Ways to right the coalition wrongs of NHS reorganisation | Letters
The letter from 140 health professionals (8 April) clearly identifies the problems the NHS has experienced in recent years. Key to the future is the issue of funding. The NHS accounted for less than 4% of GDP in its early years and this has risen to more than 9% now, with a particularly steep increase under Labour from 1997. Such increases have led to concerns regarding the system’s sustainability. But this reflects a complete misunderstanding of the nature of the healthcare system.
Decades ago the American economist William Baumol defined certain sectors as being “handicraft industries” (health, education, the performing arts) that were disproportionately reliant on people rather than machinery, and as such with limited productivity gains. Elsewhere, productivity gains are more easily attained and goods become cheaper (such as the laptop I am using to write this).
Technological developments in healthcare have been immense and we should always try to do things efficiently, but as any economy develops we should expect to spend proportionately more on the healthcare system. The good thing is that this is affordable because other “goods” are getting relatively cheaper. What is required is the political will to maintain and increase healthcare funding and less emphasis on trying to produce a system built on commercial values.
Paul McCrone
Professor of health economics, King’s College London
Far from cutting down on bureaucracy the NHS now has a bewildering number of new bodies
Dr Jane Roberts
Many hundreds more doctors could have signed the letter you published. The Tory/Lib Dem coalition wasted eye-watering amounts of money on an ill-thought-out and even less well understood reorganisation that set back the NHS many years. Far from cutting down on bureaucracy, the NHS now has a bewildering number of new bodies, with not enough clarity about who does what. There is little strategic planning and systems have become fragmented. What has this to do with patients, you might ask? One example: over three days last week we tried to find a scarce bed for a mentally ill and highly distressed 17-year-old languishing for far too many hours in an A&E department. There are too few beds for such unwell young people and where once we had some sort of system to facilitate an admission locally to those beds that did exist, now there is none. It is unconscionable.
Dr Jane Roberts
Consultant child and adolescent psychiatrist, London
The letter about the state of the NHS is unsurprising as many doctors, alongside a wide range of organisations and individuals covering consumer and professional interests, had fought long and hard against the passage of the Health and Social Care Act 2012. At that time, as is normal, a “risk register” was drawn up by officials as part of the process of good governance. However, good practice does not stretch so far as openness. Jeremy Hunt, and his predecessor – the architect of the act – have both defiantly ignored a lawful instruction from the information commissioner and then a statutory information tribunal to publish that register. Perhaps they are aware that in publishing they may be damned – and that we will learn that officials had warned them of all these issues? Time to open the books.
Les Bright
Exeter
There is much disingenuousness, even hypocrisy, in the letter from the 140 NHS professionals. Almost all NHS purchases depend on private companies for supply – be it medicines, x-ray machines or computers. Most GPs are essentially private contractors to the health service. Have the correspondents considered how their very adequate salaries are paid? The answer is from taxes made by profits. One might also ask how many promises on the NHS were broken by Tony Blair and his government? Certainly I was deceived by them.
Professor Peter Davies
Liverpool heart and chest hospital
Thank you for printing the letters in support of the NHS (7 April). Many of your readers will have examples of policies that could help reduce the misuse of the services the NHS so ably provide. My contribution involves the training of the thousands of staff with clinical expertise. Why is it that billions is spent on training staff to work in the NHS only for the private sector to then employ such staff with no contribution to their training? Surely there should be a contribution to this training; a tax contribution? Costed properly this could bring in funding that could be earmarked specifically for the training of the additional staff the political parties promise us.
Anne Keat
Corsham, Wiltshire
As a registered nurse of several decades’ standing, I ask for a simple act of honesty from any new government. Bus companies providing patient transport services; treatment centres that work for profit; social enterprise partnerships; community interest cooperatives and the rest should not be allowed to plaster the NHS logo all over their literature, buildings and vehicles. Our car does not have a particular supermarket logo on it just because it is our preferred provider. If a patient has a problem with one of these bodies and brings it to me, I feel unprofessional when explaining they are nothing to do with us, and I have to give them the relevant complaints number or email address. Their anger, directed at me on the frontline, is understandable.
Brian Booth
Rochester, Kent
Martha Lane Fox is right (Tech giants have too much power. Let’s reclaim the internet, 31 March). We need a new kind of digital organisation – doteveryone – which would fight for civic public projects to balance the power of the commercial internet. An area where this could pay immediate dividends is in health. The London health commission, which I chaired, recommended just such an organisation in its report last October to support digital health innovations that have the potential to revolutionise healthcare. New York has such an organisation – the New York ehealth Collaborative – which works closely with 23 hospitals across the state to create cutting-edge products to improve care, increase patient involvement and provide access to personal health information.
Is it possible the BBC is adopting a less-than-balanced approach to news reporting in the runup to May’s election?
