The Telegraph, 9th April 2024
Our ailing NHS needs fundamental reform (telegraph.co.uk)
This isn’t about ‘privatising’ the system, but making it work seamlessly within local communities
I took another call from Mavis last week. It was a sad but familiar story. This time it was her local GP surgery in my constituency of Fareham. She has terrible back pain but can’t get an appointment for three weeks. “Suella – can you help?”
I’ve known Mavis a long time. We’ve become friends over the past decade because of her long-term and ongoing travails with the NHS: the 12-hour wait at A&E with her husband who had a fall in 2015, and the stress of finding the right care package for him when he moved into a care home in 2017. A year later she couldn’t find a dentist, and now it’s the GP.
I should say there have been some improvements in the NHS over the past 14 years. There are 40,000 more doctors and 70,000 more nurses. And while the NHS was stretched during Covid, it did not break as many had feared. Then there was the rollout of the first Covid vaccine, thanks to NHS agility, achieving an operational feat not seen in my lifetime.
In my constituency, I led a task force that delivered a new chemotherapy unit at Fareham Community Hospital and we are looking forward to the opening a new Emergency Department at the nearby QA Hospital in Portsmouth. It’s happening because of government funding. No one can accuse the Conservatives of defunding the NHS: money isn’t the problem.
According to the OECD, the UK has seen the fourth highest increase in funding, as a share of GDP, across Europe since 2010 – an increase of 14 per cent. Yet we still have some of the worst outcomes compared to our European counterparts. Zoom out and there are systemic problems with how we care for our young, sick and elderly.
For all the cash, Mavis still can’t get to see her GP, and, in too many cases, if she needs to go to hospital her outcomes would be better off had she lived in France or the Netherlands.
Worse still, recent figures show that 1.5 million patients waited 12 hours or more to see an emergency specialist, while data suggests that 250 people may be dying each week due to overcrowded casualty wards and a general shortage of beds. The lack of capacity in social care homes gums up the system at the other end.
Currently, nobody is in control. We have a balkanised system with each local trust able to do largely whatever it pleases without any accountability, transparency or indeed leadership. The new Integrated Care Boards may plan health services, but they have too little responsibility for poor performance. Deficits are covered by the Treasury and budgets are set centrally. The system is also focused on the acute health problems rather than on the rising tide of chronic illness. With our ageing society we treat people when they get very sick, but shouldn’t we do more to stop them falling ill in the first place?
What we need is a total overhaul of how our public health is delivered. I don’t believe in “privatising the NHS” – although Labour’s suggestion to allow private health providers to offer more services is welcome, and Wes Streeting should be commended for his boldness. But this won’t get to the heart of how to deliver world-class care for all, regardless of income.
Indeed, the private sector will tend, just as it has done in the past, to pick off the easier aspects of healthcare, reducing the overall burden but without improving care for everyone.
Part of the answer is to integrate health and social care, so that patients in care homes are properly treated to prevent chronic conditions requiring a hospital admission. This should save money, since beds in acute care are more expensive than those in care homes. To make it work we need, as the think tank ResPublica has argued, to pool all health and social care funding in one ring-fenced budget so that savings in one part of the system lead to benefits for all parts.
The sheer number of trusts, agencies and authorities we have now is obstructive and inefficient, so we also need a singular governance and standards organisation that synchronises with these new devolved health authorities. Our local authorities are the best equipped to deliver co-ordinated health care through these proposed new structures. When Mavis needs a GP or hospital appointment, she should have one provider. If her husband needs long-term social care, it should be assessed by that same authority. Joined-up, but devolved locally.
I will continue to do my best for her and my other constituents, but I simply cannot make up for an ailing National Health Service.
