  1. Make GPs salaried. They are currently independent practitioners, with financial incentives to provide better care.  How about relying on their professional vocation, and take all the ‘business’ out of general practice.
  2. Hospital doctors and GPs should be employed by the same organisation. They should not be forced into loyalty to a building (eg a hospital) but work to a population.  Then the decision-makers are thinking of their patient, not their empire.
  3. For some long term conditions, like diabetes, there is a case for the GP being part of the hospital diabetes team, as the patient has access to more experience and expertise.
  4. Centralise more hospital services. We want safe effective care, and it can only be provided 24 hours a day, if services like acute surgery are in a central location.  The minor inconvenience of travelling is greatly outweighed by the benefit in morbidity and survival.
  5. Expect patients to be more responsible. There is an expectation that the patient will help in their own care.  The NHS Act of 1948 states ‘It is the duty of the doctor AND PATIENT to maintain quality of life’.
  6. Get greater diversity into our doctors. Most are the product of private or grammar schools.  A half of all our schools have admitted no-one to medical school in the last 3 years.  I suggest introducing a 2-year Bachelor of Medical Science degree, followed by 3-6 years of ward and community work as a ‘medical orderly’, learning on the job and being paid (a living wage) for their work.  Training and examination can be built in, with a final exam leading to qualification.  Student debt would not put off the bright entrant from a less privileged background, doctors would be much better at understanding the importance of nursing, and those that found they didn’t like the work could leave with a degree.
  7. Start being nice to hospital managers. These are people with just as much desire for good outcomes for the patients they are responsible for.  They use a different language, and are pushed into focussing on the money by external forces like government, rather than their own wishes.
  8. Doctors with a private practice should expect a part-time NHS practice. Rather like MPs, it should be difficult to see how a full-time NHS doctor has the time for a significant amount of private work.  If their working hours are too long, then their performance will be affected.
  9. Get the political parties to see what they agree on, for health services, before discussing what they disagree on, and before denigrating the opposition’s health plans. I believe there is as much wish in political circles, for good health outcomes, and they might just find that national agreements are possible.
  10. Get all major parties sign up in law to a 10-year financial and manpower plan for the NHS, so that we can plan ahead. It is more important to know what is going to happen, than what happens, in the NHS.

These proposals might work, they might not.  None of them would cost much.  Why don’t we pilot one or all of them?  Call it a Ten Year Plan for the NHS.

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