Blamestorming and Bedhunting
Politicians have always been adept at centralising praise and devolving blame, but for Theresa May and Jeremy Hunt to blame GPs for the meltdown in hospitals takes it to a new level of stupidity. True, the waiting times for routine GP appointments are rising (due to increased demand and a lack of GPs), but 86.3% of GP practices in England already provide pre-bookable appointments outside core opening hours. The limit on appointments is down to the number of GPs, and we have fewer of them per head of the population than comparable countries in Western Europe. Hence the alarmingly high levels of staff stress, unlikely to be eased by the government’s crude blamestorming.
We also have far fewer hospital beds per head (2.8 per 1000) than comparable countries, and are about to cut thousands more in an attempt to squeeze a further £22 billion of savings out of an already over-stretched NHS. Patients who go to emergency departments for a minor illness that a GP, chemist or sensible family member could have sorted out are easily treated. The reason hospitals are in crisis is because of the number of sick people turning up who need to be in hospital, and the cuts in social care preventing discharge. The lack of NHS intensive care and high dependency beds has absolutely nothing to do with GPs, and neither does the increasing cancellations – often repeated – for urgent heart and cancer surgery. The costs of standing down entire surgical teams because intensive care has no beds is considerable, not to mention the distress caused to patients and relatives. Without beds, hospitals are paralysed and highly paid and trained clinicians can spend all day on a bed hunt.
MD has been writing this column for 25 years, and although the NHS and social care system is not quite in the disastrous state it was in the nineties, when waiting times regularly exceeded 2 years and deaths in the queue were commonplace, it’s heading back that way. Our health spend is around 8% of GDP, heading for 6.6% by 2020. Civilised countries spend between 10-12%. UK NHS spend fell to 6.3% in 2000, when Tony Blair made a promise to match the EU average – but on the proviso the NHS accepted mass management consultancy, an expansion of outsourcing and private provision, diabolical PFI deals and a move towards American models of ‘integration’ and ‘accountable care.’
The Conservatives and NHS England have accelerated this corporatisation of the NHS whilst deliberately defunding the service, forcing departments to close because they cannot be safely staffed to cope with the increased patient demand and the costs of technological advances. May could take a lot of pressure off herself is she ‘did a Blair’ and agreed to fund the NHS to the Western European average. Yet despite months of terrible health deadlines and missed targets, a ComRes poll from January 11 and 13 asking ‘Who would do a better job at managing the NHS this winter?’ found 43% in favour of the government and only 31% in favour of Labour. If Labour can’t win on the NHS now, it can’t win on anything. And it leaves the government free to pursue its aggressive austerity agenda that is undoubtedly contributing to avoidable deaths, albeit of those unlikely to vote Conservative.
The social care crisis can be traced back to Margaret Thatcher’s decision to allow long term care to fall off the NHS. In the 20 years from 1979, over 100,000 long stay beds were lost from the NHS. Patients with incurable diseases were re-categorised as ‘social care’ rather than ‘medical care’, transferred to private nursing homes and obliged to pay the difference between social security benefits and the nursing home fees. In 1990, a 55 year old man was admitted to an NHS hospital with a severe stroke leaving him incontinent of urine and faeces, unable to talk, walk or feed himself. The hospital discharged him to a private nursing home in 1991, on the grounds that it had done all that was possible to cure him, and the NHS had no obligation to care for him. So much for cradle to grave.
Savage cuts in social care funding have predictably bankrupted many nursing and care homes. Jeremy Corbyn’s idea to take them back into state ownership makes good sense, but is unlikely to happen. The government urgently needs to invest in general practice and social care, not blame it, and halt further bed cuts. But with no credible opposition, it might get away with running services into the ground, with the NHS becoming a poor service for poor people. Everyone else is expected go private (as many do in NHS England, the Department of Health, the CQC, the GMC and even the BMA). The NHS is still the place to go in an emergency, but you may have to fight for a bed.