What’s going on with our NHS? Pt 3. What do governments want?

What’s going on with our NHS? Pt 3. What do governments want?

Every government has its own agenda for the NHS. The service is staggeringly expensive – for example, its budget dwarfs those for the armed forces or education. Governments are in a tricky position regarding this cherished facet of UK life. They bear responsibility for the service and all its failings. But also with the bill, rising at a rate far in excess of inflation. We seldom praise politicians for improving the state of the NHS. Gordon Brown got close with the marked reduction in hospital waiting lists that followed his substantial increase in funding.

So it would be no surprise if, over the years, many ministers have had two priorities of their own. If they could shift responsibility for the failings of the service away from themselves then they would find that attractive politically. If we were them, no doubt we would too. Furthermore, that would make it easier to reduce the treasury’s costs for the service. Clearly, any resulting deficiencies would be the responsibility of local health authorities, now called Clinical Commissioning Groups. Note that CCGs consist largely of GPs. After all, the government has divested responsibility to the CCGs because they are closer to the ground, best able to understood the local need, and to make appropriate decisions for their local community. Etc.

Don’t blame us; we are just the government. Nothing to do with us. Talk to your local CCG.

Brilliant. And if that is their game plan, then it’s working.

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A danger:

This evening, I watched my local news on TV and saw members of a CCG explaining how they had to make cuts to meet their budget. Very forthright. Impressive management style.

But, for most of their working week, these same doctors are GPs –family doctors, with patients reliant upon them for unswerving, personal care. They may feel important, and indeed they are, but what is the impact of such talk on patients? On all of us? It would be so nice to see them insert a couple of sentences into their interview. “With the money allocated to us by the government, we have no choice but to make these cuts in services, no matter how reluctantly we do so. We will continue to argue the case for appropriate resources.”

Unless they do that, and soon, the public will see them and their profession as rationing managers rather than doctors. The transition of unwelcome responsibility for a failing service from the government to local clinicians would be effectively, and irreparably, complete.

Inefficiency and responsibility:

It would be ridiculous to suggest that there are no savings possible, that there is no inefficiency. Of course there are, and there is. But a search for improved quality must be the driver for change, not meeting some nebulous, treasury-inspired budgetary reduction. In the previous post, I listed some statistics from the NHS Confederation that illustrate the resource gap between the UK and other comparable countries. A service is difficult to improve if already underfunded compared to the competition. It is like a rugby scrum being consistently pushed backwards. The players simply cannot get any forward momentum. Surely the way forward is appropriate funding for the services required, accompanied by a vigorous drive for quality? The government cannot absolve itself of responsibility within that process.

Lord Dawson understood this in his eponymous report of 1920. He was a strong advocate of policymakers being assisted by medical expertise, both at the health authority level and nationally. But he added, “it need hardly be said that the ultimate responsibility for decisions would always rest with the Minister.”

Next – I will consider what has gone wrong with the NHS?