The NHS has to change

nhsengland_logoOur beloved Health Service must not be preserved in aspic but modernised to meet changed times and opportunities

 

I spent a very large part of my time at the Liberal Democrat Conference talking to various parts of the NHS and associated and related bodies as I am the national spokesperson for us in local government for health and social care.

I met organisations like the Royal College of Nursing; Pharmacy Voice; the Royal Pharmaceutical society; the Salvation Army; the Terence Higgins Trust; Arthritis Research; Independent Living for the elderly and many, many more. I also spent time with Lib Dem members including Dr Clare Gerada a former President of the Royal College of General Practitioners who has recently joined us after many years in the Labour Party.

They were all delighted with the announcement from Norman Lamb and Tim Farron that the Liberal Democrats not only recognised the financial pressures on the NHS but also realised that this must be met by the creation of a dedicated tax to pay for it.

Equally however everyone I met realised that putting more money in was only part of the answer. In the long term we need to crack down on waste and find very new ways of doing things. Its cultural change that we need in the debate (or regrettably none-debate) on health not organisational change.

I was intrigued to find out, for example that not only is the drugs bill the second highest item in the NHS bill but up to one third of the money spent is wasted or misapplied. People are prescribed too much; they are prescribed inappropriately; they don’t make effective use of their drugs; large amounts are simply chucked away as they become out of time. Just suppose we could change these things and we could save say 25%of the drugs bill. That would mean a saving of £5 billion or twice the current deficit. What really annoyed me is that the Government have failed to take action to deal with the ramping of prices for drugs coming out of patent. That alone would save £300,000,000 every year.

Let’s take obesity. In simple terms 95% of people who are obese are so because they eat and drink the wrong things. Let’s say that by doing the right things with those people we could have that amount. That’s another £2.5 billion saved. But of course in this discussion the statement is easier than the solution. They might be eating the wrong things because of poor labelling; because they can only afford cheap food or because they are depressed. We need to work with them to deal with the causes of obesity and not the symptoms. It could eb that in this case the Government could intrdocue effective labelling so that people knew what they were eating nd what effects that the food would have ont heir diet.

Let’s take the elderly. Too many people are in hospital beds because they cannot be properly looked after at home before or after necessary medical treatment. The costs of keeping someone in a hospital overnight are roughly the costs of supporting them in their own home for a week. Quite simply in this context we are spending far too much on hospitals (where people don’t want to be) and not enough on care in their homes or communities where they do want to be.

Where can one stop? Drugs; tobacco and drink still are huge drains on the NHS. People turn up to A and E because their GP practices cannot give them an appointment. GP practices are full because we don’t use the skills and premises of High Street Chemists enough. My view of the Health services because I was told this time and time again of things which help prevent illness and or can provide better, cheaper solutions to a range of problems.

We need to have that thought in our heads very much in the next few weeks when the NHS launches its 44 STPs in England. The STPs are supposed to a review of the NHS which looks carefully at the current state of the provision of clinical and medical services in light of the pressures on the service. This process could not have been handled more badly if they had set out to make a bollocks of things. The public will now be consulted on plans which have already been decided upon. The reaction will be overwhelmingly negative. Of course it will as there has been no laying of the ground by giving information to councillors and the public.

Some hospitals will need to close. This can and should be done if we are to do the sorts of protractive and pre-emptive things mentioned above. The way we provide services has changed massively and could change more. The biggest waste of money in the system is the failure to use pharmacies properly. We have people going vast distances for a range of services which could either be provided directly by the pharmacists or in the premises of the pharmacist.

The danger will be that we automatically go in to save institutions when what we need is to have a clear understanding of the clinical needs and opportunities in terms delineating how and where that service is delivered and by who. Buildings are not the Health Service, people are the Health Service. We need to make access by the public to professionals closer to where they live and we need to develop care and support services which are in many cases more important than pure clinical services and drugs.

We in Liverpool should know that better than anyone. The first medical officer of health was appointed by Liverpool way over 100 years ago. People in Liverpool were dying from Cholera. The rich built themselves a good water and sewage system. They kept dying because no-one had provided the same services for the poor. There was a very clear understanding that health was a community issue and needs community solutions.

My fear is that the NHS which is such an important part of our lives will be the subject of accusation and blame over the next few months. The health debate will not be a sound one as we discuss just structures and finances. Yes the Lib Dems have led the way with our tax proposals but we have been clear that we need the debate. Spending more on what we do now and the way we do it will ultimately be self-defeating. It’s part of a solution but not THE solution. Any politician who thinks and says that money is the answer is a fool or a charlatan. Let’s have that proper debate.

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About richardkemp

Leader of the Liberal Democrats in Liverpool. UK representative on UCLG Finance Committee, Executive Bureau and World Council. Deputy Chair and Lib Dem Spokesperon on the LGA Community Wellbeing Board. Married to the lovely Cllr Erica Kemp CBE with three children and three grandchildren.
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One Response to The NHS has to change

  1. The trouble with the NHS is that “the market” has been introduced into the internal workings of the NHS in the blind ideological belief that “the market” promotes efficiency; like it did for the banks??!!

    If the NHS needs to cut costs, it must be clinically efficient. I take this to mean that diagnosis should be timely and treatment immediate. However, under the current regime, market efficiency and clinical effectiveness are mutually exclusive; there is an inbuilt conflict of interest.

    So remove “the market” from the NHS and to fund Clinical Efficiency have a banded employee NIC ranging from 8% for the cardiovascularly fit.e.g. can run 10K in under 50 minutes. to 20% for those who choose not to exercise at all. This would be consistent with Liberal principles of personal freedom and personal responsibility.

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