It is with some trepidation that I venture in my first Blog for March to take on two venerable British Institutions – Shirley Williams and the NHS.
I have massive respect for Shirley and even remember being devastated when she lost her seat as a Labour MP. But in her analysis of the changes in the NHS she falls into the trap of thinking that there are only two ways to do things – public and private and that even then the ways operate at the extremes of those methodologies.
The NHS in my view needs massive reform. Over the 13 years of the last Labour Government the amount spent on it in real terms went up by about 90%. Even allowing for the fact that pressures on it increased, particularly from the elderly, we didn’t get anything like 90% increased outcomes. In fact we have a National Illness Service with vast amounts being spent on getting people better when more lives could be saved and more life satisfaction given if we concentrated on stopping people getting ill in the first place!
Just look at 3 facts if you disagree with me:
- 23% of cancer patients are only diagnosed when they present as emergencies;
- England continues to have poorer survival rates for bowel, breast and lung cancer than Australia, Canada, Sweden and Norway; and
- Premature mortality rates from respiratory disease are worse than the EU-15 average.
The Health Bill currently before Parliament has two main elements. It is a popular belief that councillors have been bought off by returning to us the Public Health elements. It is absolutely true that we are absolutely in favour of this! We believe that we are the public health service. Everything we do promotes better physical and mental health if we do it properly. Public health colleagues are keen to ‘return’ to local government because they recognise that they relate more to us than to colleagues in the national illness service. Placing the additional expertise and resource of public health within our sphere of influence will improve our ability to consider health aspects of our work in everything that we do.
The second element is more contentious – the commissioning by GPs of health services. This has been portrayed as a massive opportunity for GPs to become rich and to commission rapacious parts of the private sector to make a fortune from illness. Apparently American Corporations are eagerly awaiting the chance to get rich on NHS money.
This is, I believe, far from the true picture. I am sure that somewhere some GPs have already got their Bentley catalogue in anticipation of untold riches coming their way but not most GPs. I have had the privilege of chairing three meeting lately about health issues. The first two of these were with representatives of the 6 GP organisations the last was with a much broader cross section of professionals from across the Health Service. There I found a tremendous desire to do things differently. GPs are tired of just meeting clinical outputs. The numbers of people seen; the number of babies screened; the number of ‘well man’ clinics attended. They want to be able to move to outcome based activity where the solution to a person’s problems may well lie outside medicine and may be dealt with by other levers.
One story gives a clear indication of this. A GP told us how she is continually giving drugs to a person with respiratory problems. Eventually that person will end up in hospital. Ignoring the drugs the hospital visit will cost a minimum of £2,500. £2,500 would buy a new damp proof course so that the women would not be ill in the first place. Another GP told us that about 30% of the people he sees really only come in for a chat and reassurance. Somewhere where they would be the focus of attention for at least a few minutes. A well located community cafe run as a social enterprise could give health reassurances that would save untold millions of wasted visits to the doctor.
The commissioning by GPs will have three key elements that will make it, in time, a keener more useful service:
- It will have to respond to a Joint Needs Assessments prepared by the Local Council. This means a response to real local needs and not needs guessed at by remote Whitehall warriors.
- Those assessments and the work undertaken by commissioners and deliverers will be subject to real public scrutiny by Health and Well Being Boards led by Councils and involving other players. This will end deliberations by PCTs which are at best opaque. Hardly anyone knows what a PCT is never mind how to find and influence them.
- The details of commissioning will be decided by local people who will then oversee that service delivery and get regular feedback from patients that they put into the system. This will enable them quickly to find shortcomings in the system and change the commissioning appropriately.
This might mean two things:
a) So called post code lottery. We will need to be far more robust in explaining that money is used to meet local needs and the totality of the spend is used to maximise life opportunities and life chances
b) Some current NHS units may close. Anyone who goes to a hospital or clinic knows that although the care is usually good the process of getting the care is often tortuous. When Erica needed help with hearing difficulties a few years ago she turned up at a unit where everyone was given the same appointment time because that was the easiest thing for the unit. It meant a two hour wait before she was seen to.
So I hope Lib Dems will be brave. The only way to introduce big changes like this is to do it quickly. Announce a ten year programme and the ranks would close and staff would start to defend their own territory, their own mortgages and the methodologies that they have used since time immemorial. Come on Lib Dems get stuck into this exciting opportunity and make it work.