Hi everyone
I think we had the same problem as I did on FrugalFashion. The email did not get sent out! But I’m not sure. Could you let me know if you’ve had one or two emails – thanks!!!
Now for the post.
This is a howl of rage and frustration at the state we’re in. And I use state as in what an absolutely dire, desperate and devastating mess and state we’re in – nothing works especially our poor knackered NHS.
Actually, I began this piece with the aim to take a look at public sector wages and funding but that became a dry and dusty misery fest of how awful things are. Instead, I have decided that this piece will lead to some positive thoughts on transforming the NHS. Nevertheless, we have to look at the context.
For starters, the UK is currently in the midst of an unprecedented number of strikes. We have strikes and planned strikes by train drivers and guards, bus drivers, postal workers, teachers, nurses, paramedics, border staff, firefighters, baggage handlers, civil servants, energy workers, ground handlers, driving examiners, rail carriage cleaners, National Highways employees, court officials, NHS physiotherapists, university staff. I think that’s all. But there could be more.
What exactly is happening and why? The problem is, the UK is now a low wage economy and the working population of this country is fed up with their insecure and exhausting jobs (think nursing staff for the latter) and the diminishing buying power of their weekly wages and monthly salaries. Factor in the rise in energy prices and you can see that the UK is in the midst of a perfect storm of civil discontent.
As an ex-nurse I think it must be an extraordinary situation for a nurse to contemplate not being on their ward or department for a day or so. But the NHS, our beloved NHS set up in those austere post-war days to serve the country is bleeding out. And it is ghastly to contemplate where we are today, what with ambulances queueing up outside A&Es with dying patients in them, only for the patients to be brought inside the hospital, after many hours, to be nursed in corridors, and only getting a bed if and when someone (they’re called bed blockers as if it as their fault!) is discharged from their bed into the community with social care that is so very depleted these days.
For goodness sake, how many decades have I heard about older people blocking beds because there is no social care? Many, many decades. This is not a new problem. But it is worse, much worse now and no, it is not all down to Covid. Think Brexit for starters. Did you know that Brexit has reduced the workforce by 330,000 workers? (The figures are the UK lost approximately 460,000 workers from the EU. Consequently, around 130,000 replacements have come from elsewhere, leaving us with a loss of 330,000. *See below for source). Meanwhile in 2020/21 there were around 165,000 unfilled social care posts, and somehow, one can’t help but think that to fill those posts you’d look to the EU, but no, that’s not possible now. And don’t forget the pittance these care workers are paid, which needs attention.
But it is funny how things began to change when the Tories came to power in 2010, no? Safe in our hands, was it? Our NHS? It was never safe, ever. This government has been utterly deceitful, as the NHS has been in a deliberate managed decline ever since they came into power.
The depths of my dismay are deep when I contemplate what this government has done, but let’s set my dismay aside. The problems with the NHS are enormous and it is not sufficient to say, it’s all down to bad management or even down to underfunding.
However, it is important to set out that while Labour was in government spending on health was brought up to the average amongst similar countries. But since the Conservatives came into power funding has fallen below the level needed to sustain the needs of the population. For example, (and I quote from a report ** see below for source) in 2019 the UK spent £3055 per person on total health expenditure, which was 18% below the EU average of £3655 per person. Over the decade only four countries in the EU14 spent less on health per head of population. The report concludes that had UK spending kept up with European neighbours the NHS would be more resilient and had greater capacity to provide care during the pandemic and reduce the backlog of care that has come about as a result of Covid. Ah yes, the backlog, there are 7 million patients waiting for more than 18 weeks for hospital treatment.
And before you say, but, but, there was no money when the Conservatives came to power. That is not the case. A panic was whipped up and Labour blamed for the budget deficit when in fact there had been a huge global crisis. Austerity and the push to reduce the deficit was a deliberate ploy from the Tories, as a cover for their goal of a smaller state. Austerity, which meant cuts to all our public services was their policy and their way to their vision of a low tax, small state nation.
But the problems in the NHS are deep and structural, and as well as underfunding, it is a systems and an approach problem (which I will discuss below) which won’t be magicked away with a few more beds and ambulances, which is the government’s recent short-term solution. My immediate response is where are those nurses for those beds, and where are the paramedics for those ambulances, who if they do arrive at an accident or an emergency quicker than they do at the moment, who is to say they still won’t have to wait outside the hospital to get into A&E?
