If something can’t go on for ever then eventually it will stop – so says Stein’s Law – attributed to the eponymous American economist.

Senior Health service managers are now openly admitting that the NHS cannot continue in its current state. Writing in the Observer recently, Chris Hopson, Chief Executive of NHS Providers commented: ‘It is surely now time for our national health and political leaders to publicly acknowledge that the NHS can no longer deliver what is being asked of it for the funding available. The evidence that there is now an unbridgeable gap between what the NHS is required to deliver and the money to pay for it is both widespread and compelling.’

The much vaunted plan to save £22 billion through ‘efficiency savings’ has been described as ‘virtually impossible’ by former Health Minister Norman Lamb and as being ‘substantially off target’ by the Health Foundation.

Despite the sombre inevitability of Stein’s Law, the NHS shows no sign of going down quietly. As former chancellor Nigel Lawson observed, the NHS is the closest thing the UK has to a national religion. Any politician brave or foolish enough even to suggest that the funding model for the NHS requires amendment or adjustment is instantly attacked by a variety of NHS zealots in a manner verging on the hysterical. Taking on the National idol is a recipe for political suicide, so Mr Hopson’s call for an ‘open, honest, realistic, national debate’ about the future shape of NHS services seems unlikely to be realised.
After 30 years working at the coal face in the NHS I have come to ignore what politicians and managers say and instead watch what they do. Few informed people dispute that the way the NHS does business needs to fundamentally change – the tricky part relates to who can make that case to the public and, more importantly, who is going to be responsible for forcing the change through in the face of personal and political abuse verging on the criminal – just take a look at the behaviour of junior doctors towards the current Health secretary for an example.

Redrawing the boundaries of what the NHS provides is one way by which the NHS reduces the volume of work it has to do. In my own specialty, the boundaries for varicose vein surgery have been changed substantially – it is no longer sufficient for patients to have aching and discomfort from varicose veins to get effective treatment. Instead the definitions have been changed, so that only the most severe cases with established skin damage leading to an ulcer can be put on the operating list. Elective surgery like varicose veins is an easy target for this type of manipulation – by redrawing the boundaries, health service managers simultaneously reduce the number of patients on waiting lists (thereby facilitating attainment of targets) and reduce the number of procedures carried out – thereby reducing cost to the commissioning groups. Similar schemes are in place across most of the country for a variety of other complaints such as hernias, cataract surgery and joint replacements. Initiatives to deny treatment to patients on the grounds of smoking habits or obesity have recently been reported.

Restriction of access to treatment on grounds of ‘insufficient severity’ preserves the ideological purity of the NHS ‘free at the point of use’ by sweeping the problem under the carpet. Unfortunately, pretending that the need has disappeared by a semantic redefinition does not make the problem disappear for the patient who cannot afford to pay for private treatment. This is not an open and honest way of dealing with real world clinical problems.

A serious examination of low cost social insurance systems or co-payment plans similar to those that exist in most developed Western economies is long overdue. Dogmatic adherence to a monopolistic model of centrally funded universal healthcare paid for exclusively via general taxation will not meet the health requirements of our population in the coming years and redefining the definition of severity of varicose veins isn’t going to solve the problem either.

Eddie Chaloner is a consultant vascular surgeon who operates at Lewisham and Greenwich NHS Trust and through his private practice Radiance Vein Clinic. Chaloner pioneered endovenous laser surgery treatment for varicose veins in the UK, which has revolutionised the treatment of this common condition worldwide.

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9 Comments

  1. John Wattis says:

    How about just funding the NHS at the European average? The redefining has been going on for years but is likely to get a whole lot worse but if we simply funded at the European average and got rid of all the extra costs of the CCG and the market and privatisation we might just find we have enough to pay for a world-beating NHS again! There are some politicians willing to do this though there are others who would be only too glad to see the NHS die.

    1. F.M says:

      Totally agree John.

  2. jcashbyblog says:

    This is simply a wrong argument with a simplistic solution by a doctor who does not understand how organisations really work. There are some assumptions about the way the companies work that are simply not applied in the best ones. The best do not have targets, nor constant re-organisations, nor an outside agent like J Hunt who can dictate both policies and funding, and can demoralise an entire workforce just because he is an incompetent control freak.
    First of all, the NHS is the third largest national company in the world, after the US and Chinese military, larger than Walmart USA and Indian Railways.
    All the above are run by people who admire, respect and feel a huge responsibility towards their charges (selfishly and otherwise). This is not the case with Hunt. The NHS is his plaything. He is doing to it what General Percival did to Singapore, i.e. handing it over to an occupying power – the private sector.
    Your comments about the Junior Doctors are scurrilous: “personal and political abuse verging on the criminal”. Now that actually describes Hunt’s behaviour perfectly.
    “Dogmatic adherence to a monopolistic model”. This is a totally absurd comment. One of the key attributes of a model is that can charge any prices it wants to as well as making independent decisions about price and output, based on its product, its market, and its costs of production (attr. Joan Robinson). The NHS does not charge at the point of delivery or at any other point and it cannot make independent decisions on its markets or all its production costs.
    Finally, the NHS could find the £22 billion savings in a year – if it stopped PFI and outsourcing, got rid of all its regulators and drove out the waste that accumulates from trying to meet the ridiculous government targets so it could concentrate on continuous improvement in providing value to its patients.
    I recommend you read Professor John Seddon and Don Berwick’s works on the NHS and other public services before taking to print on the NHS again.

    1. rotzeichen says:

      I concur entirely with your comment.

      I can only believe this doctor agrees with the privatisation model and doesn’t understand that money for the NHS is not the problem. It is Neo-Liberal politicians deliberately starving the NHS of the money it needs to function properly.

      Noam Chomsky: “That’s the standard technique of privatization: defund, make sure things don’t work, people get angry, you hand it over to private capital.”

      Need we say more.

  3. John says:

    I think May, Hunt & Co. are all perfectly happy at the increasingly shambolic state of the NHS. It should mean that slightly better-off people will turn to privatised healthcare services, in which a significant number of Tory MPs hold private investments of their own.
    The Tories want to see the NHS fully privatised – even more than in the USA.

  4. Petition
    Properly fund the NHS and scrap the proposed STP programme.

    The UK spends less on health as a share of its GDP than most other G7 countries. Our NHS is under pressure as never before and is in danger of failure. The NHS is effectively only getting an increase of 0.95% per year. The STP programme will close A&E’s and essential services across the country.

    Spending on health compared to other countries:
    http://www.kingsfund.org.uk/projects/nhs-in-a-nutshell/health-care-spending-compared

    Effective increase of 0.95% per year for the NHS:
    http://www.kingsfund.org.uk/projects/nhs-in-a-nutshell/nhs-budget

    Draft sustainability and transformation plans (STPs) which propose ward closures, cuts in bed numbers and changes to A&E and GP care in 44 areas:
    http://www.bbc.co.uk/news/health-37186455

    1. jcashbyblog says:

      I will sign up if you include the next step of supporting the Reinstatement Bill. Are you with any group, i.e. KONP, We Own It, SONHS etc?

    2. John says:

      Where is the hyper-link to the petition by David Donohue?

    3. John says:

      I have found the hyperlink: https://petition.parliament.uk/petitions/165948.
      Please – everyone! – sign it.

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