Judy Terry is a marketing professional and a former councillor in Suffolk.
In a BBC interview, responding to yet another call for more money for the NHS, the highly respected Chief Executive of Ipswich Hospital commented that a) any additional funding would undoubtedly be funnelled through ‘local commissioning groups’, and b) a priority would be improving social care to avoid older people being kept in hospital unnecessarily.
Healthcare funding is one of the Government’s top priorities, alongside education and defence, but it is so emotive, taxpayers are never given the facts about how money is spent. That must change if we are ever to have a proper debate about the future, with our population expected to rise to 69.2m by 2026. There is too much of a blame culture, if services don’t measure up to expectation, when everyone on the front line works so hard to save lives.
Like so much of the public sector, the NHS is a vast, unaccountable, bureaucracy, employing 1.5 million people, excluding GPs, dentists, temporary staff, pharmacies, and other external health providers. So it would be very helpful if the Department of Health could provide a ‘family tree’ to illustrate the different tiers both nationally and locally, identifying the responsibilities of each tier so that we ‘ordinary people’ could understand the benefits (if any) of the structure, and the outcomes. I fear that we would be astounded at the unnecessary duplication, growth in the number of ‘managers’ (over 30,000 of them) and lack of joined up thinking.
Why, for example, are hospital nurses spending 33 per cent of their time on form filling (according to a former Blair adviser, Sir William Sargent in a Sunday Times interview 21st January 2018) when, he says, cutting this would put more nurses on wards, at no additional cost? The UK has some of the best IT professionals in the world, who could surely provide solutions, tailored to local circumstances.
There are 207 GP-led Clinical Commissioning Groups (CCGs) in England, responsible for £73.6 billion in 2017/18. Each should provide a simple grid to identify how many staff they employ, salary range, including the Chairman (usually a GP), the annual budget and total running costs as well as the amount of cash distributed to the front line. Since there are variations around the country, the grid should identify policies on what each CCG will and will not commission (e.g. IVF, hip and knee replacements for the elderly or obese, cataract surgery) as well as the Care Quality Commission (CQC) verdict on services.
As part of the ‘family tree’ it would be essential to show the relationship with social care, provided by local authorities, and the crossover with the ambulance service, as well as the CQC evaluations for each region.
Having such data would enable a full and frank debate about any reforms needed, and how they should be prioritised. It would help if politicians stopped ranting at each other, exchanging meaningless statistics.
Evidence points to our ageing population contributing to growing demand, and even overwhelming services. According to Lord Carter’s February 2016 report, Operational Productivity & Performance in English NHS Acute Hospitals: Unwarranted Variations the cost of bed blocking could be as much as £900m a year, affecting 6,600-8,600 beds a day. In some areas, including the relatively small CQC-rated Outstanding West Suffolk Hospital, the NHS is working in communities to look after vulnerable people in their homes; how is this information being shared across the country, and are there opportunities for local authorities to co-operate with such initiatives by joining forces to create regional social care provision?
Some hospitals have GPs in triage, alongside A&E, reducing waiting times for patients in urgent need, whilst others have introduced specialist emergency departments for older people, and created convalescent wards.
As we’ve seen from the Carillion demise, public sector procurement is something of a ‘hit and miss’ when it comes to best value. In his report, Lord Carter noted that a sample of 22 trusts identified 30,000 suppliers, 20,000 different product brands, over 400,000 manufacturer product codes, and 7,000 people placing orders. The cost of hip prosthetics varied from around £800 to nearly double that.
Millions are evidently wasted because of time pressures and a lack of skills. How can it be justified for London hospitals to pay £900,000 on hotels for patients, or that Ipswich Hospital spent £422,223 on photocopying in a six month period last year.
There is, for example, considerable expertise in Essex County Council, which provided the very best advice on EU procurement regulations when I was a school governor seeking guidance on a new catering contract. Could it take the lead on a regional procurement pilot scheme? The director responsible told me that rubber gloves are used everywhere, including by Police, in schools, as well as hospitals and care centres, yet because there is no co-ordinated procurement across services, the difference in prices paid is eye watering! To keep it simple, regional procurement could be based on Local Enterprise Partnership areas.
Can prescription charges be reduced, when some common drugs cost a pittance in supermarkets, but ten times as much on prescription, enabling more to be spent on revolutionary new treatments as advocated by Baroness Jowell in her Lords speech?
For several years I was a hospital governor; it may have ticked the appropriate boxes as we ploughed through various reports, but just about everyone sitting round the table admits it was a complete waste of time (and the administrative cost). Do governors really benefit efficiency?
So much more is achieved by listening to the experts, like the CEO of West Suffolk Hospital, who admits he helps ‘on the ground’, as a porter, in the pharmacy, or serving meals, touring the wards and talking to patients and staff. Like the CEO at Ipswich Hospital, who is also responsible for Colchester Hospital, they know what needs to be done, and are doing their best to ‘implement change through hard work, but we need to do things differently, with more resources and closer working with GPs and social services’.
So, they both agree that social care must be reformed to avoid continued crises in our much-loved and prized National Health Service. It needs more funding than can be provided through local council tax, when there are vast disparities in property values, incomes and population size across the country, with the potential to penalise residents in areas with a high proportion of older people, but smaller populations.
Now that the Health Secretary has added Social Care to his job title, let’s hope he’s listening – and implementing Lord Carter’s recommendations.
In the meantime, it’s time we had a national Award Ceremony to celebrate our wonderful Emergency Services, who are selfless in their devotion to helping others, as we have seen in the last year alone during terrorist attacks, the Grenfell fire and in our hospitals every day. It should be televised, with a red carpet procession, and the fashion industry providing some glamorous outfits – just as they do for film and TV stars at their annual events. Prince Harry and Meghan could perhaps provide the necessary high profile to present prizes, and all those companies making billions from pharmaceuticals etc should be sponsors.