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