Brave New Dawn for the NHS?

It is rare in the UK for the majority to agree on something. Whatever your political persuasion, it is now widely accepted that the NHS needs to reform itself in order to continue as a free service for all. I accept that use of the word free is somewhat spurious given that the majority still have to pay just to park when they get there. Some would also argue that it isn’t free anyway because we all pay for it through taxation. Setting aside these arguments, my basic point remains. As I write, I can arrange an appointment with my GP or present to my local casualty department and be seen by a trained doctor.

The new man at the head of the world’s second biggest employer is Simon Stevens. Few would envy his task. I can’t imagine a more challenging time for anyone to be taking over the helm of the NHS in the UK. Obesity levels in the under 20s continue to rise as do their poor health outcomes in later life. People are living longer due to major improvements in drug treatments and medical interventions. With old age comes more illness. Care of the elderly has become something of a political football in which nobody seems willing to address the real problems. Dementia continues to challenge policy makers. Mental health continues to be treated as the forgotten cousin. Although the numbers who smoke have dropped slightly, the numbers of young people taking up the habit has hardly changed in spite of so many campaigns to address it. As a nation, our consumption of alcohol continues its inexorable rise and the after effects continue to exert immense strain on both our hospital wards and A and E departments.

Simon Stevens has just given one of his first interviews and I found his ideas refreshing. Assuming he can overcome the political resistance which is sure to come his way, I believe he has some great solutions. He wants to see a move away from mass centralisation in favour of more local hospitals. In terms of care of the elderly alone, it is a mystery to me why local community hospitals were ever abandoned in the first place. When my father died recently, he did so in a large hospital on a bay in a general ward. Aside from it being a completely inappropriate setting for a dying man, there were so many other elderly people who should never have been there. Some had severe dementia and the hospital nursing staff just couldn’t cope. Some had minor illnesses which would have been much better supported within the setting of a local cottage hospital. The nurses in our hospitals are generally very good but are just not in a position to deal with many of the patients thrust upon them. That is not their fault. This is just a case of horses for courses. Our general hospitals are really important for those with serious illness but are just not geared up for dementia, palliative care and minor illnesses in the same way. My local community hospital is highly prized in the town where I live. It has an x-ray facility, it has a phlebotomy service and local women can now go there to have their babies as they did when I was born. Simon Stevens seems to understand that if our local community hospitals are properly utilised, they can take a huge strain off the larger general hospitals. That is indeed what they always used to do! The important point here is the absolute advantage of treating someone in the locality of where they live whether their condition is terminal, dementia or minor. The need to raise money for our wonderful Hospice movement has become all the more great in recent times due in no small part to the relentless destruction of our community hospitals. It is comforting to know that the new man in charge of the NHS recognises the importance of community hospitals from so many different perspectives.

He also cites the devastating effects of waiting time targets on patient care. The politics of who introduced them is secondary to the recognition that they have done so much harm. Targets are all well and good but not when they compromise patient care. Mr Stevens also alludes to the negative impact of the European Working Time Directive. He asserts that the EWTC just made it harder to keep the smaller community hospitals open. Few subjects have polarised opinion more than the EWTC. As ever, there is a sensible middle ground which has become lost in a political quagmire. Expecting junior doctors to go back to the days of a 100 hour week is just silly since sleep deprivation is hardly compatible with good patient care! But applying the EWTC to the letter is also silly since many people are quite capable of working a 60 hour week without too much trouble. Many people in other industries regularly work such hours and nothing is ever said so its sometimes hard to see why it has become such a big issue within the health service. Most of the people I know who run their own businesses regularly work 60 hour weeks or greater. Their businesses don’t seem to be suffering too badly. I know huge numbers of carers who work around the clock day after day for little or no money and nothing is ever said. This is another clear example of an area in which we can renegotiate the extent to which we are prepared to comply with the dogmatic approach of the European Union.

In his last point, I do take issue with Simon Stevens. He proposes that employers reward their employees for losing weight and taking up healthier lifestyles. Reward always worries me because the incentive doesn’t come from within. I also question where employers are expected to find this money from? I can see his idea but can’t see how it can be applied in a practical sense. The strategy of rewarding and penalising people seems to avoid the real issues. Wouldn’t it just be easier to educate people properly in the first place? Surely, they would then be better placed to make the right choices in terms of their future health outcomes. We always have to respect freedom of choice but we also have an obligation to educate the public if we want to continue with an NHS which remains free at the point of access. He is right to suggest a strategy though because he obviously recognises the urgent need to get people to take ownership for their health choices. I just don’t think rewarding them will achieve that. Give a man a fish.... 

Overall, I like what I hear from Mr. Stevens and wish him well. He is making all the right noises at the beginning of his tenure. I only hope those aspirations are converted in to reality by the time of his departure. If they are, he will have gone a long way to addressing the key challenges which threaten the continued NHS model in which we can all present to our GP or casualty department free at the point of access. Failure to do so will make charging inevitable irrespective of political persuasion.