Alastair Stewart: If we're spending more cash on the NHS then we need better performance

The pandemic has put a smoke screen behind which a structure that increasingly seems unfit for purpose can hide.

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This year’s quarter of a million pound Wolfson Economics Prize will go to the brightest idea to make the Government’s planned 48 new or improved hospitals by 2030 even better. The shortlisted ideas include clever pods for A&E patients - safer and kinder for the sufferer - greener hospitals and more logical designs, and hospitals with self-reporting systems for patient satisfaction and staff ‘happiness’.

Splendid, all of them - I’m sure. Lord Wolfson of Next thinks so and so does Sajid Javid, the Health Secretary. But if there was a Stewart prize, I’d be looking for more profound ideas.

The key questions would be: Does the NHS still work and, if not, how can that be changed?’ Does it offer value for money, and, if it doesn’t, how can it? Is the public-private balance right and, if not … well, you get my point.

If we don’t address those profound questions, I fear the Wolfson short-list risks fiddling while Rome burns.

Of course, the coronavirus has put an historic strain on the NHS and made all that it does tougher. But it has also offered a smoke screen behind which a structure that increasingly seems unfit for purpose can hide. You criticise the NHS at your peril but, if you don’t, it becomes like the Emperor whose news clothes were a myth.

The NHS, a part of the post-War settlement from Attlee’s Labour Government that defeated the wartime hero Churchill, would offer a cradle to grave health care serve. It was also part of new Welfare State, and would sit alongside a safety net of benefits for the poor, for those in short-term economic distress, and would provide a state pension when folk ended their working life. Elements of that have also become a scam but that’s another minefield for another day!

Over the years since 1948 the NHS has been subject to chops and changes in management and structure; devolution saw the demise of a UK NHS and the creation of separate health bodies for Scotland and Wales. Local versus top-down management structures are a regular feature of debate. And funding, a constant in the diet of party political positioning.

Yes, there are more diseases, more treatments, cleverer and costlier treatments and drugs. The NHS and Government response to all of that is fudge; roll with it and woe betide any Government seeking re-election who dared say, of the NHS, we need to pause and think and reflect.

When did we last have a really profound debate about what it’s for, what it does, and how well it does it? The funding crisis and the impending health and social care reform package from the Government would both be assisted if someone had the guts to ask what the NHS is for, and what it is not for; and what might be done better if charges were applied, where folk could afford them?

In headline terms, hospital waiting lists and the under-cover reinvention of GP services are perhaps the most striking examples of why we need to talk about the NHS. On waiting lists, a sharp decline in transplants was reported today and added to the growing lists of people waiting for vital hospital treatments, including surgery. As for GPs, again an army of them have graced the airwaves assuring us you can still see a GP - nothing has changed - so long as you don’t mind doing it on the phone, on zoom or via your smart watch which can beam vital signs and data to your GP.

Well many are not and many cannot, from those living in poor broadband spots to those being of a certain age, to those who don’t trust their deeply personal data, dashing across the air waves. And it as all happened without anyone asking me or you if we were happy with it. I don’t think the Tories want to privatise the NHS but aspects of GP services - from PCR covid tests, to sight and hearing problems - already have, and by stealth. If you'd asked me; I might have agreed. Don’t ask me, and I'm suspicious!

If there’s an argument for more cash for the NHS then there’s an argument for better performance. The latest King’s Fund data demonstrates we are increasingly dissatisfied, and the NHS is increasingly less effective.

All four of our children were born in the NHS and to our total satisfaction.When I broke my hip, I went private - not for a better operation but for privacy and comfort. I had insurance which I could afford to buy. My money, my choice.

When I have my PCR Covid tests, which my employer insists on, and which the NHS seem to think are a very good idea, I have to go private because my NHS GP doesn’t do them. And we have to pay. Seems odd…

Failing hearing, the GP will refer you to a private practice. Worries about eye-sight - probably the same. That may all be perfectly sensible but how we got here isn’t. We fund it as tax payers: we deserve a say in something so fundamental.

I think we all need to be honest: are there things that the NHS offered for free, in the past, that should now be charged for as a matter of course? Are there things that the NHS shouldn’t offer? Some who are ill cannot afford to pay for anything - I accept that - but many of us can and would. We just need an honest open debate about what the NHS is for and how it is funded.

Is the NHS a suitable and urgent case for treatment?