The thing is behind every visit (Did I say visit? Huh!) in actuality, every phone call with your GP there is the most enormously complicated structure you can possibly imagine. For starters there is a quasi-market system of tendering and commissioning of services which (and read the details of the 2012 Act for this) must include the private sector. You don’t want the NHS to be privatised? It is pretty much already. The only thing that seems to be sacrosanct is that health care is free at the point of contact – for now. But for ever? I think not if the Tories remain in power and, heaven forbid, win the next election.
Another problem is that the NHS was set up when health care was thought to consist mostly of short stays in hospital for operations, so huge amounts of money go into secondary care, and all that is necessary to keep hospitals open, maintained and staffed. But now today, in 21 Century Britain there is a lot of morbidity, and a lot of unwellness and chronic illness amongst those with low wages, with insecure jobs. In addition, people are living far longer than they did in 1948, so what goes on in the community is actually key to keeping the population healthy.
But is primary care coping with the huge numbers of people who are unwell, who are ageing, who have chronic health conditions? No. Not now, when you cannot get an appointment for weeks on end. And is social care coping with caring for these numbers of the chronically sick, and ageing people? No. People stay in hospital when they are better (and block beds) because they cannot be discharged as their care package is useless when there is nobody to do the caring. And where is Public Health, once the key to campaigns to improve the population’s health, and once was safely in the domain of the NHS? It was hived off to Local Government, which I have to say is madness.
What is happening with this current crisis is that there is a huge mismatch between Supply and Demand. The Demand is coming from our sick, our stressed, our low waged and our ageing population. And the Supply? Politicians, are you listening? Anyone? Supply is not solved by building 40 more hospitals. Or by providing more beds. Or by providing more paramedics. Could you possibly, think outside the box and see that what this country needs is a National Health Service rather than what we’ve got which is crumbling National Illness Service.
Yes, we need to increase the Supply, and by the way, that won’t come about by introducing private medicine as the saviour of the NHS as the private health sector is manned (and womanned) by consultants and nurses who also work in the NHS. So, do you see, consequently, the size of the medical cake will not increase, there are only so many doctors and only so many nurses. In addition, the private sector is a paying carbon copy of the NHS, which I know only too well, as I have paid to see two different consultants of which one (cardiac) was brilliant when I was ill, but when I asked about my lifestyle and being healthy – he was rather non-plussed. There is, of course, support for the very unwell cardiac (heart attack) patients but not for anyone else. Doctors are not trained to keep the population healthy – it is all about rescuing us at the point when we are ill. It is this that needs to be changed.
I’d argue that what we need is a major transformation within our health services to diagnose and prevent conditions early enough before they become chronic. And how, you might ask? Well, the science is there, the data analytics are there, it just needs to be harnessed and brought into NHS systems. Because, if Covid vaccines could be produced as quickly as they were then bringing a more analytical and more scientific mode of working is not impossible to do.
But why bother – don’t we just want to reduce the waiting lists? Yes, of course, but do you see what I am asking for is a completely new way of working and a new mindset to prevent the frailty of our ageing population, to reduce the unwellness of our population, before they need an appointment with their GP, before they need an appointment with a consultant, and before they need an ambulance.
And above all, there is a need to reduce the pessimism that currently surrounds the NHS. People in this country need hope, the doctors need hope, the nurses need hope, the paramedics need hope.
What needs to happen now is the recognition that the NHS currently is in a very, very bad place. And there should be an acknowledgement that the NHS needs a properly thought-through long-term plan that looks at the future health of this country, a plan that is not about short-term sticking plasters. Alongside this all the staff need to be brought into this plan, this new direction, so that all the staff, doctors, nurses, paramedics and other therapists and support staff, know that there is an idea, and a plan, and some hope that the NHS has a future and that they have a role to play in it.
Unfortunately, what we have is a government that barely recognises there is a problem, that treats the nurses like naughty children, that seems to have no interest in any worker’s views, that wants to sack staff that go on strike – what! When there are huge staff shortages in the NHS and elsewhere?
