Unfortunately, if history is anything to gauge this year by, it won’t be a year of bringing down government spending and demanding never before seen increases in public sector efficiency.
As we approach a late spring election, no politician in their right mind will say publically that they are going to hold the public sectors’ feet to the fire. The private sector and taxpayer have already made their contribution to the monumental bailout that we are faced with through lower wages, higher taxes and job losses. So far the public sector, and remember they have been some of the largest beneficieries of the past 10 years, have not contributed at all. The public sector and how we repay our massive public debt is today the problem, the elephant in the room.
Take health for instance, the biggest beneficiary by far of this huge increase of public spending under Labour, we have see a tripling of funding for our health service. By most measures, we have funded it at a level commensurate with the French and German systems. We don’t get the same level of services unfortunately. Cancer and heart disease outcomes are some of the worst in Europe and we still suffer very long waits to access services. Some countries spend significantly less on health than we do and get far better outcomes, disabling the NHS’s constant plea for more cash, or using it as a reason for such a poor service. Last year, the Department of health decreed that there would be a 20% across the board cut in NHS spend. Unfortunately for the patient, the NHS does not either understand, or have the management capacity to translate that into anything more than a cut in services to the user.
What the next government needs to do is place the onus of producing results on the NHS, break the monopoly and mandate the introduction of new high to medium level management as well as continue to pursue, with increased vigour, the introduction of the plurality of providers. The two central issues that should be tackled immediately is workforce and thus pensions. The public sector cannot continue to be protected from the realities of the pension shortfall by the government sacrificing our financial futures. The next government must step in immediately and reduce the destructively generous NHS and civil service pension provision, renegotiate the GP contract and make Consultants choose whether they want to be privately employed or remain public servants. Once the decision is made, it should be contractually stated that the consultant public servant should not cross the private divide and private Consultants should be contracted on the basis of outcomes and throughput. The next government should acknowledge immediately that doctors control 70% of NHS spend thought the decisions they make and hold them accountable for that spend as well as the welfare of their patients.
The value destruction in the NHS over the past 10 years has been eye watering. The tripling of the NHS budget has not translated into even a doubling of the output. If anything, as measured by the NHS itself, there has been a reduction in productivity. The NHS has become very good at buying itself out of trouble by lazily purchasing services from the private sector while at the same time publicly bashing it. This practice should be brought to an abrupt halt. Trusts who continue to take the lazy way out at taxpayer expense should see their management terminated, not reemployed elsewhere which is the current practice, and not expect to be bailed out centrally.
To ensure that change benefiting patients and taxpayers takes place the new government will have to inflict change on not only the top rank of management in the NHS but also many layers below. The professionals will have to adhere to realistic quality markers and agree to be paid for real performance and not potential or perceived outcomes. The department of Health will have to move from being cheer leader for the service and become its biggest critic. No longer should Ministers tolerate the many thousands of preventable deaths.
Unfortunately, for the current NHS management, real change is never effectively implemented by the incumbents. It is unrealistic and cruel to ask a person or management team to change a system they have created over the lifetime of a career. First and foremost, the majority will have significant ownership of the model and will never be able to see the need for change. Secondly, they are usually the ones who have the most to lose if change occurs. Which brings me to the real problem; change creates winners and losers and many of the current management and senior clinical professionals tend to be the biggest losers as they have generally been the biggest beneficiaries. It’s the old adage of turkeys won’t vote for Christmas.
To give them credit, this current government has tried to work with the NHS to solve these issues, drag it into the 21st century, coerce it into acting prudently and in the best interest of the patient and not the selfish interest of the NHS. It has failed to a greater extent, not as a result of its efforts, but as a result of the anecdotal war that has been fought by the embedded special interests against the changes. Fortunately for politicians, the electorate is fast becoming the NHS’s largest critic as they experience other health system on a first hand basis or read about the lack of waits and significantly better outcomes in other countries on the internet. The power of the patient, if allowed to grow and prosper, will ultimately be the change mechanism that brings the NHS into the 21st century or commits it to the history books.
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