|Publisher:||Elliott & Thompson|
|Product dimensions:||4.40(w) x 7.10(h) x 0.60(d)|
Read an Excerpt
The NHS: Things that Need to be Said
By Iain Dale
Elliott and Thompson LimitedCopyright © 2015 Iain Dale
All rights reserved.
Politics and the NHS
Politicians treat the NHS as a political football, insisting on initiative after initiative, to prove that there really is ACTION THIS DAY, and yet consistently fail to plan for the long term. They seem to think that structural reform and targets will yield results – and sometimes, in the short term, they do, but who can really say that they can think of a single health secretary who has been able to plan for the long term – of either party? During the thirteen years of the last Labour government there were six different health secretaries.
The Conservatives under Margaret Thatcher and John Major did a little better and managed only seven in eighteen years. The coalition government has had two different health secretaries. So a health secretary serves for an average of a little over two years. Of the fifteen holders of this post since 1979, very few had any direct experience of health policy before they took on the job. So they spend six months reading themselves into the job and the last six months trying to save themselves from being sacked. This gives them each just a year to make an impact. A few years ago, the Adam Smith Institute published a report which opened that:
Secretaries of state and their junior ministers come and go with sometimes breath-taking frequency. But the one thing they all have in common is the desire to make headline-grabbing changes to advance their careers. As a result the NHS is besieged by a bewildering array of initiatives from one minister, only for him or her to be replaced by another minister with their own (often conflicting) ideas. Politicians tend to think that they can improve the health service by simply giving orders, or setting targets. But such measures always have perverse effects, distorting clinical priorities and encouraging creative accounting. NHS policy should be determined by medical priorities and not by political ones.
Bearing in mind that the NHS is one of the world's largest organisations, this way of running it is utter madness. If IBM or Glaxo changed their chief executive every two years, their share prices would plummet and within a short time the company would be considered a basket case.
And so we constantly hear pleas to take the politics out of the NHS. Liam Fox, when he was Shadow Health Secretary, said it. Various Labour ministers have said it. Andrew Lansley said it. Jeremy Hunt actually believes it. But surely none of them can be so naive. Well, it seems the general public agree with them. A poll for the British Medical Association conducted by Ipsos MORI found two-thirds of the general public wanted the NHS to manage itself without the involvement of politicians. Another 46 per cent also said politicians should have low or no involvement in how the NHS is run. They are all wrong. We have to have democratic accountability in the NHS.
After all, the fact that the Health Service eats up £115 billion – a sixth (!) of public expenditure – means that the way that money is spent has to be made accountable, and that has to be through the political system. The trouble is that half of this sum has, according to the Wanless Report, gone on price inflation and extra pay – 25 per cent to consultants and 23 per cent to GPs.
Was that the right thing to do? Voters will be judge and jury on that point. It had to be a political decision, not one made by a faceless independent board. So any politician who calls for politics to be taken out of the NHS is likely to be doing it to get a cheap round of applause on Question Time and can safely be ignored. It isn't going to happen, and nor should it.
That's my view but, interestingly, the think-tank the Adam Smith Institute (ASI) begs to differ. Its briefing paper documents the bewildering and counterproductive range of political initiatives and interference which, it says, has wreaked havoc on our nation's healthcare system.
The paper's proposal is for a distinguished panel of health professionals to be appointed to run the NHS, to allocate its budget, determine its priorities, and operate it according to medical needs rather than political aims. A YouGov poll taken on the subject showed massive popular support for precisely such a proposal, with 69 per cent in favour and only 12 per cent against.
The NHS budget would be set by Parliament every five years, and increased each year in line with inflation. The ASI's YouGov poll showed that this idea, too, enjoys widespread popular support, with 74 per cent in favour. The suggestion that 'the NHS has become a political football' receives 72 per cent backing.
Whatever the merits of the ASI's proposals or those of the Conservatives, an independent NHS certainly isn't going to happen when we have such consummate political brains in Number 10. Think back to the Gordon Brown government.
I'm told that the Deep Clean initiative wasn't thought up in the Department of Health. It came direct from the Number 10 Policy Unit, who gave the Department of Health a few hours in which to consider how to make it work. It was duly announced by the prime minister, who made it sound as if this would be the only measure needed to eradicate MRSA and C. difficile from our hospitals. Indeed, when I heard about it, I too thought it sounded a deeply sensible measure.
