Tuesday, 3 August 2010

The NHS Should Not be Protected from Cuts

John Swinney, Scotland's Finance Secretary, continues to insist upon excluding the Scottish health budget from forthcoming cutbacks. Cosla president, Pat Watters, says that protecting Scotland's £11bn health budget would result in local government bearing the brunt of the cuts and threaten the services that councils provide for vulnerable members of society.

Ah - the vulnerable; a word which politicians hope is emotive enough to create sympathy from the 'non-vulnerable' population. It's a word which has been so overused in recent years that it's true meaning has been greatly diminished. Anyone who visits a hospital these days is vulnerable and not just because they're exposed to hospital-acquired infections.

Pat Watters wants the NHS to take its fair share of the reduction in Scotland's budget. The NHS was created to provide healthcare free at the point of delivery for working people who could not afford private treatment for illness or disease. Nowadays many can afford private treatment and can even afford to go abroad for it, yet when things go wrong it's the NHS which is left to sort out the mess - free of charge. How much money does the NHS spend righting the wrongs of foreign and UK-based poorly skilled 'private' surgeons?

The NHS should not be protected from cuts. A root and branch review of our healthcare system is long overdue and one would be required if any changes in the service are to be identified. If NHS expenditure is ring-fenced the organisation will escape scrutiny.

There's a myth that Britain's NHS healthcare is the best in the world. It is not. It's average. Australia, Canada, France, Germany, Singapore, Spain, Sweden, Switzerland, to name but a few, provide better healthcare. The myth is perpetuated by those who have vested interests and accepted by those who have never experienced the healthcare system in any of the above countries.

When a retired Scots consultant is prepared to be speak out about the current state of Scotland's NHS, the government should sit up and listen. I met John Blair some twenty two years ago. He was the person who told me my father was terminally ill. We talked on several occasions and I found him to be direct and honest. Another senior doctor in England is prepared to speak out and explain why European Union rulings are causing untold damage to the health service - in particular the European Working Time Regulations.

Is anyone listening to these people?


JRB said...

Well said Mr Blair.

Excellent and outstanding as our NHS is, it is being slowly suffocated by the ever burgeoning layers of management and bureaucracy reaching all the way to Edinburgh.

As an NHS patient, as a patients representative on several NHS committees and as a patients representative at Holyrood, I see the NHS from several different angles. In all honesty, I do believe that those involved are well intentioned genuinely wishing to improve the patients lot. However they seem in many respects incapable of implementing some excellent ideas in a positive and constructive manner. They seem hamstrung with the mind-set to over bureaucratise everything.

What is urgently needed to improve the running of the NHS is a benign dictatorship not the woolly management we currently have, whose only answer to any task, problem or innovation is to create yet another working group or sub-committee.

Bureaucracy costs money which we can no longer afford.

Alex Porter said...

I think the problem I have here Rosie is that 'cuts' and 'reform' are two completely different things. I mean cuts are not going to solve any of the problems that you mentioned. The system will be left in place except for some services will be gone and/or you'll have to pay directly for some of them.

Arguing for cuts because there's problems is like taking away a married couple's salary because they're not getting on so well these days - it's missing the point.

For a start, we have to realise that 'cuts' are not needed in Scotland. This is all about the people paying for the super rich to be kept in the manner to which they are accustomed. Maybe it's an inefficient system but I'd rather have it than axe it and send the proceeds to various Swiss bank accounts!

Yes, I agree that we need to reform the NHS. I'd like it to be top quality and keep the profit motive well out of it. If you want a private system then fine but when you put profiteers into a public system like that it's going end up sucking the public purse dry - creating inefficiences through bad management systems and ignorant managers, reducing quality and increasing the cost of subsidies..

I think a long hard look at how we want to move forward as a nation is required. I think government is in far too many aspects of our lives and that is a dangerous thing. It stupifies people into a big brother knows best. Where government is found it should have an excellent reason for being there. I understand defence, health, education, transport infrastructure and maybe even utilities but why do we need politicians to set minimum prices on alcohal? The government are involved in so many aspects of our lives and we should look at why. If there's not a good reason close it down. No government control over interest rates - gem them out!

