CHRIS PHILP: Why the NHS needs radical reform
The NHS has dominated local headlines of late. The Whittingon s A&E is threatened with closure. The Royal Free s physiotherapy department is going out to private tender and its award-winning stroke unit has just ceased emergency treatment. There is talk
The NHS has dominated local headlines of late. The Whittingon's A&E is threatened with closure. The Royal Free's physiotherapy department is going out to private tender and its award-winning stroke unit has just ceased emergency treatment. There is talk of the Free and Whittington merging. We read reports of substantial job cuts at the Free.
In the 62 years since its birth, the NHS has become a much-loved national institution. Its founding principles were put well by Aneurin Bevan: "No longer will wealth be an advantage, or poverty a disadvantage. Healthcare will be free of charge based on clinical need and not on ability to pay." I agree with him.
The NHS of today looks very different to the one Nye Bevan set up. It is the world's third largest employer, behind the Chinese Red Army and Indian railway (some say fourth largest, depending on how you count Wal-Mart's staff).
So why, 62 years after its foundation, are so many local services apparently under threat? Could it be lack of money from taxpayers? Emphatically, no. One positive thing the Government has done is spend on the NHS. As a Conservative, I agree that the NHS should be properly and fully funded. I was delighted when David Cameron said he would protect the NHS budget. There is no doubt some serious savings will have to be made from the national budget, but the NHS is not the place to cut.
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The scale of the spending increases over the last 13 years has been vast. NHS spending went from �37 billion in 1997 to �120 billion today - more than tripling. Camden's economic contribution to NHS spending works out at �12,000 per household on average.
So has this money been wisely spent? According to Office for National Statistics, it has absolutely not. The ONS reports that NHS productivity has in fact fallen by a shocking 10 per cent since 1997 - at a time when private sector productivity has grown dramatically as a result of better management and use of technology.
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Around 60 per cent of the spending increases have gone in cost inflation, and so hasn't even resulted in more resources being deployed. One thing that has grown is the number of NHS managers and administrators, at a rate three times faster than clinical staff.
So what's going wrong? A former nurse with many years service, said: "I knew I had to leave when the paperwork became more important than the patients".
In the last 13 years, the current Government has tried to run the NHS as a vast centralised bureaucracy. They have set targets that deny doctors, nurses and GPs control over how services are run. Professionals' careers depend on satisfying Government targets, not delivering patient welfare. This vast bureaucracy soaks up money and actually makes the system less efficient.
Doctors for Reform put it like this: "Doctors are beset with political targets and central direction, distorting clinical priorities. The monolithic structure of the NHS simply does not allow the effective transmission of resources to frontline services."
This is why so much of the money has simply disappeared into a huge centralised system. This is why local services are under threat. If only the system consumed less in administration, then the Whittington's A&E would not be under threat. If only the Government had spent our money more wisely, we would not now be contemplating staff cuts at the Royal Free.
The answer lies in radical reform. Instead of the Government trying to run the whole system, let's give doctors, nurses and GPs the freedom to deliver the service local patients need - to again make the patient more important than the paperwork. Let's allow hospitals freedom to run their own affairs, and put GPs back at the heart of commissioning what they believe is best for their patients.
This needs to be accompanied by proper patient choice for elective care. The money will follow the patient. Instead of the Government telling us which local services will expand or close, patient choice and local GP commissioning will drive it. This will be a radical improvement in the way the NHS operates - instead of running from the top down according to diktats from headline-hungry politicians, local people and their GPs will become its heartbeat once again. No longer will we see important local services closing on orders from Whitehall. And the money saved by slim-lining the current bureaucracy can go back into font-line care.
The NHS could once again be a great institution. But it needs reform to flourish.
q Chris Philp is a Camden councillor and the
Conservative candidate for
Hampstead & Kilburn