PRAYING FOR THE NHS WILL NOT BE ENOUGH TO SAVE IT
By Ivor CampbellWith budgets already stretched before the Covid pandemic, the additional cost pressures since heaped on health trusts across the country by double digit inflation has brought the NHS closer to breaking point than at any time in its history. Every passing day seems to bring bleaker news for the beleaguered service, with a seemingly endless rollcall of damning statistics and publication of official reports charting yet higher levels of institutional failure.
If anything, the relentless flow of anecdotes of patient betrayal, breathlessly reported in the pages of local press, is more shocking.
At the time of writing, we had just learned that four patients waited more than 20 hours in the back of ambulances outside Royal Shrewsbury Hospital; that GPs in Peterborough are now responsible for the care of more than 2,000 patients each; and that Stockport NHS Foundation Trust is offering food bank vouchers to hospital workers struggling to get by on poverty wages.
In the same week, a British Medical Association (BMA) survey found that 44% of senior doctors are planning to leave their roles “in some capacity” over the next 12 months, while the Care Quality Commission (CQC) reported 132,000 NHS and 165,000 social care vacancies, meaning a workforce the size of the population of Newcastle-Upon-Tyne is needed to fix the logjam. Meanwhile, the average wait for category two, 999 calls for an ambulance — including for chest pains and strokes — in England and Wales is now 60 minutes, compared with a target of 18 minutes. And in Scotland, throughout August, one in ten operations was cancelled due to lack of resources.
Of course, none of this is likely to lead to any significant change – at least not in the short-term. Traditionally, the response of politicians to complaints of a ‘crisis’ in the NHS has been to throw more money at it, and right now there’s no money to spare.
While both Conservative and Labour governments have previously toyed with reform, none has dared challenge the universally free, taxpayer-funded model upon which the health service was founded.
Towards the end of last year, it was reported that NHS chief executives in Scotland – one of four autonomous
health service areas in the UK – have discussed abandoning its founding principles by having wealthier patients pay for treatment.
The prospect of the first ‘two-tier’ health service in the UK since its founding in 1948 is raised in draft minutes of a meeting of NHS Scotland health board leaders in September. They also discussed the possibility of curtailing some free prescriptions.
While Humza Yousaf, Scotland’s Health Secretary, sought to play down the reports – insisting NHS Scotland would stay publicly owned and operated and free at the point of delivery –the reports represent something of a watershed. Yousaf’s comments were only to be expected. If there is a single, immutable reality of British political life it is that the NHS is an untouchable shibboleth, and any party that says otherwise risks courting elec toral oblivion oblivion.
Yet, there is a dynamic to the latest spot in which the NHS finds itself, which appears different to
anything in the past. Again, you need only scroll through some of the local press articles to discover that waits are longer, levels of basic care poorer and patient experiences grimmer than ever before. Figures published by NHS Wales last week revealed more than 60,000 patients are waiting more than two years for treatment.
Ian Hembrow, 53, from Maesteg, in Bridgend was told the waiting list for his urgent hip operation was four-and-a -half-years. In Bonhill, West Dunbartonshire, 69-year-old grandmother Mary Travis has already lived in crippling pain for more than two years, waiting for a back operation to straighten her twisted spine.
Earlier this month she was told that, despite being at the top of a waiting list, she could face a further, two-year wait. The NHS has changed little from the model envisaged by its founder Aneurin Bevan because there is an almost spiritual belief in its universality. People of all classes and backgrounds accept the same level of treatment as a right and consequence of being British.
Those principals have survived because NHS care, as as well as being universal, was also universally excellent. That can no longer be said to be the case. The withholding of treatment for years is worse than receiving poor treatment and those who can afford to pay privately for a better service will inevitably opt to do so. The most compelling argument against privatising the NHS has always been that the provision of healthcare should not be left to the vagaries of market forces.
The irony of the current crisis is that those very mar ket forces may now compel its demise. No matter how strongly Britons support the NHS, few will be prepared to wait months or years to have an ingrowing toenail treated or a cyst removed if they can have it done privately the following week for a few hundred pounds. And while we may be happy and willing to pay European levels of taxes in return for a European-style health service, we’re unlikely to do the same for a US-style system. With the growing development of robotics and telemedicine, as well as an expansion of over-the-counter diagnostics, more people are now seeking remedies, for a greater range of treatments, from their local chemist or from a private therapist or
practitioner. By spending a small amount each month, they can have more-or-less unlimited telephone or video access to a private GP. More is being done online than was the case a few years ago. Much of it remains minor, but the direction of travel is such that, before long, more serious illnesses will be diagnosed remotely and by high street providers. If patients can be diagnosed with prostate or breast cancer sooner,
plaints, while accidents and serious illnesses are treated by a publicly funded service, similar to the NHS, which is free at the point of delivery.
It’s unlikely the NHS will ever be wholly privatised, but we could see – slowly and over time – some of its more routine functions being taken over by private companies. Even the most traditional religions are forced to adapt and evolve to remain relevant and the NHS is no different. How it responds to the current crisis will determine its role in treating the next generations of patients and whether they will hold it with the same reverence for another 70 years.
Ivor Campbell is Chief Executive of Callander-based Snedden Campbell
It’s often said the National Health Service is the closest thing the UK has to a unifying religion. If that is the case, then the faith of its population is being tested like never before.HEALTH LESSONS: Ambulances queueing outside an A&E department and, left, a hospital ward from the 1940s. Inset left, Humza Yousaf, and inset below, Aneurin Bevan