Shock therapy for ailing British NHS?

by Dr Upul Wijayawardhana

That it invariably leads to disaster when politicians attempt to tinker with what they know very little about is well illustrated by what is happening to the British National Health Service (NHS). Unfortunately, the politicians who attempted to reform the NHS over the years, with disastrous consequences, seem to have completely disregarded the aphorism—if It ain’t broke, don’t fix it. Although it is fast heading towards the bottom of the league now, the British NHS once was the best in the world and many countries attempted to emulate it because it was a cost-effective system providing free healthcare to all, irrespective of one’s ability to pay. It stood as a testimony to the socialist foresight of the post-war Labour administration of PM Clement Atlee and his Health Minister Aneurin Beven, considered the ‘Father of the NHS’; he made the ever-true declaration: “No society can legitimately call itself civilised if a sick person is denied medical aid because of a lack of means.”

Although I am not a fan of his, I must admit that Keir Starmer deserves to be lauded for attempting to reverse that trend with his recent announcement. Giving a fillip to his administration, which has been faltering up to now, PM Starmer announced plans to get rid of a resource-draining quango, pointlessly duplicating the work of the Department of Health: NHS England employing 13,500!

Margaret Thatcher seemed very keen to reform the NHS, her motive probably being more political than anything else. She was toying with the idea of introducing a scheme for compulsory health insurance, but her Health Secretary Kenneth Clarke, who was against this idea, persuaded her to introduce a less controversial ‘trust’ system instead, which took hospitals away from the control of District Health Authorities. Despite being a far less successful system, Clarke wanted the UK to ape the Managed Hospital System in the USA! Clarke’s argument was that hospitals needed enhanced management with independence to compete in an internal market and created Hospital Trusts, in stages, beginning in 1990. To anyone with common sense it was a daft idea, especially the concept of hospitals competing with each other, but that is politicians for you! The downward spiral of the NHS started with the trust system and I have no hesitation in referring to this as the ‘Clarke’s Curse’!

Trusts were given further independence with the creation of ‘Foundation Trusts’ and other service providers like ambulance services also converted into trusts during the John Major administration that followed Thatcher’s. Towards the end of this administration a Private Finance Initiative (PFI) was set up where the private sector built hospitals and trusts had to pay back regularly with huge interest, like a mortgage. This scheme was enhanced by the Tony Blair administration, but, unfortunately, became a millstone around the neck later, some trusts having to declare bankruptcy!

Keir Starmer

Tony Blair, who became Prime Minister in 1997, could have changed direction to save the NHS but instead opted to continue with the Conservative health reforms. Perhaps, his New Labour was more Conservative than Labour! The most significant political change during the Blair administration was devolution of power, leading to the creation of the Scottish Parliament and the National Assembly for Wales in 1997, followed by the creation of the Northern Ireland Assembly in 1998. As health became a devolved subject with these changes, paradoxically, the Health Secretary of His Majesty’s government looks after the health services of England only! However, devolved health systems usually follow the English system but there can be significant differences like the prescription charge. It is only residents of England that pay for their medication, with a fixed prescription charge irrespective of the cost of medication, the current charge being £9.90 per item. Those with exemptions in England as well as residents of the other three devolved nations get all their medication free.

During the disastrous Cameron-Clegg coalition government, the Health Secretary Andrew Lansley decided to give the NHS in England an ‘independent arm’ and NHS England was created in 2013, which currently employs 13,500 staff, three times more than the Department of Health! NHS England is an executive non-departmental public body of the Department of Health and Social Care, which oversees the budget, planning, delivery and day-to-day operation of the commissioning side of the NHS in England and according to its website: “NHS England shares out more than £100 billion in funds and holds organisations to account for spending this money effectively for patients and efficiently for the taxpayer.”

All these reforms made the NHS top-heavy with management and the resources poured by governments went to feed the managers mostly, only dribbles going for patient care, and my experience at Grantham Hospital mirrored what happened across the rest of the country. When I started working at Grantham in 1991, it was a District General Hospital, which has been in existence since 1876, with 300 beds and a large estate with quarters for most employees. It was managed by a General Manager, a Matron, and an Estates Manager. When it became a Trust in December 1994, we had a Chief Executive with Directors in Medicine, Surgery, Nursing, Estates and Operations, all drawing hefty salaries, and many assistants! Later, it joined Lincoln and Boston Pilgrim Hospitals to form the United Lincolnshire Trust. By the time I retired, 20 years later, there were only 100 beds and much of the estate was in the hands of private property developers! Since then, it has become a shadow of its former self: there are no acute beds at all though around 3,000 houses have been built around Grantham during the past two decades. For any acute emergency, Grantham residents must travel to Lincoln, a car journey close to an hour!

Hospital overcrowding has got so bad that many hospital corridors are blocked with beds now. In fact, some hospitals have started advertising for staff to look after patients in corridors! Only thing missing yet are ‘floor patients’, which I presume is an impossibility because of cold floors! In spite of introducing corridor beds, too, patients often have to wait over 24 hours in Accident and Emergency Departments for a bed, lounging in chairs with drips and oxygen tubes! Imagine this happening in one of the richest countries in the world!

One of the biggest drawbacks in UK healthcare is the lack of private emergency care, private hospitals being geared to do elective work mainly. Therefore, even those who can afford to pay are at the mercy of the NHS for emergencies, in contrast to Sri Lanka where emergency care is readily available in the private sector; the fact that even a short stay can bankrupt is a different story!

I may be voicing the fears of the many who are waiting in the ‘departure lounge’ when I state that I prefer death to the ignominy of waiting in chairs or corridors.

Things are so horrible that shock therapy was badly needed. Though he had no choice, it was still brave of Keir Starmer to announce the demise of the redundant, wasteful NHS England. There are claims that job losses will come to nearly 30,000 and cost of the exercise would be in billions of pounds. Perhaps, there is some truth as NHS managers assume duties with water-tight fat severance packages! Even that short-term cost is justified to improve the NHS long-term, as there are no further depths to descend! I can only hope that Starmer’s decision will produce the desired result and, in the meantime.