Julia Manning is Chief Executive of 2020Health.
In the ‘Emperor’s new clothes’, everyone from the Emperor to
his ministers to the townsfolk, not wanting to appear stupid, go along with the
pretence that the Emperor’s new suit is fabulous. It takes a child to blurt out
the truth that there is nothing there, but even then the Emperor keeps up the charade.
The question for the NHS in 2013 is whether our leaders will
continue their collective denial that the NHS and Local Authorities cannot cope
with current demand? The 1948 NHS emerged into a very different country to that
of 2013. TB, diphtheria, scarlet fever, pneumonia and syphilis were the big
challenges. No one bothered the doctor unless they really had to. There were
few drugs to offer (salicylates for rheumatic fever, digoxin for heart disease,
sulphonamides and penicillin) and giving bed rest was a major function of
hospitals. There were more beds for the mentally ill than all other general
hospital beds put together, and a fundamental part of the NHS Act gave the
government executive control of all hospitals to allow effective planning.
The original aims of the NHS were to be a comprehensive
service, available to all, free at the time of need and administered by
centrally appointed, not elected, bodies. It was a transformational approach
that pooled risk and dramatically reduced health inequalities. Over time, the comprehensive
promise of the NHS has meant that its remit has expanded exponentially as new
treatments have been developed (with new medicines and approaches keeping
millions of people out of hospitals). Despite this the NHS has remained pretty inclusive
but some controversial rationing has developed, based either on age, behaviour
(e.g. requirement to stop smoking before surgery) or ‘low therapeutic value’ of
a treatment. Charges were brought in after three years for some items such as
eye glasses, dentistry and prescriptions and over time certain medicines have
become unavailable on prescription, and many hospitals have become
self-governing Trusts. The original NHS budget was about 3% of GDP; today it is
In 1948 only 11%
of the UK population were over 65 Years of age; it’s now about 17% and will
rise to roughly 23% by 2030. In Europe as a whole it will be closer to 27%, but
the UK is also predicted to be the most populous country of the continent. Meanwhile
the latest figures show a drop in GDP spent on elderly social care from 7% to
6% of the welfare budget (of £111bn) despite the rising numbers of elderly in
the population, and reports over Christmas revealed that Germany (having the
highest projected proportion of elderly within the next 20 years) has already
started ‘exporting’ older people to cheaper care homes in eastern Europe.
The ageing population, costs of new technology and
fossilised state of our professions all mean we cannot carry on doing things as
we are. We need our politicians and health leaders to show the way in setting
out what are the issues and genuine choices. Simply put, we need a culture
change in which we are all involved with the following three key elements:
1. Much greater public involvement in health
- Professionals letting go, seeing patients as
partners and helping to shape a more appropriate workforce
- Public taking hold, involving themselves through
more self-care, community caring and controlling their electronic personal
- Rewarding healthy behaviours.
2. Transparency of data including…
- Outcome data on treatments and detailed GP
- Publication of NHS Trust losses and action plans
to reduce fraud
- Public health information on food and drink.
3. Refinement of expectations including…
- Public discussion on national decommissioning,
e.g. of procedures with low medical value and common medicines e.g. paracetamol
- A new Constitution with clarity on rights,
responsibilities and redress
- Develop opportunities to adopt the latest
The imminent report from Sir Robert Francis QC on the
appalling experiences of patients at the Mid-Staffordshire Hospital will mean
the NHS and elderly care is in the full glare of publicity from the start of
2013. Ministers and leaders must not shy away from the challenge of proclaiming,
like the honest child amidst the Emperor’s court, what those patient’s families
already know to be true: that the NHS and social care is not fit for purpose.
Nor must MPs make any more false promises that the NHS can continue to be a
totally comprehensive, free-at-the-point of use service giving everyone the
best possible treatment alongside (of course) ‘saving’ their local hospital. We
are not stupid. The Francis Report, painful though it will be, is the ideal
time for Parties to start an honest conversation with the public: We need to be
involved in our healthcare; they must provide the data; and together it is
essential to review both how all necessary care can be provided through tax
funding and where common sense efficiencies and opportunities can be found.
> See point eight of Tim Montgomerie's blogpost from Monday on the importance of the Francis Report.