That is until I switched on a radio phone-in and heard a succession of health service professionals slam it. Not a single one of them thought it would work. Not a single one of them was taken in by it. It was at that point I started to wonder if this gargantuan political brain was actually as formidable as we'd all been led to believe and that his administration wasn't just as driven by spin as the previous one.
Just as a transport secretary is judged on whether their tenure of office is free of a major rail crash or transport disaster, a health secretary is now judged on whether he or she can keep NHS stories off the front pages. That's why Andrew Lansley had to go, and was replaced by a politician with a far better bedside manner.
So that's my first thing which needs to be said: you can't take politics out of the NHS, and nor should you. In fact, as I shall explain later, I think we ought to be having a big debate about the NHS, but we are being denied that debate because whenever any politician on the right or left, but mainly the right, has the temerity to criticise the NHS, he or she is jumped on and warned about the consequences of having a go at a beloved institution.
If you point out that outcomes in the NHS are in most areas way below other comparable nations, you are accused of denigrating people who work so hard in the NHS or advocating privatisation even when you're not. If the NHS can't stand up to robust critique, it says an awful lot about the arguments of its very vocal defenders.CHAPTER 2
Private sector v. public sector
The private sector versus public sector debate has bedevilled health policy for some time. It lies at the very core of the failure of politicians to provide the leadership the NHS needs.
The public good, private bad mindset which is held by many politicians on the left is equally matched by the private good, public bad attitudes often prevalent on the right. Only in this country could this happen. Even in these days of supposed consensus, these attitudes still prevail.
Do any of these politicians think people care if they are treated privately or in an NHS hospital, if they get the treatment they want, where they want, when they want it? Of course not. Yet people who use BUPA or other private health providers are made to feel as if they are somehow being elitist, rather than being praised for taking responsibility for their own healthcare and not burdening the NHS with their demands. A ComRes poll in July 2014 showed that two in three people (67 per cent) say that they do not mind if health services are provided by a private company or the NHS as long as they remain free of charge.
Beveridge and Bevan never meant for the NHS to have to meet every single demand ever made of it. Two systems can work happily together as long as each respects the other. For too long in this country Labour politicians have seen private medicine as a class enemy and Tory politicians have viewed the NHS as something for other people to use, not them.
David Cameron makes great play out of the fact that he is a regular user of the NHS. He had a disabled son whose fits made regular overnight stays in a local hospital a normal occurrence for him. His view was shaped by his experience. He put the NHS at the top of his agenda. He says his three priorities can be summed up in three letters: N. H. S.
One of Cameron's first acts was to abolish the Tory policy of encouraging private sector health-care. George Osborne said in opposition: 'We are having no truck with ideas for some alternative funding mechanism like social insurance. Nor are we looking to help fund escape routes from public services for the few who can afford it, which is why we have moved away from the idea of the patients' passport.'
All very well, but where are we going to get the extra capacity the NHS needs, if the private sector is not embraced in a way it hasn't been before? Ministers in the last Labour government would freely admit they would not have been able to reduce waiting lists without utilising private sector capacity.
Let's not pretend that private sector involvement in the provision of healthcare is anything new. Most people use private sector dentists. GPs are effectively in the private sector, as are most osteopaths and physiotherapists. A lot of primary care is provided by the private sector – the out of hours service and 111 to name but two examples.
Drugs are provided by private sector suppliers. Chemists and dispensaries have never been in the public sector and no one has ever suggested they should be. It was recently reported with some horror in the Guardian that 70 per cent of NHS contracts are with the private sector. They put this down to the Lansley reforms, omitting to say that the private sector has always played a major role in health provision.
Opponents of the private sector also raise the spectre of the NHS introducing charges, conveniently forgetting that patients already pay prescription charges. From time to time, the issues of charging for hospital food or GP visits are floated, but quickly ditched until the howl of public outrage subsides.
However, on radio phone-ins such as my own, the idea of charging for NHS services is quite popular in some areas. For example, people ask why the taxpayer should pay for the treatment of people who bring their own misfortune on themselves.
People who binge drink on a Friday night often end up in A&E. Why shouldn't they be charged? People who regret getting a tattoo can apparently have it removed courtesy of the NHS. But where do you draw the line? Charge smokers for lung cancer treatment? Charge obese people for diabetes drugs? Another one for the too difficult box, I suspect.
Very few people have anything nice to say about NICE, the National Institute for Health and Care Excellence. And let me be no exception.
