Last week I handed in my badge.  No, I was not playing a disgraced sheriff in a western.  It was my NHS badge and my term of office was up.

I carry some treasured memories away with me.  The first thing I have to say is that everyone I encountered was very dedicated and extremely professional about how they did their job.  Secondly I am convinced that the NHS needs fundamental reform and that will not be easy.

It needs more resources.  Even Theresa May thinks that. But that is not all.

We need to think about what we are actually trying to do, and the best way of achieving it.  As Professor McKeown pointed out the big advances in health were achieved through better public health – that is better food, hygiene, housing and sanitation. Hospitals, perhaps it is stating the obvious, deal with the sick and injured.  Long term conditions need care, and that has to be provided in a community setting.

Since the NHS began medical science has developed fantastically and the number of specialist consultants has increased far more than the number of GPs. The main killers in 1948 were circulatory disorders, in particular rheumatic heart disease, respiratory disease and infection. Today the picture is different and the main killers are heart disease, in particular coronary artery disease, and cancer. The incidence of these diseases can be reduced if we can tackle lack of exercise, unhealthy eating and smoking

Publicity focusses on the problems of the hospitals.  Over half of them are in financial difficulties,and need funding

But long term we need to prevent people becoming ill if we can,and to  look after those who have conditions which cannot be cured. Neither of those last two can be done in hospital.

People live now longer, which is a good thing, but it means that we have many more things wrong with us as we get older. The majority of NHS patients are elderly. Many have conditions, rather than illnesses, such as mobility problems, which cannot be cured but have to be cared for. The obvious need is for more to be spent on social care and public health, which encourages healthy living. In fact the budgets for both are being reduced. The total NHS budget is over £120 billion. Public health gets £2.5 and Adult Social Care £17 billion. Both got less this year than last year.

The people who see most patients are the Family Health Services, that is GPs, Pharmacists, Opticians and Dentists. They get 22% of the budget whereas hospitals receive 43%.

The obvious answer is we have to get our act together so fewer people end up in hospitals which are at breaking point. If more could be done outside hospital our system would run better and would be more patient friendly as more people could be treated locally and stay at home.  Durham Council and the NHS are showing how to effectively cooperate.

Unfortunately the infamous 2012 Health and Social Care Act works totally contrary to this idea.  The then Coalition Government thought the answer lay in more efficiency. They believed, with scant evidence, that many public sector employees in the NHS were living a protected life and needed to be exposed to a competition. Hospitals were to compete like supermarkets and the private sector could bid for  NHS work. This goes totally against the idea of a cooperative model where GPs,Hospitals and Local Authorities, who run public health and social care, all talk to each other to provide the best for each patient.  Private providers are reluctant to fit into such a model, and there is little evidence that privatising services improves them. The present Government admitted it did not work in their last manifesto,but are in such a mess they are unable to do anything about it.  Meanwhile the NHS was to work round the rules as best it can.

A future Labour Government needs to do two things quickly.  Repeal the 2012 Act and restore the NHS as “preferred provider” when contracts are awarded.The private sector should only be used if the NHS cannot do something. Moving to a cooperative model means building trust between different organisations. This will be difficult enough without people fearing it is a recipe for privatisation by the back door.

The NHS is a fine example of where cooperation and mutual help works. Let us keep it that way.

This was first published in the Newcastle Journal

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2 Comments

  1. Anonymous says:

    Don’t fool yourself .
    In any tightly controlled environment there is competition for scarce resources. It may manifest itself in rivalry , lobbying for special favours, willingness to act as guinea pigs for the latest ideas in return for cash, etc.
    And non -rules based competition is not necessarily nicer or more efficient than a quasi market. It is subject to cronyism, domination by in-house vested interests, and unintended consequences.

    The message of this article is not about returning to an NHS golden age its about getting the NHS signed up to agreeing to new “collaborative ” models , including working in Accountable care systems , working to contracts designed by “integrators” not subject to democratic influence.
    Caveat Emptor . And don’t trust those that say it’s all about restoring the NHS to a pre-market era. The NHS was shit in the 1980s.

  2. Mervyn Hyde says:

    Both the article and the above comment seem to overlook that the NHS is being deliberately driven on to rocks by Neo-Liberal marketisation.

    Under-funding is the means to transfer the NHS into the hands of American corporations which is the Tories ultimate objective.

    I am shocked that anyone after this length of time and working in the NHS is so blind to what has been happening since the Tories came into office 2010.

    There is no place for any private company in the NHS, privatisation takes money out of the nhs and does not fulfill the responsibilities it claims on getting the contract. Do people forget the hygiene problems started in hospitals when private cleaners won the contracts, where hospitals had to take back it all back in-house to retain control.

    It does appear to me that some people need to wake up and recognise what is really going on in the world.

    Reinstate the NHS and end all privatisation, the is no place for private profit anywhere in the NHS.

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