As I write, I’m waiting to take to the operating theatre a very badly injured biker. This could take a while. However, it’s a blogging opportunity, and it focusses the mind. So, amidst all the hype about reforming the NHS, there is at least one certainty, wherever you are in the UK:
The NHS is currently dysfunctional, and in that sense it undoubtedly needs reforming.
The Knife has yet to meet a doctor who would disagree with that. The problem is what sort of reform is needed?
Well, I would suggest the following broad categories
1. There are too many employees – and that includes a few nominally clinical ones
2. Its core business is the wrong way round. It should be emergencies then cancer then elective stuff
3. It tries to do too much that isn’t directly relevant
4. The GP’s frequently do what they want, which is often not what the taxpayer needs. They are the problematic private contractors.
5. NHS management contains too many ex-nurses
6. Good care intrinsically includes safety/governance, so all the extraneous stuff under that heading should be scrapped
7. The career structure for hospital doctors has been very badly damaged. This will cause big problems for the future.
8. Rationing healthcare explicitly is long overdue
9. Some hospitals are too small to justify everything that they attempt to do. Local politics gets in the way.
10. Public health as a specialty wastes far too much money, and importantly, has far too much influence on policy.
Each one of these points could be explored, but it would take far too much space to do justice to the message. My point is that reform is essential, but the reforms chosen by politicians are primarily selected for reasons other than enhancing patient care. They also, surprisingly, don’t aim to seriously reduce costs.
Some very senior Labour figures privately contend that the coalition has made such terrible mistakes over the NHS that it could rival the economy as the pre-eminent issue for the voters at the next election. What Labour has to beware is that it does not lose the argument on welfare as badly as the Tories have on health.
He’s wrong about the public’s perception, as Charles Moore points out, any member of the general public has reason to be dissatisfied with at least part of their personal contact with the NHS. They already know it’s not an ideal service. The challenge is to pick the right targets.
Labour by and large didn’t, and Dave isn’t doing it now.