It was set up by the Labour government with the best of intentions. Part of its mission was to end the variation in medical treatment across the country and ensure that if a drug was found to be effective, patients should not have to fight to get it. Clearly there needs to be a body which licenses drugs, but there is a huge suspicion that too many drugs are still licensed through budgetary consideration rather than clinical need.
And, in turn, drugs which are available in some parts of the country are not in others – for much the same reason. And if a cancer patient should have the temerity to decide to use their life savings to fund their treatment using a drug which for budgetary reasons is not available via the NHS, what does the NHS do?
Instead of saying 'thank you very much for helping us out and paying for your own drugs', it refuses to continue any treatment for that patient. See? Public good, private bad. It's the politics of socialist envy and basically says that just because everyone can't have it, you can't either. So people die. Is that really what should be happening? I don't think so. It's an exemplification of the kind of dogma which has bedevilled our public-sector thinking over many decades.
This is what happened to one of my listeners who emailed me her story:
'My twenty-three-year-old son has just been turned down for a course of drugs for his acute vasculitis, which he has been waiting around five months for. It costs around £4,000 for the course. His consultant has stated that it's one of the few drugs that would really make a difference. He had to go back into hospital in the early hours of Tuesday morning, and they have probably spent half that amount, running more tests, and keeping him in under observation, when he could have been back at work, earning a living, paying taxes, and with a reasonably pain-free outcome. How short-sighted can you be?'
Well, it's a good question, isn't it? I am surprised that no one has yet taken the NHS, or NICE, to the European Court of Human Rights over issues like this. I suspect it is a matter of time. Perhaps then the postcode lottery may forcibly be brought to an end.
No other country's health system operates in such a bigoted and uncaring way. The sooner we eradicate this sort of thinking, the better. If we are to get anywhere in improving standards of healthcare and quality of outcomes, then surely it is obvious that the public and private sector healthcare systems need to operate side by side and help each other where possible.CHAPTER 3
Targets, outcomes and a seven-day-a-week NHS
People questioned whether the Conservatives would also embrace the target-driven culture which so obsessed the previous Labour government. It seemed to be the only way to increase throughput, although NHS managers continue to try to convince us that we can do with fewer and fewer beds and various management consultants still try to hypnotise us into really believing their reports that people prefer to be treated at home, no matter what their affliction.
The Conservatives professed to want to abolish the target culture, yet have so far failed to explain how this can improve capacity. Because the truth is that weakening targets has led to capacity issues in many areas of the NHS.
Labour brought in targets, at least in part, to improve outcomes. They, like many others, were mystified by the fact that despite investing ever more money, other countries did consistently better than us in terms of outcomes.
Take cancer. For years Britain has outspent many other countries in cancer research and treatment, yet our survivability record is shockingly poor. The Organisation for Economic Cooperation and Development (OECD) brands it 'unacceptable' and it is easy to see why. In 2013 the OECD reported that women with breast cancer were more likely to reach the five-year survival point in almost all countries other than Britain, with only the Czech Republic, Poland and Ireland trailing behind. Only the Czech Republic, Poland and Denmark had worse rates for surviving bowel cancer than Britain while cervical cancer rates were worse in only Poland and Ireland. This ought to be a source of national embarrassment, but we are constantly told that we have the best health service in the world.
Part of the reason for this lamentable performance in cancer survivability is our chronic lack of funding for life-saving cancer drugs. Drugs which are freely available in most other developed countries are simply not on the NICE list. The government promised to alleviate this disastrous policy by creating the Cancer Drugs Fund, but this has been fought every step of the way by NHS managers, who for reasons best known to themselves don't want to see these drugs made available to the very people who need them most. Furthermore, they have also restricted the availability of advanced radiotherapy so that pathetically few patients ever benefit from it. Meanwhile, the very machines used for this sit unused because NHS England refuses to provide funding for various cancer treatments.
Excerpted from The NHS: Things that Need to be Said by Iain Dale. Copyright © 2015 Iain Dale. Excerpted by permission of Elliott and Thompson Limited.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
1 Politics and the NHS 1
2 Private sector v. public sector 9
3 Targets, outcomes and a seven-day-a-week NHS 17
4 What is 'national' about the National Health Service? 27
5 The coming funding gap 35
6 Care and the patient experience 45
7 The challenges of population growth and demographic change 53
8 The challenges of personal responsibility 61
9 Still the NHS Cinderella: mental health 75
10 Transparency and the right to know 81
11 Diet and the nanny state 85
50 things which could make the NHS better 95