The Socialist Health Association is immensely proud of what the NHS has achieved in its first sixty years – a comparatively young organisation, it is still growing and developing. The NHS has world-class services and has literally exported thousands of innovations around the world. Its growth has been supported by a social agreement that individuals collaborate to their mutual benefit when pooling their resources to provide a comprehensive health system for the whole of society – this is the core belief of the Socialist Health Association.

It is typical of the political nature of the NHS that on its birthday most discussion relates to its past. Discussion of its future tends to raise questions about its long-term viability. Yet as the Economist has noted (5 July 2008) amid all the discussion of whether the NHS is sustainable it is a system other countries are moving to – France, the system ranked as best in the last World Health Organisation rankings, for example, and even the USA, where some States are looking to pooling resources. If the NHS did not exist, we would have to invent it. Yes, the NHS faces financial challenges, but so do systems all over the world. The NHS has constantly evolved through its lifetime. To be effective, it has to adapt to changing conditions. The current review of co-payments for cancer drugs is an example of this. What is important is that the NHS is for the whole of Society.

The first sixty years has taught us many important lessons, especially the difficulty of managing precious resources – a broad term for a myriad of complex issues. We know more about the multifaceted causes of ill-health and are learning, slowly, that efforts to prevent ill health, rather than purely treat illness and disease, not only save money further down the line, because of expensive hospital admissions, they much more importantly improve an individual’s quality of life. Successive governments have talked about a primary care led health system and we are again taking tentative, but still uncertain, steps towards GPs working together to provide a wider range of services across communities.

The recent Next Steps Review, the report by health minister, Lord Darzi has been described by Alan Johnson as the most important development since the NHS was established. To live up to this billing – and be more than just fine words – the NHS has to do steadfastly focus on four things (i) support the emphasis on localism by supporting local innovation, not disseminating detailed models. Clinicians can and will innovate and collaborate in a variety of fashions if supported to do so; (ii) incentivise integrated care, bringing together professionals to forge pathways of care; (iii) replace central steering with local accountability, focusing the NHS on the community it serves rather than the Department of Health; (iv) the Department of Health and Ministers should focus on national level strategy, particularly on the reduction of inequalities between social groups and geographical areas – it should decide funding for services.

The major barrier to reform in the NHS is the often poor relationship between NHS management and staff. A recent survey revealed that the vast majority of staff do not think that quality is important to their managers. While clinicians are often presented as barriers to reform, they are in fact the means by which it will be achieved. The promise within the Darzi review to create opportunities for clinicians to innovate and develop services must be kept.

The one step that revolutionise the culture of the NHS, would be to face NHS managers towards patients and the community. At present they are too often distracted by having to look up to the demands of the centre that they are unable to effectively reach out to their communities and patients, or within their organisation, to support clinical teams to develop services. The health service should be run for the benefit of society and of patients and not driven by either central targets or professional interests. The big gap in the government’s reform plans is a lack of clarity on how services can be held to account and influenced locally. While supporting local innovation, the Department of Health would best support new approaches to ensuring local accountability.

Patients want to see integrated services. There is no reason this should necessarily mean all services are managed by a single board – this has not achieved integration in the past. But as recent work from Chris Ham has shown, integrated services achieve better quality and value for money, such as the Kaiser Permanente system in California. The NHS has never fulfilled its potential to deliver integrated care, around common pathways. At present, GPs and hospital consultants have no opportunities to meet, making it difficult to bridge the gap between care sectors. To improve the quality of care, incentives should exist for collaboration between professionals. Chris Ham’s view is that integration will be achieved by strengthening relationships between clinicians rather than changing structures, such as merging organisations. Bottom-up approaches are needed to reform the NHS.

The Department of Health should ensure arrangements are in place to hold the local NHS to account. Current policy tends to emphasise information and choice as the way accountability can be achieved, and this will help support greater patient knowledge. Yet it is important to allow patients not only to respond to provision but also to influence commissioning and services that are planned. Groups of GP commissioners should be thinking though ways of involving patients in their decision-making processes.

Local professionals are better placed to construct new care pathways and relationships with patients than are central government. Central government should stop designing models of how services should be delivered. It should instead have an unstinting focus on public health and on health inequalities in particular. This includes ensuring the NHS promotes as well as treats health. Despite the success of the NHS, the famous district line journey that demonstrates rapid falls in life expectancy as you journey east is a reminder that we cannot be complacent. Just as we can now be proud of the rising life-expectancy in recent decades, let us in the future celebrate plummeting levels of the inequalities that exist in our society as a result of poor health.

Tom Smith

What do you think?

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Subscribe to Blog via Email

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

Join 481 other subscribers

Follow us on Twitter

%d bloggers like this: