EMPIRES WITHIN EMPIRES

THE SCANDAL THAT IS THE NHS!

We once had, arguably, the best Health Service in the World. One that was free at point of entry and one that put patients first. The Health Service in this country is now ranked, according to Business Insider International, a lowly 18th. Their figures taken from the WHO Report of 2000.

One ranking below the Netherlands and, surprisingly, four below Greece. On expenditure per capita the UK is ranked 26

(The rankings are based on an index of five factors — health, health equality, responsiveness, responsiveness equality, and fair financial contribution.)

Top of the league is France and they are ranked 4th in expenditure per capita. The French system combines private and public sectors to provide universal health coverage to all. Most citizens receive their insurance through their employer and almost everyone has supplemental private insurance. The majority of medical bills are paid for by the government (funds from payroll and income taxes) and the remainder is footed by individual's supplemental private insurance.    

First, let me state here and now that I am a great believer in the National Health Service in this country. However, I don’t believe that many people would disagree when I say that the NHS is unaffordable. It probably was from the day of its inception. However, once it was formed it was up to Government, through the various hospital boards to make it as affordable, in terms of Government expenditure, and as accessible as possible. 

Not one administration since Aneurin Bevan launched the NHS on the 5th July 1948 has managed to come to terms with the behemoth that was created, albeit, created out of good intention. 

It is my contention that ‘modern career politicians’ have given up on the NHS and would see it in the Private Sector, run by insurance companies and foreign investment. In other words, care for the shareholder not for the patient.

There is a ‘Timeline for NHS Reform’ which I am going to refer to in order to try to make my point.

http://nhstimeline.nuffieldtrust.org.uk/

• Sir William Beveridge (1942)
  Sir William Beveridge’s report,Social Insurance and Allied Services, proposes major changes to create the foundations for a welfare system and, in its support, a national health service (the details are left for later)

• Anuerin Bevan is made Minster for Health following the 1945 General Election.
  The National Health Service Act 1946 is published. Bevan stated that, “this is the biggest single experiment in social service that the world has ever seen undertaken.”
• The National Health Service (NHS) is created 5th July 1948.
• 1949 December, The NHS is given the power to levy a charge for prescriptions.
• 1949 It is the policy of the Government to relieve nurses of all work not requiring nursing skill.
• Baron Shepherd, House of Lords Chief Whip (1949)
  The Nurses Act 1949 establishes a modern framework for the role of nursing within the NHS. Rising costs give cause for concern.

Collings JS (1950)
JS Collings’ survey of English general practice, funded by the Nuffield Trust, is published in The Lancet.
It concludes:- the overall state of general practice [in England] is bad and still deteriorating.

So, on this timeline we see that the NHS has been running for a little under two years and already cracks were starting to appear. It would seem to me that this was the time when Government should have sat back to have a good look at the direction in which the Health Service was going. I may be naive in my thinking here but in my opinion the practice of running this service by committee based on reports and analysis from independent bodies should have been nipped in the bud there and then. A department should have been set up in Whitehall staffed by health and financial professionals with the sole purpose of overseeing the NHS so that it would at all times be fit to operate in the modern World. 

Politicians have not changed much, if at all, in the past sixty five years. Their penchant for meddling was the same then as it is now. So too was their complete lack of interest in history. I have heard it argued that at the time when the Welfare State was set up the general public were not expected to live beyond seventy years of age. The taxes and levies to pay for the Welfare State were  based on this assumption and were thought adequate to fund it. As I stated earlier they, obviously, were not because Baron Shepherd had already voiced concern at the rising cost of the service. Government had three choices, pump more money into the NHS from the Exchequer, offer a mix of Private and Public Health Care, Increase NI contributions.  They took the fourth choice.

I think that by then (two years) Parliament had forgotten the words of Anuerin Bevan when he said that “this is the biggest single experiment in social service, etc, etc.” The operative word in his statement being, “Experiment”. Both the Labour Party and the Conservative Party saw the NHS as a banner to wave at the World. A beacon of achievement borne out of post war loss. Great Britain leading the rest of the World in social reform. Well, it is all very well having a beacon but at some point you have to light it! In my opinion, this was the time or, should have been.  An experiment examines the validity of a hypothesis or, determines the efficacy of something previously untried. Anyone who has conducted an experiment will tell you that it is carried out in order to learn from the results. Unfortunately, scant regard was given to the results of this ongoing “experiment” and therefore, no real lessons were learned and no beacon was lit.

• 1951 April 21 The new Chancellor of the Exchequer, Hugh Gaitskell, proposes a one shilling (5p) prescription charge and new charges for dental treatments (chiefly dentures) and spectacles.
• 1953 The report, The work of nurses in hospital wards: Report of a job analysis, is published by the Nuffield Provincial Hospitals Trust.
• 1954 A wide-ranging review of the role of general practice encourages the formation of independent GP group practices.
• 1954 The Bradbeer Committee publishes a report on the internal administration of hospitals for the Central Health Services Council.

In 1950, a committee headed by Alderman Bradbeer is appointed by the Central Health Services Council (advisors to the Ministry of Health) to examine hospital administration arrangements in the English NHS [pdf].

The resulting guidance is supportive of the system typical in voluntary hospitals (which avoids the hierarchy of local authority hospitals). It draws on the former’s concept of a ‘tripartite administration’ of medical, nursing and lay elements, but with the lay element (in the person of the group secretary) given overall responsibility for implementing policy and coordinating the activities of the group. 

Was this the start of the decline?

• 1956  December, What is most needed at the present time is the prospect of a period of stability.RH Turton, Minister of Health (1956)
• The report of the Guillebaud Committee’s inquiry into the cost of the NHS is published. The report lays to rest many fears that the service is extravagant or cannot be afforded.

The report  showed NHS spending had fallen between 1948 and 1954, from 3.75 per cent to 3.25 per cent of Gross National Product; that capital spending was running at only 33 per cent of pre-war levels; and that additional costs implied by an ageing population could be financed easily by economic growth.

Unfortunately this ‘economic growth’ was based on the solid manufacturing base that the UK enjoyed then. The Civil Service at that time saw no reason why Great Britain should not continue to grow economically, as it had before the War. It was this arrogance and the mirrored arrogance of many business leaders that led to the gradual decline in British industry. This decline would also change Government attitude to the NHS.

I won’t list any more of the timeline, click on the link to see what changes have been made year to year since 1948.

Earlier I said that politicians have a penchant for meddling. In 1971 The Conservatives revised Crossman’s plan for reform following their election in 1970, with major management consultant involvement, coterminosity and consensus management being introduced.
This was the beginning of the downfall for the NHS in my opinion. Having failed to see the cracks, let alone fix them in 1950, the Government decide to employ the tactics of “Big Business” to run the NHS. Before any of you Labour supporters out there start bellowing about ‘useless Tories’ destroying the Health Service. I would remind you that it was, more or less a cross party decision to employ these management tactics.

During the period 1979 - 1997 there were 7 Conservative Secretary’s of State for Health under two Prime Ministers. Did they make the Health Service more efficient? Yes in some areas although I would put this down to new technology rather than good management. They created an internal market whereby the different departments within the Health Service had to compete for financing. Good for the number crunchers but not so good for the patients.

During the period 1997 - 210 we had 6 Labour Secretary’s of State for Health. We also had more of the same plus a vast increase in hospital management. Front line services declined in the wake of Government targets. Doctors and nurses became bogged down with paperwork which took them away from their primary job of patient care.

Has this changed since 2010? No! If anything it has got worse. Mortality rates are at an all time high whilst patient care is at an all time low. We have a leader of the NHS who presided over one of the worse scandals ever to effect a hospital in this country. In the Mid Staffs Hospital 1200 patients died needlessly. The man in charge was Sir David Nicholson and he now enjoys the Prime Minister’s, David Cameron, full support in his position as head of the NHS. Calls for his resignation fall on deaf ears. It is not without reason that he is known as “The Man With No Shame”.

To force through Government policy he gagged staff, threatening them with loss of job and no prospect of re-employment within the NHS. He paid off potential whistleblowers and generally ran roughshod over his staff.

In his defence, senior Whitehall sources say that he is ‘driving up standards for example, waiting lists, he has a real grip on NHS hospitals. Tell that to the eighty year old war veteran who was dumped in a wheelchair by ambulance staff with blood streaming from a cut to his head. He waited for five hours, desperate to go to the toilet, cold and confused. His family eventually gave up and took him home without treatment.

No, I believe that Sir David’s remit is to make the NHS an attractive proposition for the Private Sector to buy into. We, the Public will be given the usual rhetoric by today’s career politicians about affordability and patient care and an ageing population etc, etc, blah, blah, blah. In my opinion, the Health Service was set up with all good intention but with little thought to the future. An experiment gone wrong but with no one reading the results. The lessons were there in 1950, alas, it seems, school was out. Subsequent Governments have toyed with it, tweaked it, thrown money at it but, mainly stood back and watched as it fell into politically made decline. 

People are afraid to use it because of the lack of front line care. They are afraid of being put on a pathway to death where no one is blamed. They are afraid to have an operation because of post operative diseases. People have been manipulated into a position whereby they no longer trust the NHS. Well done Sir David, Job complete!

The political elite should be ashamed, we had a chance to shine, a chance to show the World Britain at its best but we failed. Like all good politicians, today’s breed do not accept failure, it is not good PR. So they bring in a ‘hatchet man’ such as Nicholson to trim it, wrap it and put a ribbon around it, readying it for sale.