Deliverance Day minus 15. Resurgence has a big idea for the National Health Service – democratise it. In addition to the need to democratise the NHS there is also a need to adopt the principle of subsidiarity. It has been pointed out that since New Labour abandoned Clause four of its constitution there has been a political consensus which has precluded the consideration, never mind adoption, of alternative models for running the NHS. A false impression of independence has been created with the conversion of hospitals and Heath Authorities to Trusts and Foundations. If these had a Founding Body with an ethos and aims and values there might be some individualism. Their other failing is that they do not have real financial control but exist on the handout received from central government. They are not accountable to the people they serve.
The NHS is a monolith that is unwieldy and bureaucratic, marked by central control and a drab communist uniformity. It has always lacked a democratic dimension with political appointments being made at each and every level. Even its watchdogs, the Community Health Councils, despite doing a good job were appointed on a sectoral basis. It has also been pointed out that the biggest threat to our NHS is the move towards treating it as a plc and breaking it down into commercial units that provide services to a customer, whether that is a patient or a client unit within the NHS. This is achieved through privatisation of packaged parts of the NHS or contractorisation, the setting up of arms-length companies or agencies and commissions.
Whitehall’s inherent solution of throwing money at any problem has failed on many fronts with the NHS. The tax payer is in revolt because this extra money is not providing improvements for the benefit of the patient. They (we) do not mind paying extra taxes but neither must that revenue be wasted. The financial crisis within the NHS is therefore difficult to comprehend but is due to a loss of political will and mismanagement. With the financial clout of the NHS they should be getting £2 of value for every £1 spent. What we have got is ward closures and reductions in beds, more centralisation of services, too many trainees for the future level of provision and no job opportunities for recently graduated doctors. NHS managers are not free to manage as they might wish (good or bad) but constrained to conformity. Existing contractorisation of ancillary and peripheral services (eg car parking and cleaning) has spread to mainline services (laboratories and certain surgical and medical procedures), and there is the Private Finance Initiative which we will be paying back for generations.
The introduction, for example, of Polyclinics is a distraction from the real issues that people want addressing. There is a pressing need for the National Health Service to go back to its founding principles. Not its founding organisation and management, but something better. It needs to be patient (not customer) focused. This can be best achieved by democratising the National Health Service. MPs would sit as the elected members on the relevant Strategic Health Authority. Primary Care Trusts would be governed by an elected Health Commissioner and a Deputy with responsibility for appointments of executive and non-executive members. Elections and fixed-term contracts would be for four year periods. PCT areas would correspond to district or unitary local authority areas. There would be joint working with LAs on public health and community care. District Community Health Councils would monitor PCT and health services.
An important factor has been the break down of the Team Concept – all NHS workers working together for the benefit of the patient. This concept might have been illusionary more than a reality but it should be a vision for the future. The ward cleaner does a vital job (when the contract and the contracting firm allow) but the contract does not provide for them to pause and speak with the patient, pass on concerns to Sister or contribute to the Team. They should be valued. MRSA and other virulent bacteria have shown the need for thorough cleanliness. They should be directly employed and answerable ultimately to a Real Matron. The catering staff are a vital component in the health and recovery of patients, but they are invisible. One of the biggest wastes in hospitals is the cost of the uneaten food thrown away. There are more complaints about this than any other. Organisation and management of that service together with low financial provision are the problem. Catering staff are not the problem and are probably the solution. Let’s include them instead of putting them at arms length.
The reality for hospital patients differs from the picture presented by Health Ministers. They have also presided over the disastrous decline in provision of frontline GP services. The patient’s experience is that they cannot make appointments when they want them, cannot get out of hours calls when needed, never see the same GP and miss the continuity of seeing their designated GP on a regular basis. Access to that other frontline service of dentistry is a lottery and becoming more difficult as it becomes more private orientated. A&Es and maternity services are being closed with the result that people – patients and visitors – have to travel further. It is also worth noting that NHS central purchasing procedure was resulting in goods having to travel further. We would decentralise and reinvent the rural cottage hospital and an equivalent urban community facility nearer to family and friends where patients could recuperate.
The conclusion is that the situation we have now is not good for the environment and not good for the poor who have no choice. The rich can buy what they want, when they want and where they want. New Labour is dominated by technocrats who inhabit a different world from the rest of us. Given any situation that needs addressing and they will come up with a complicated solution that is expensive, difficult to administer, hard to understand and usually based on unproven computer systems. So, we have the mega computer system for the NHS which is proving to be unworkable. If a computer based system is needed, why not go with a simple idea that is both secure and relatively inexpensive? Somebody has suggested that each patient has a personal memory stick which the patient keeps and takes to surgery or hospital where it is immediately updated. This uses proven technology. Every aspect of the NHS gives cause for concern.
Our proposed Bill for the Right to be Born would enable the transfer of funds released by the outlawing of abortion towards improving ante-natal and neo-natal services. More midwives would be trained and employed to provide a more personal and localised service with better home visit provision.
Another major concern relates to the administering of medication to hospital patients. There have been too many cases of people being overdosed or underdosed, and in some cases having their medication stopped without any explanation. Labour promised to get rid of mixed wards but have not done it and only achieved segregated ward-bays.
To sum up, we would abandon the target culture and set broad objectives. These would be to keep health premises clean, administer medication correctly, provide fresh and nourishing meals, eliminate mixed wards, and make sure that nursing staff and doctors are able to communicate clearly with patients. This would be achieved by making hospitals nursing led with a real matron in charge. There would be more tiling and copper fittings and an overpowering smell of carbolic. That should fix it.