The Future Of The NHS

Yes the NHS has problems, but they are solvable by good management. Despite the extra resources, there has been money wasted, excessive micro-management and sledgehammers to crack nuts. This has led some doctors and nurses, and a large section of the press, to not appreciate what we do have.

I firmly believe that the previous patient is alive today because of the health service we have in the UK. In the USA, he wouldn’t have been able to afford the costs of this expensive state of the art treatment. The ambulance service, GPs, A&E , cardiologists and intensive care team all worked thinking about how best to care for the patient without thinking about how we could make a profit out of our patient. He got excellent care, but also efficient care because there was no incentive to do unnecessary test to create extra profits. Health care isn’t appropriate for it to be run like a business, where cutting costs and removing competition leads to more profits. Working together, improving quality and co-operating with local hospitals and GPS is the best way to run health services and we are lucky that we in the UK, have the NHS which in essence does this.

Recently there has been an appreciation that the government needs to let clinicians take the lead on how to improve care. For instance in A&E, the government worked with A&E doctors and nurses about implementing new standards of quality of care and not just a time standard- the old 4 hour rule. The debacle of modernising medical careers, where good doctors were left without jobs, has largely been resolved as has reforms about improving accountability of doctors and learning from mistakes.

The ethos of the NHS - co-operation, not competition, and putting patients before profits - has served us well, despite years of underfunding which has only partially been rectified in the last decade. The new reforms to the NHS in England, are essentially following Blair’s reforms but at breakneck speed (the NHS in Wales and Scotland are not following these reforms), and I believe very risky.

Although I agree that GPs should be central to commissioning health care for their patients, it is the future of hospitals that concerns me. GPs will be able to buy services from any provider, and hospitals will start competing against each other, and against any other provider (including for profit private companies) and they may become financially destabilised and have to close needed services. The ethos of co-operation will be eroded and the NHS could just become a kite mark for an umbrella of organisations who are providing healthcare independently often with the aim to make as much money as possible, rather than working together for the health of the local area.

It doesn’t really matter if your local hospital stopped doing elective hip operations as the private treatment sector undercut them, but what happens at 2am when your Nan has broken her leg and there is no orthopaedic doctor available in an emergency as they no longer work for the NHS? Or worse still they are available but so inexperienced at what should be the bread and butter of their job, that poor care is given in the end?

I don’t honestly believe that the government wants to dismantle the NHS. I do, however, have concerns that a blind acceptance of market forces in health care could lead to the unintended consequence of a dismantling of the ethos and structures of the NHS. It is these that have served us well, from cradle to grave, regardless of ability to pay. Please let it not be dismantled.





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