Love the NHS, we'll miss it when it's gone

The NHS is in meltdown, and nobody with any modicum of power seems to care. I've been meaning to have a rant about where the NHS is going for some time, but the trigger for finally writing this was the second story on the BBC front page this morning. It was titled "NHS trusts with deficits rise to 39", and it goes on to say that "18 of 147 trusts missed a target that 85% of suspected cancer patients started treatment within 62 days."

To anyone with half a brain cell, it would be pretty clear that these two things are linked - the trusts are being starved of cash, so they can't treat the patients. However, it goes on to quote a Conservative health spokesman as saying "we do not accept that delivering safe and compassionate care in the longer term costs more money." Really?

I don't know what would be more upsetting - that the people in charge of the NHS are clueless, or that they know exactly what they're doing.

The NHS provides this country with one of the best healthcare systems in the world. If someone falls ill, they will receive treatment regardless of whether they are young or old, rich or poor. I'm biased, and you should be too - it is a unique and precious thing, one which has saved or significantly extended the lives of millions of people. It saved my dad's life last year, gave my mum an extra 10 years to see me grow up and go to university, and helped my gran live to 105. But everything we hear in the media makes it sound terrible - and our politicians seem to be doing everything they can to make that the reality.

This government, as those which went before, have set a lot of targets for the NHS - financial targets, waiting list targets, hygiene targets - and at face value, that may seem to some like a reasonable way to do things. After all, successful businesses have targets and budgets, so why not use those techniques to get the NHS's spending under control and to improve the quality of its care?

Because the NHS is not a business. That's why.

People bring money into businesses, but take it out of the NHS. That's why businesses advertise to reach more people, whereas the NHS advertises to avoid them. A hospital has no control over how many new patients come in through their doors on a given day, nor how many in their catchment area get cancer or need hip replacements. That means that they ultimately have no control over how much money they have to spend, so saying that they are a terrible organisation for going over their budget is insanity.

Trusts in deficit should be assessed for efficiency and quality, and then praised for doing their job. Throw money at them, give everyone a bonus. But that doesn't happen. Regardless of what politicians say, the reality of the NHS is that it's being starved of cash while costs are going up. Several years ago trusts embarked on a process of reducing their staff through "natural wastage" - a lovely way of saying that when critical front-line staff leave, they aren't replaced and their colleagues have to pick up the slack. This inevitably forces corners to be cut, and patients suffer.

At the same time, the odious administrative structure soaks up vast amounts of financial resources while issuing directives and making changes to services without any idea of the implications for those actually doing the jobs, nor any thought to the effects on patients. Pencil pushers who never leave their comfortable offices in administrative buildings miles away from the hospitals end up making decisions about patient care based on nothing but the numbers.

The trusts have their budgets cut at one end, targets and fines raised at the other, and the staff and patients are caught in the middle. This can only lead to one outcome: management lose sight of what the hospital is there to do, staff are pushed past breaking point, patient care suffers, and we have more Mid Staffordshire scandals. If anyone thinks that trust was the only place this has happened then they're living in a dream world.

Recent and current governments have forced a culture in the NHS of putting money above all else. A trust gets a certain amount of money at the beginning of the year. If a waiting list time limit is breached, it is fined, regardless of the causes. If more than n patients on a ward have C. Diff, it is fined for poor hygiene, despite the fact that it spreads in the community and they probably all had it before they came in. And these aren't trivial fines, they're tens or hundreds of thousands. But to make up the shortfall, a hospital can sell its services to other NHS bodies, or private healthcare.

Ah, private healthcare. I remain convinced it's a con. Some private patients will be treated in private hospitals, will have nicer accomodation and shorter waiting lists; sure, those are nice, but they don't fix what's wrong with you. Say what you like about the NHS, but thanks to its qualification requirements and training programmes, the staff skill mix in its hospitals are miles ahead of the private sector. If a doctor in a private hospital isn't a moonlighting consultant, chances are they're there because it's the only job they could get. But not all private patients are treated in private hospitals; some are lucky enough to go directly to the NHS hospital in the first place - where they'll end up on the same wards as NHS patients, being treated by the same staff with the same drugs. It's just they're paying for it twice.

This leads me back to what I alluded to at the start - the mismanagement of the NHS could just be incompetence, but it's increasingly clear that successive governments are deliberately causing budget deficits and missed targets so they can point at them as proof that the NHS is in meltdown, implicitly encouraging people to opt for private healthcare while "improving services" by opening up more and more opportunities for private companies to get a bite of the NHS pie. It's not just the current government - both they and Labour have allowed or forced the NHS to outsource logistics, catering, cleaning, parking, legal services, and actual treatments. They're even turning into landlords, letting hospital space to Boots and Costa. And don't get me started on Labour's PFI deals or the Tory's insane GP reforms.

What I can't understand though is why. Do the politicians genuinely believe that a private sector model is a good fit for the health service? Do they really look at healthcare in the USA and aspire to bring that to the UK? Can they really be that stupid? Why does the mainstream media only ever focus on the official line that the NHS is terrible, and not do anything to fight to protect it?

Healthcare is not a business, and patients are not customers - they are our sick friends and relatives, and we should do everything in our power to support them and those who look after them. Instead we let our politicians and media bicker about budgets and targets while they conspire to run one of humanity's greatest achievements into the ground. This isn't healthcare - it's insanity.

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