At the Labour Party Conference Wes Streeting made a declaration. He would ensure that the NHS was going to thrive on his watch, and the decline we have seen in recent years would be turned round. I pointed out that he was taking on a big challenge, but one dear to the Labour Party which feels it is responsible for the NHS as we know it, and wants to present visible signs of improvement to the electorate as soon as it can.
The immediate challenges are waiting lists and GP services. GP surgeries are now open longer. But reducing waiting lists for operations is a real problem. These are the things which impact on the public most. Both require the training of more doctors. Establishing more training places in UK based hospitals will result in more coming forward. An example near home is the collaboration between Sunderland’s University and Hospital, which has already resulted in more local people qualifying, and more importantly, wishing to practise here.
The North East has some very good hospitals renowned for their innovative research. There was no shortage of people wanting to come and train here from the rest of the country, and from abroad. The trouble was: they all used to disappear elsewhere once they had completed their training. Aiming for local recruits means they are far more likely to want to stay and practice here.
Health promotion and care at home
If the NHS is ever to become sustainable, and the service for everyone Wes Streeting has made it clear he wants, there is another long-term problem to be solved. That is: making the population healthier so there is less need for long stays in hospitals. It also means supporting the old and vulnerable in the community so there is less need for them to go into hospital.
Jeremy Hunt, when he was Health Secretary, once commented that he knew the NHS needed long term reform, but he was so engrossed in solving the immediate problems that he never had the time or energy to do it. Wes Streeting has committed himself to long term reform. Let us hope he has the stamina and endurance to do it.
Division of resources
The NHS spends almost half (49%) of its budget on staff. Hospitals, of course, are capital expenditure and secure their income by being commissioned by GPs and other bodies to perform operations. The majority of the rest of the budget goes to GPs, but as indicated much of it ends up back in hospitals. But, though most of the budget goes to GPs, only a small proportion is spent on actual care in the community. (The exact figures are difficult to find.)
The overall picture however, is that power is concentrated in hospital trusts. They have the prestige, and they are going to solve the immediate problem of reducing waiting lists. Although everyone pays lip service to the concept of providing more care in the community, in practice there is not much left when the trusts have been paid.
An added complication is that social care and public health are paid out of local authority budgets, and they are a key component of any programme to provide care in the community. We all know local authority budgets have been severely squeezed over the last few years, and we now have Reform 2025 Ltd in power in many councils and they are making a virtue of cutting back on spending.
Effective Community Health 2001 – 2013
Wes Streeting does not have to look very far to find examples of successful community health programmes. Tony Blair’s government did increase the amount going to Public Health and his Health Secretary, Alan Milburn, established Primary Care Trusts (PCT) which lasted from 2001 to 2013. These actively brought together local authorities, GPs, and other community health services to pursue ambitious programmes of community health.
They had an extensive public engagement programme which took the public with them. I remember a PCT meeting where over 300 people attended to debate health programmes. In Rochdale NHS workers rode on the trams to explain their work to the public. In the North East the PCTs, working together, successfully reduced the amount of smoking and the number teenage pregnancies. Their approach was always one of working with the public, taking people with them rather than telling them what to do. There were successful community programmes to encourage people to grow healthy food, engage in appropriate exercise, and many other practical activities which promoted good health.
Then came ‘competition’ in health care
The Conservatives stopped all this. The new Health Secretary Andrew Lansley introduced a totally different way of organising health. The most efficient health care was to be secured through competition, and cooperation between local government, different parts of the NHS and charities was discouraged if not forbidden. Most health professionals disliked this new model since it prevented different agencies cooperating to deliver good care, including community care. Even Lansley himself finally admitted it had been a mistake.
Return to proven good practice?
If Streeting is going to successfully deliver better health and reduce demand for hospital services, the NHS is going to have to work cooperatively with all the different agencies who deliver health care in the community. Local Government will pay a large role and need more funding. But most important of all Wes Streeting must draw on all the good practice that has already been done. Good luck!
