Two stories which came out concerning the NHS in the past few days – a woman suffering from cancer who has been refused a potentially life-saving drug costing £5,000, and an NHS Trust which asked its staff to do an audit of how many gifts such as boxes of chocolates they have received. For many people these two stories will have summed up what is wrong with the NHS.
The NHS will never be an easy organisation to run. On a recent visit to my in-laws I read an account in an Irish newspaper of the controversy surrounding the man who is trying to sort out the health service in Ireland. He was quoted as repeating a comment made by Enoch Powell, then Health minister, that everyone in the NHS said how dreadful it was until the moment he proposed radical reform, at which point everyone suddenly said the existing system was excellent.
Over the past 25 years both Conservative and Labour governments have increased spending on the NHS, both in cash terms and in real terms after allowing for inflation. (The last government to impose savage cuts on the NHS was the Callaghan Labour government in 1978-9.) So where does the money go ?
As medical technology and practice improves, more and more new treatments are available, but at a price. Life expectancy has continued to improve under both Conservative and Labour governments, as new treatments ensure that people who would once have died are able to live longer, which is an excellent thing, but at considerable ongoing cost, which is one reason that pressure on NHS resources is an inevitable fact of life. I do not believe that there is any remotely attainable level of funding for our health service which could deliver all the things we would ideally like the NHS to do.
But the fact that a shortage of NHS resources, like the poor, is something we will have always with us, makes it all the more important to use those resources effectively. At this week’s Prime Minister’s Question Time, in between all the party political knockabout, a number of MPs asked about their local community hospitals. This is a reminder to us in Cumbria that the threats to our local hospitals are part of a national picture in which 80 valued local hospitals are under threat.
Over the past few years there has been an increase in the number of doctors and nurses, which is welcome, although many of the people affected by some 6,000 NHS redundancies announced so far this year are nurses. But the increase in the number of administrative staff taken on is much larger than the number of doctors and nurses. Even as 6,000 NHS jobs go this year, a thousand more management jobs in the NHS have been created. This set of priorities has to be reversed. The NHS will always need some people in management positions. Just as the vast majority of doctors and nurses and hard-working, competent, and caring people, I know that there are NHS managers to whom the same applies. And perhaps the present massively complex system of 400 targets cannot be run without large numbers of bureaucrats. All the more reason to change that system. Any trust which asks its nurses to conduct a “chocolate audit” obviously employs managers who do not have enough to do. It is time for a radical rebalancing away from administration and towards front-line patient care.