Cathy Wood
The amount of health data now available is opening up new possibilities to shift care from “diagnose and treat” to “predict and prevent”. Better data will mean more personalised medicine as well as better ways of understanding the effectiveness of treatments. But in London too many digital entrepreneurs find it too hard to access capital, obtain clinical input and get products adopted by the NHS. So they end up launching overseas. What would be good for patients would be good for London. London could lead the world in this field with its strong creative and tech industries. Just as the National Institute for Care and Health Excellence was the global pioneer for assessing new drugs and treatments in the last decade, London should become the pioneer for digital health technology assessments in the decade ahead.
Ara Darzi
Director, Institute of Global Health Innovation, Imperial College London
On 1 April the Telegraph published a letter signed by 103 business men and women, many of whom are Tory supporters and donors, stating that “Labour would threaten jobs and deter investment” (Report, 1 April, guardian.com). This letter was widely reported and analysed on BBC radio and TV. On 8 April the Guardian published a letter signed by more than 100 doctors. I have heard no mention of the letter on either BBC radio or TV news bulletins. Is it possible that the BBC is adopting a less-than-balanced editorial approach to news reporting in the runup to May’s general election? I find this deeply worrying.
Cathy Wood
Chiselborough, Somerset
The letter from NHS doctors surely fails the NHS in exactly the way that all political parties are failing it. The cost of healthcare is rising and will continue to rise as our population ages. Politicians may or may not be able to find a few billions to get us through the next few years but further ahead there is a stark choice. Either there must be a really large increase in taxation for healthcare or the system must be altered. The coalition has gone for the second and its failure to get many things (anything?) right does not alter the underlying argument.
I would suggest three topics that should be brought into public debate. First, payment for some services. Payments could be low and might cost more to collect than the yield but it would help limit demand (the poorest should not pay). Second, a huge amount of money is spent on screening. This may save some lives but the main effect is to turn well people into patients while consuming medical resources. Finally, an enormous proportion of the budget is spent in the last few weeks of life. Surely we need to be a bit tougher about heroic measures for the dying. This would put a great burden on doctors but it is not clear that they have the balance right now.
I am only suggesting an informed debate on these difficult subjects. Burying our heads in the sand will only work for so long.
Oliver Gillie
London
Many years ago I took round our general practice a visiting party of American family physicians. Discussing the large proportion of our work that was dealing with minor illness, they nodded their heads and said that although they all charged their patients for every consultation they found that a large proportion of their work was dealing with minor illness. Charges at the door would do nothing to keep down attendance rates and everything to destroy what surely even politicians can see is the finest of Bevan’s founding principles.
Simon Barley (retired GP)
Hope Valley, Derbyshire
It is clear there must be a stop to the return of a Conservative-led government, but how is this to be achieved? You can find out what your candidates think about the draft NHS reinstatement bill by visiting nhsbill2015.org and following the links. This bill does not give a blueprint for the future but rather erases the mistakes of the past while minimising further reorganisation of the NHS. The Greens and the National Health Action party support it. If only we had a transferrable vote we could all express our feelings about it at the ballot box.
Jeanne Warren
Garsington, Oxford
Five years ago, I believed the Conservatives’ pledges on the NHS. It is not a mistake I will repeat
Brian Waterland
Why is no one demanding of the Tories publication of the report on the NHS presented to government in December 2014 (Report, 7 March)? It is said to be very critical of Andrew Lansley’s reforms and would be a major election issue. If the government will not release it why is there not a huge demand for transparency? The Tories are hiding this until after the election. What right have they to do this?
Brian Burnett
Northampton
Jeremy Hunt says he will “spend on the NHS whatever it needs”. As Polly Toynbee and David Walker’s book Cameron’s Coup reminds us, David Cameron stated just prior to the last election that “the last thing the health service needs is a major reorganisation”. Post-election, when we were in just such a reorganisation, Michael Portillo said, “They [the Conservatives] did not believe they could win if they told you what they were going to do.” Jeremy Hunt works hard to exude a well-meaning and concerned persona but this is the man who co-wrote a book that said: “Our ambition [is] in effect denationalising healthcare in Britain” and the NHS was “a 60-year old mistake”… “A fundamentally broken machine”.
Five years ago, I believed the Conservatives’ pledges on the NHS. It is not a mistake I will repeat.
Brian Waterland
Lincolnshire
Zara Aziz (It’s a painful list of ailments we can’t treat, Society, 8 April) is misleading on restrictions for exceptional funding, now called individual funding requests. IFRs are considered on a case-by-case basis by a multidisciplinary panel. In south-east London IFR decisions are based on well-developed ethical-legal principles and the process conforms to governance rules. For instance, a patient’s varicose veins exhibiting pain or bleeding above certain severities will be treated. A ganglion cyst will most likely be treated if pain severity criteria are met, but recurrence rate can be high.
David Lawrence
IFR consultant, SE London NHS
Some 60 years ago I came to London as a qualified radiographer. I wanted to work as a locum (NHS could save £2.5bn a year on agency staff, 2 April). I was horrified to learn that agencies would charge both me and the NHS for their services. I could not understand why each hospital did not have its own employment office. I still cannot understand this. I decided to contact each hospital myself and this resulted in all the work I wanted. At the same time I saved myself and the NHS some money.
Joyce Morgan
London