Labour too, I’m sure, supports the NHS, but it is still unclear what its policies are. What an opportunity if Labour could look at the NHS in the round, and said less about how the government’s approach is not working (it isn’t) and instead thought through a policy for the NHS based on prevention and the health of the nation.
It can be done. It must be done. For the sake of us all.
Penny Kocher, 1st February 2023
Further reading:
*Bloom, J, Brexodus: where have all the workers gone? The New European, Issue 326, January 26-February 1, 2023
Mason, P, Transform the NHS into an engine for the redistribution of wellbeing. The New European, Issue 326, January 26-February 1, 2023
Elliott, L, On the NHS, Sunak and co seem unable to grasp economics 101: pay more. Guardian 15.01.2023
Blyth, N. Ross, Strategies to Reduce Waiting Times for Elective Care. King’s Fund, 12.12.2022
Denis Campbell, Decade of neglect means NHS unable to tackle care backlog, report says. Guardian, 12.12.2022
**Robolledo, I. Charleworth, A. How Does UK Health Spending Compare Across Europe Over the Past Decade. The Health Foundation. 16 November 2022
NHS Confederation Press Release. NHS leaders warn that social care workforce crisis risks patient safety. 28 July 2022.
Also please note, I was enthused and inspired on hearing Alan Milburn’s views on the transformation of the NHS. Do listen to him being interviewed on the podcast Leading, by Alistair Campbell and Rory Stewart.
Just had one email
I live in Scotland similar problems including inept health minister
the SNP peddle the lie that Independence will solve everything
Phew – good to know it’s got through! The disconnection of the email from the blog (which is automatically activated by WordPress not me) must have happened at the same time as it happened to FFS but as I hadn’t written anything on MOB I obvs didn’t know about it.
Thanks for letting me know
The email has just arrived but the sender is WordPress not you.
Now to read your article
Thanks Sue. Yes, the email is automatically activated by WordPress when I publish. It must the got disconnected (and we don’t know why) at the same time as it happened on FFS.
second email from ‘myotherbolg’ has just arrived
Really? Oh goodness. I suppose when I reconnected the blooming thing it went looking for posts that hadn’t been sent an email. I have btw, binned the first one!!
Gosh my stress levels went up! Thanks for letting me know!
Hi Penny
What an amazing summation of our present situation, plainly explained and easy to follow.
If only the Government would admit
and be honest with us all.
In my opinion the NHS needs a total restructure, too top heavy with non carers!
I hope you have rattled a few people with your post.
Keep them coming
Joyce Lynch
Thank you so much Joyce. I’m noticing that there are more and more articles asking for radical change in approach within the NHS – maybe it’ll filter up to the politicians? I do hope so!
Thanks again for your kind words – I do feel passionately about this.
Just one email, Penny, from WordPress. Good to read anyway.
Like you I despair at what’s happening. We had a salutary lesson in NHS problems just before the pandemic when my 96 year old mother in law was reaching her end, in and out of hospital. The treatment itself was fine but the systems around it so inefficient, and as for the home care….. hopeless. And that was before we’d even heard of Covid. My husband and I, together with friends we have talked about this with, are continuing to ensure that we stay as fit and healthy as possible, barring accidents of course. Determined for the time being to stay out of the need for health care intervention. I believe that an election won by Labour will start to halt this awful decline and eventually bring us back to at least where we were in 2010. Just bring on the general election, it can’t come too soon.
Stay well!
Yes, I had to reconnect the automatic email response – it had somehow got turned off.
Honestly I barely scraped the surface of the deep structural problems within and without the NHS. Social care has to be sorted and soon, as that is in an even worse state than the NHS as you found out with your mother-in-law. We need to have not only have a debate about how social care is paid for, there needs to be a grown-up debate about the reality of ageing and the needs thereof that ageing generates. But it is never tackled as politicians think in ways that are so very short-term.