Then we look at reforming government we do have. I mean, why are we in various foreign military entanglements costing many billions?

No, the councils should be trimmed right down. No-one wanted the wars but we have them. Are we studpid? Why do we let them do what we don't want? What happened to the anti-war campaigns?

There's no need for cutting the NHS. Reform it yes but not from the need to make savings. There's no need for cuts anywhere in Scotland but if you do want cuts reduce the size of government. I'm sick of moron politicians who think they know what's best for me better than I do.

Stop the wars, Stop the cuts!

Oldrightie said...

Just add one word, Subrosa. "Frontline".

subrosa said...

Thanks John. I wouldn't call our health service excellent or outstanding. It's average these days. But I concur with your comment about many of those involved being well intentioned.

That isn't enough though is it? There needs to be root and branch investigation to ensure an efficient and effective management structure is in place.

subrosa said...

Good point Alex, although I was trying to say a review about 'cuts' would hopefully lead to showing up where reform is required.

I'm not proposing cuts but proposing a root and branch review as I said to John. We'll not have a review if the NHS is able to avoid the cuts issue.

No, there's no need for another private system in Scotland, we already have one. Those who can afford it see consultants privately and have operations paid for privately. That works for (I'm guessing here) around 5% of the population.

We need to use the money allocated to the NHS far more effectively. Basic services need to be of the quality they were when I was young ie cleaning and basic nursing. Too many people aren't having their basic needs cared for when they're in hospital. Nursing staff are too busy.

John Blair says staff are demoralised. That's the feeling I get when I've been visiting a friend in hospital. Her husband is having to wait over a week to see her specialist. Back in 1988 I don't think I waited longer than 2 days to ever speak to John Blair about my Dad.

'Reform but not from the need to make savings.' That's it exactly Alex. But to reform we need to know where the problems lie. It's not rocket science is it although politicians would like us to believe it is.

subrosa said...

No use having posh chairs in the reception areas OR if the toilets are filthy.

Alex Porter said...

I can understand demoralisation. I'm sick of having to squeeze the people that matter to pay for foriegn wars, weapon systems, bail-outs etc. Reform of the NHS is about moving forward as a nation. Impossible to do in current Britain with the disgusting priorities of the British state being as they are..

William said...

Swinney comes out against NHS cuts, but waiting to see how the UK cake is divided in October (remember that all the English Parties fought the election on a commitment to "no cuts")
Meanwhile, consensus forming in Scotland that NHS should not be ring-fenced. Swinney looks at Barnett figures and agrees that he needs to cut NHS after all. All Parties in Scotland now in unison and one third of his budget agreed, with no comeback from Labour on the sick being turned away from hospitals etc.
Nice one John!

William Brown

Dramfineday said...

Unthinking cuts - no way but as you and I have discussed SR, Mr John Seddon has some great views on how VAST savings can be made through reducions in waste, duplication and the removal of dud processes.

You'll no doubt recall my earlier post of being treated to a WALL FULL of stats and mangement speak in the National Heart Hospital in Clydebank? Who's producing that and more importantly HOW is it being used? Tackle the waste first before waving the hatchet

subrosa said...

Low job satisfaction is a killer Alex and also very unproductive. Of course it's not possible that everyone achieves total job satisfaction, but that should be the aim of any employer. It's a win win situation.

subrosa said...

Oh I don't think the sick will be turned away William. Wee bit of a dramatic statement that!

subrosa said...

We have indeed Dram but how is the waste going to be found unless a proper review is undertaken? If they just say ring-fenced then the NHS will not come under any scrutiny at all, except for their little bit of tinkering round the edges to save the odd £m or so.

If the money was sensibly and effectively dispersed then we could have a first class service for the same price.

Hamish said...

I wouldn't call our healthcare system average; I would call it patchy. I was fortunate enough to experience the NHS at its best.

