Manchester – The National Health Service (NHS)

22 October 2024 , categories: Health, Manchester, Meetings

On Tuesday 22nd October 2024, Politics in Pubs Manchester met at the Briton’s Protection for a discussion on the National Health Service (NHS). The session was led by Garcia, a Registered Mental Health Nurse, drawing on the challenges she faces working within a crumbling NHS and how it has weathered the storms of crisis and a lack of investment in light of recent government changes,

Introduction

Since its inception in 1948, the NHS has been a cornerstone of British society, set up to embody the principles of equity and compassion and symbolise the nation’s commitment to healthcare for all, free at the point of use. However, like any institution, it has its share of challenges and successes.

Challenges

Underfunding throughout the NHS increases waiting times and creates staffing shortages, which in turn displaces patient demand to Accident and Emergency services (Garcia cited a report that 50% of A & E attendances are for non-urgent matters). Only 9% of NHS funding is spent on procuring community-based GP services, an essential first point of contact for people seeking medical advice/care (some patients are waiting two and a half weeks to see a GP for a routine appointment). Garcia believes that funding has suffered under Conservative and Labour governments.

Understaffing also affects NHS performance and contributes to Britain’s brain drain – Garcia stated that 15% of its doctors are necessarily from overseas and that the NHS still carries 120,000 vacancies (for doctors, nurses and admin staff), leading to staff shortages. At the same time, our education system does not seem to funnel enough future doctors and nurses into NHS careers. It is understandable why the prospect of better working conditions and fewer cutbacks in countries like Australia is a temptation for British trained medics.

Waste and inefficiency from poor administration and procurement, and too much bureaucracy amounts to £5 billion a year – tax payer money which could be used to recruit staff. Patients admitted via A & E can’t be discharged without the correct paperwork, therefore they unnecessarily occupy beds needed by other patients. In the meantime, ambulances staffed by paramedics and bearing casualties wait outside hospitals for hours awaiting admission to A & E.

Legal claim payouts as a result of lawsuits against the NHS for safety, training, safeguarding and risk management matters, account for 6% of the annual budget. The blood contamination scandal and Lucy Letby murder conviction are among the high profile cases of things going wrong.

Abuse of the system by patients who exaggerate or mimic the symptoms of mental health crisis in order to be admitted to a ward, avoid the usual living expenses and save up for Christmas.

The ‘postcode lottery’ of healthcare leads to a variation in the availability, accessibility and funding of services depending upon which part of the country you live in. New housing developments in low income areas don’t always include provision of GP services. Garcia believes that all patients should receive equitable care.

Security is provided in general hospitals but not in mental health facilities. Garcia listed the injuries she has received after being assaulted at work.

Positives

The NHS employs many dedicated professionals with the skills to provide world class health services.

It is capable of showing incredible resilience to an unexpected demand for services.

The NHS develops pioneering treatments and research programmes.for addressing problems like cancer and heart issues.

The treatment of mental health issues has not always had a parity of esteem with physical health matters but this is beginning to change. However, some mental health provisions still look like asylums, rather than state of the art health facilities.

The NHS is able to offer high quality services: how can we save the NHS?

Discussion

Is the NHS underfunded or is it badly managed? Private healthcare facilities don’t seem to have the same issues. There are too many managers and not enough frontline staff. Yet there is money to hire DEI managers and ‘carbon literacy’ officers. Many nurses have ‘green’ personalities i.e they are kind and caring but are they tough enough in the way they manage staff in order to maximise performance? Managers need to be business brained AND good at man-management.

The 8000 GP surgeries in England and Wales are set up like profit-making firms of solicitors.

The King’s Fund reports that there is no point providing more funding until the underlying structure of the NHS is fixed. Also, increasing the nation’s population by a net three quarters of a million people in a single year is bound to have a huge effect upon demand for public services like the NHS.

The government’s response to Covid denied access to NHS services and contributed to excess deaths. Over recent decades, the policy of successive government of dramatically reducing the number of beds available for patients has clashed with immigration policy designed to achieve a huge increase in the population. The NHS did nothing to prepare for a pandemic. Deaths were inaccurately categorised as Covid deaths.

The transition from publicly owned hospitals to PFI rent collectors has had a significant impact upon hospital trusts and their ability to fund services.

Why is the current government asking the public for solutions to NHS problems when it has is own very well-paid policy advisors?

We should be concerned about the government’s apparent intention to rely on the use of ‘rules based’ AI in healthcare resulting in a part qualified diagnosis of treatment which ignores alternatives. This kind of approach was demonstrated during Covid where Vitamin D levels were not taken into consideration even though medics knew early on that Vitamin D deficiency was linked to the severity of illness.

The removal of holistic and personalised care and a reduction in the role of human observations in the assessment of patients is likely to lead to an increase in deaths. Ill-health manifests itself differently in different people and human observation of the patient is an essential part of health care. General health care nurses are doers, mental health care nurses are thinkers – mental health issues are very personalised and require exceptional problem solving skills.

Social care and health care are still not operating together in the way they should. Social care funding, has not been increased and the turnover and recruitment of social workers is highly problematic. The spiral of decline in health care will continue until there is an improvement in social care but the government is not yet having a sensible conversation about this. This can have a devastating effect upon independent living. Nurses working in healthcare struggle to secure housing options via local authorities – which occupies their valuable time and shows that services are not ‘joined up’.

Is there a wider problem and basic unfairness with workless households accessing health and social care when they have never contributed via taxation and everything is funded for them by the nanny state? Should there be tax breaks for people wishing to buy private health insurance? Why aren’t overseas visitors and health tourists charged for services they receive from the NHS?

Private health services are able to offer more effective treatments such as drugs which fix damaged tissue as well as alleviating pain.

Compared to American health care, the NHS seems bureaucratic and tolerant of staff who who merely ‘coast’. Britons need to be more demanding about their health care, chasing up appointments and insisting upon better service.

Devolution of some healthcare budgets to Metro Mayors may lead to more competitive procurement. Currently, the NHS’s Procurement Agency offers contracts to service the whole of the NHS and most contractors can’t do that. This leads to higher pricing. Regional procurement should open the competitive field. Individual boroughs in Greater Manchester should employ their own salaried GPs.

The privatisation of the optician service for the provision of glasses has been a resounding success. The privatisation of dentistry has been less successful.

The parachuting in of middle managers who don’t understand the core business of health services is problematic. It is better for managers to work their way up so that they understand what they are asking staff to do.

The NHS provides a cradle to the grave service which is necessary and needs to be carefully planned out. But people also need to be responsible for their own health too. There is a whole industry of health care skills around patients but this needs to connect to social care too. How do we insist that this happens?

Processes, methods and preparation are key. A doctor working in private health care can execute 20-25 cataract operations in a day. In the NHS it is four a day. Why can’t the NHS be as efficient as the private sector?

Where is the incentive for people to help themselves instead of seeking a magic bullet to cure their ills? For example, losing weight and going to the gym instead of taking anti-depressants? Why is the recommended food pyramid upside down?

Many thanks to Garcia for providing an insight into the NHS and for initiating a fascinating discussion. Thanks also to our temporary hosts at The Briton’s Protection – cheers all!

Useful links:

https://www.nhsconfed.org/articles/are-other-health-systems-more-cost-effective-nhs

https://www.kingsfund.org.uk/insight-and-analysis/long-reads/nhs-crisis-evaluating-radical-alternatives