Thanks Kathy
Only one email…. Sorry I haven’t had time to read this yet 😉 I’ll be back with comments as Your Other Blog usually needs my earnest attention! Trish S
Wow Penny. You know your stuff. I can’t disagree with any of it. The problems are manifold and the solutions are not simple. I have personal insight into the poor running of the hospitals, but with regard to the older patient, the lack of community care, the tendency of many GPs to wash their hands of things once it has escalated to specialist level, the lack of social care, community nurses, specialist nurses, social workers, beds for intermediate patients in some sort of care facility; the expectation that often aged partners will provide all of this, with little input from social services, or NHS services. The weird idea that virtual wards will replace hands on care! What is that about! Then there is the exhaustion of these carers, making them ill themselves. The lack of any mental or social support for them, if they don’t have children who can help, or who are nearby; and even if they do, who have the time and can afford to step back from work, or their own children’s care. It’s a positive juggernaut of need that is going unsatisfied. How can we possibly get this ‘rich kid’ government to listen. VOTE them out! Currently it seems like the only way. I just hope the situation is retrievable by the time we do! I can see that many other states are also in difficulty but none as difficult as ours.
Yes, I barely mentioned these points, there is indeed a juggernaut of need out there in the community that is so badly dealt with, let alone anything that might mitigate ageing and delay the decline into frailty – that’s not dealt with at all. I think that happens because i) politicians think in short-term bursts and deal with immediate crises, and ii) we, as a population, see chronic illness in the young and old as something that won’t happen to us – it is a problem but not ours – yet or hopefully at all. Not blaming anyone for thinking that way, because it’s only human.
What we need right now is some leadership but not sure from where it will come. But in the meantime, yes, let’s get rid of this ghastly government which is at the route of so much that is wrong with our country.
Fingers crossed that the great British public will finally realise what is going on!
A well presented and easy to understand explanation. I totally agree with your comments and suggestions. If only the politicians were willing to take a long term view of the situation. It needs a cross party.
group to work on a solution to the problem. It should be taken out of the political arena as we are in an emergency situation.
best wishes
Heather Wilson
Yes, indeed it should be a cross-party matter, or even a non-political matter, but it won’t happen as the NHS is always a political football.
And yet we do need some leadership on this and a nation-wide grown-up debate on how social care is paid for. Unfortunately attempts to deal with social care are often blown up into all sorts of nastiness, e.g when Gordon Brown and then Theresa May tried to look at this, their attempts got called, a Death Tax, or a Dementia Tax and numerous articles spoke about the iniquity of taking away people’s life savings which could have been left to their children. But this does have to be debated and discussed in hopefully a grown-up way – as a solution is so badly needed.
Thanks Heather
Just the one email. Thank you for putting it all together.
Hi Penny
I received the email from WordPress and your excellent summary of the general state we’re in in the UK and particularly the NHS. It’s so depressing and as you said we desperately need a change of government. However if Labour do get to form the next government – and it can’t come too soon – they will have a lot to do to sort out the mess we’ve been left in after 13 years of Tory government. Please continue with these blogs Penny.. they are great!
Oh good – the automatic WordPress email must have got disconnected when we changed the look of the blogs. I will look into why it has become more apparent that it is from WordPress – there is something we can tweak that will sort this, I think.
And I agree, oh my word, the mess this current government is leaving for Labour to sort is immense.
Thanks Tina
Hello Penny, thank you for this very interesting article. I am from the UK but have been living in Milan for the past twenty years.
There is a greater emphasis on preventative care here. It’s not perfect and taxes are high but I can see a doctor on the same day I ask for an appointment.
Oh wow, Charmaine, seeing the doctor on the same day has flown out of the window. You can’t get through to the doctor for starters, not in Lewes, as you can be 40th in the queue – it’s awful. There is an email pathway but it’s very clunky and I think impossible for anyone who isn’t au fait with IT to deal with.
I am so interested that in Italy the emphasis is more preventative. I wish it could be so here, as really it is so logical. Why wouldn’t a nation wish to prevent its population from declining into unwellness? Here’s to a change of direction within the NHS towards diagnosis and prevention – but how? I think more and more people have to shout from the rooftops that this is what we want.