Let me re-phrase that, I was unfortunate enough to suffer an aneurysm of the aorta 14 years ago. It had to be explained to me what that meant: basically the main pipe coming out of the heart had sprung a leak.
It took a bit of time to diagnose the problem, partly because the pain was so severe that I couldn't work out where it was. Two fledgling doctors were allowed to examine me under the eye of a consultant; one pronounced it was gall-stones; the other disagreed but didn't know what it was.
It was only when the professor of radiology took the view that the X-rays weren't showing the whole picture and carried out a CT scan, that the truth emerged.
Now comes the fortunate bit: if you are going to have an aneurysm of the aorta, and I wouldn't wish it on my worst enemy, the two best places to have it are St Louis in the USA and Edinburgh.
They have (or had at that time) the best surgeons. The general mortality rate from that condition is 75%.

But it wasn't just the surgeons. Anyone who has been in Wards 17 and 18 of the old Edinburgh Royal Infirmary knows that they led from the top. Everyone in those wards
(cleaner, doctor, nurse, porter, technician) was inspired and motivated by the surgical and medical consultants to perform to their very best.

Of course there were incompetents and those who couldn't care less about their work in the NHS, always calculating whether they could get more pay elsewhere. Both surgeons and nurses.

Subrosa, I suspect I am approaching a parting of the ways from you when you write "The NHS was created to provide healthcare free at the point of delivery for working people who could not afford private treatment for illness or disease".

Anonymous said...

The NHS is great in principle but a shambles in practice. I have had the misfortune of witnessing the way it is managed at first hand over the past 6 months and I can confirm that it is an utter shambles from top to bottom. The NHS is made up of a multitude of fiefdoms that only rarely work together and occasionally work for the good of the patients. Nothing short of a root and branch reform can turn it into a world beating health system. Perhaps the Scots government should bring in TESCO to show them how to run an efficient service to the public!

subrosa said...

Hamish, I can't understand why you say we're approaching a parting of the ways. What I wrote was true. People who can afford private health care do tend to opt for it if they can't wait.

As for your experience it validates those of the people I know. In fact there are two people within a few hundred yards of me here who know they wouldn't be alive today without the expertise of Edinburgh Infirmary cardiac medics.

Fortunately I've never experienced the department, but if all of our health service was run in the way you say the cardiac unit at ERI is then we wouldn't have a problem.

It's true though Hamish that the NHS was created to provide healthcare free at the point of delivery etc.

It wasn't provided for boob jobs and to rectify the work done in foreign countries on UK citizens. They ought to take out insurance to ensure any remedial work is paid for and not for taxpayers to have to foot the bill.

subrosa said...

You're right M, the likes of Tesco could should the NHS the way to efficient and effective management without throwing more money, or cutting the present budgets.

I can feel NHS managers quaking in their shoes right now.

William said...


I meant to put the bit about turning away the sick in inverted commas, because that is more or less the Labour line already on "Salmond's cuts".
If ALL the parties agree that the NHS must take its share of future cuts, then Labour attacks are muted.

William Brown

subrosa said...

Yes that's true William. Clever move of Swinney's to invite everyone round the table.

Anonymous said...

"The managers have taken away our on-call room. They've allocated it to administrators and have already changed the locks. "

That quotation from 'Tony Strong' summarises the NHS perfectly. Doctors are expected to work long hours whilst pretending not to (and not being paid for them).

The management of the hospital, knowing this hypocracy, removes the doctors' rest room - but still expects them to perform as before - even though if the new rules are strictly followed, operations will be delayed & patients will suffer.

It seems rather akin to Pharaoh's command to the Israelites to continue to make the same quota of bricks whilst (locating and) providing their own straw (if that's not too religious an analogy!)

subrosa said...

No it's not too religious an analogy Nick2 and it's rather a good one. Thanks.

Anon said...

Sack some of the managers, and the NHS will improve.

- Aangirfan

subrosa said...

Aack most of them Aangiran. Bring back matrons. That's the answer. They were the best managers we ever had in the NHS. They did the back line and front line services.

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