Many of us have contradictory views on the NHS. As an idea and institution, we admire it, but at the same time know it is not functioning well and needs rescuing.
When he took office, Keir Starmer commissioned Lord Darzi, a respected clinician and former minister, to do a rapid investigation into the state of the NHS, assessing patient access, quality of care and the overall performance of the health system. He has certainly burnt the midnight oil and produced it in only nine weeks. He produced 28 points in this report. I will try and summarise them before thinking about how these problems can be resolved.
The report
His first point which encapsulates all the others, is that the National Health Service is in serious trouble. Public satisfaction, which stood at a record high in 2009 is now at its lowest ever.
He points to a worrying statistic:
“Overall life expectancy increased in the 2000s, but plateaued during the 2010s, before decreasing during the Covid 19 pandemic. It has started to rise again now, but the absolute and relative proportion of our lives spent in ill-health has increased.”
In other words, we live longer, but less well.
There has been a surge in long term conditions, particularly mental health, and as a result an increase in those unable to work and claiming invalidity.
To summarise the rest of the report, the NHS is in a mess for a multitude of reasons, not all due to political decisions. The population is ageing, and older people tend to need more health care.
The original model of the NHS centred around hospitals. It now finds it difficult to deal with older people who need support and care, but on a long-term basis. Most medical experts agree that if there was better community health support, older people would be able to live happy lives without needing to visit hospital so medical opinion has advocated transferring resources away from hospitals to community care for some time. But it is the hospitals which have power within the system and much support from the public. Having a proper hospital is seen as a sign of prestige for a community. Look what happened in the Hartlepool by-election in 2021 where one of the reasons given for Labour losing was the removal of A&E services from Hartlepool hospital.
The fabric of hospitals is decaying too. Many do not have adequate buildings or kit, and some A&E departments struggle to cope.
All these problems were made worse by government decisions taken in the decade 2010 to 2020. The Conservative government had two beliefs. One was that there were too many managers in the NHS, and the other that private providers were necessarily more efficient. A reform instituted in 2012 by Andrew Lansley which tried to bring private enterprise in and reduce management was a spectacular failure but wasted a great deal of money. The austerity policies of the then government also hit the NHS hard.
The new government’s approach
The current government is trying to prevent ill health. Many diseases such as cancers, heart diseases and diabetes are in part caused by bad lifestyles. Trying to improve this would reduce pressure on the NHS. There have already been successful measures to reduce smoking, and measures to control poor diet and therefore reduce obesity are under discussion. Dealing with obesity will be harder than reducing smoking. You either smoke or you don’t, but tacking obesity means moving to a better diet and probably taking more exercise as well. I am not sure if Keir Starmer’s approach is the right one.
He seems to like banning things. Already a proposal to reduce junk food advertising has produced the headline in the Daily Mail “Nanny Starmer bans junk food”. Labour’s opponents will seize upon this.
I am not arguing that restricting advertising aimed at children is not desirable. The real villains are the food manufacturers. Government needs to pressurise them to reduce the unnecessary fattening substances in food. We did it with lead in petrol, so it can be done with fat and sugar in food. Be prepared for a fight though. The food manufacturers will support those complaining about “the nanny state”. Bad diet is not the only factor encouraging obesity and bad health. Lack of exercise is a big factor too. Encouraging a healthy lifestyle cannot be done by government edicts. We need to work with people, not just tell them what to do.
Working with people
There are examples of where this has worked. There used to be organisations called Primary Care Trusts which brought together GPs, community health services and local government. They employed community health workers who worked with community groups to encourage people to grow their own food, cook simple meals, and take exercise. They organised running groups and even purchased bikes for people to use. Regrettably the new government in 2010 reduced public health spending. It has now declined by 25% since then.
Dealing with the NHS crisis will demand capital expenditure to repair those buildings which are in disrepair. Money and time could also be saved by introducing better IT. At the moment different parts of the service use different IT systems. Some records are even kept by hand.
There is much to do. But changing people’s behaviour cannot be done by edict. Leading and working with people is often hard and expensive, but it is the way to go.
CLICK HERE TO DONATE TO OUR CROWDFUNDER
HELP US BECOME STRONGER SO THAT WE CAN CONTINUE TO DELIVER POWERFUL CITIZEN JOURNALISM!