Thanks Charmaine
Oh Penny……..where to start! I remember Gerry Robinson – some kind of hotshot CEO – having a look at the NHS and ending up with his head in his hands in near despair. It’s such a massive organisation so full of intensely clever people who all think they know best. I know, I was a Non – Exec on a hospital board when the only game in town was Foundation Status. A massive waste of time and money for a political ‘flagship’ that was fudged to make it work, only many of the FTs ended up in financial difficulty anyway. I also remember being shown a triangle which represented how much money is spent on each tier of care and the most money was being spent on the small number of people in acute and tertiary services. The aim was to invert the triangle and put the most money into community and primary services to keep people well but you could never release the money to make it work. This was the late 90’s and has anything really changed? Now I’m a cancer patient and I must say that after a slower than optimum start to my ‘journey’ (how I hate that term!) I am receiving very responsive care. This morning I realised I had a urine infection , went into the acute oncology unit for obs.bloods etc and left with antibiotics 2.5 hrs later. This included getting the blood results so they could give me the appropriate one. However, I’ve been a bit alarmed by some of the stories I’ve heard (first hand) about late and/or incorrect diagnosis of cancers. I’m on a drug that would cost me £3000 a dose if I had to pay for it and there is a system (bought from the private sector) where it can be administered at home. Perhaps this is not the best use of scarce resources seeing as I’m 70 but on a personal level I’m grateful. However I agree that we must put more focus on preventative work and earlier detection of disease so that it’s easier and cheaper to treat. Those who can, i.e. the majority, must accept personal responsibility for their health and well-being with the support of professionals and be pro-active where possible. If only a cross party agreement could be brokered so that there is time for a new approach to be embedded. Government expect too much too quickly in order to bolster their party’s election prospects. I could go on like this for some time so will stop now!
Oh yes, I remember Gerry Robinson and his take on the NHS. Actually Alan Milburn said it is such a massively complex organisation that is practically unmanageable, so it’s best if you give some autonomy to secondary care. And you know more than anyone else how difficult it is to manage these organisations what with your experience as a non-Exec. How interesting for you to have been through that experience.
I too remember Foundation hospitals. There are so many failed initiatives. It’s all about Integrated Care Systems – see a very good explanation from the King’s Fund https://www.kingsfund.org.uk/publications/integrated-care-systems-explained?gclid=Cj0KCQiA2-2eBhClARIsAGLQ2RkQ6BcSn2lGeMVVwtDv-XSwxG3yg7ugQGFtFRQ2MemrLaWVZ-0XOqIaAmFlEALw_wcB
Yes, I can see the principles behind it – anything to move social care and health care nearer to each other the better. But what else do I see? I see many, many grey-suited men (and women) talking in meetings about how to go about this ‘initiative’. The thing is how does it translate down to the front-line? How is Mrs Brown affected when her care company tells her daughter they have to cut down her care to 15 minutes from 30 minutes. And seriously what can you do in 30 minutes anyway? It’s all so very bureaucratic. I am not convinced that things will change all that much. It’s like stopping a tanker – it seems to take for ever. What we need is some radical thinking and critically some leadership.
And now you have the experience of your recent diagnosis of a melanoma. It’s good to hear your care is responsive now, but I was so shocked when I heard how long you had to wait for your op. Diagnosis is so critical to good outcomes for so many conditions but especially cancers but acting on the diagnosis is also key – as you know yourself. I keep coming back to the need for leadership and going beyond the immediate crisis with a few more beds being the answer. The question is never asked: why are they in those beds in the first place. Yup – we need an overhaul in approach and some bod, ( I don’t know who) who can carry this through.
I too will stop now!
Thank you Penny for such a well researched article. I almost deleted it as Spam as it came from Word Press. I am so glad I didn’t. I wish there was something more we could do as individuals. Your article deserves to be sent to politicians and published widely by the newspapers.
Ah yes, I realise now that there still needs to be a further tweak. The email always has come from WordPress (and it got disconnected when we changed the look some weeks back) but there is another thing we need to do to get that WordPress email looking as though it has come from me. We’ll work on it!
And thanks for those kind words about my article
Hello Penny, I do agree with your analysis but I think that it’s important to recognize that the NHS does waste on procurement and management. More importantly, 50% of NHS resources – I have read – are spent on illnesses arising from obesity. We need to do much more to look after people and eliminate poverty.
I agree with you that the complicated system tendering for contracts to procure services is incredibly wasteful and so very bureaucratic to boot. And so many managers for this very complicated system of health care. It does need a different approach. Societal factors come into play a lot here. Poverty makes people ill – I think politicians have forgotten that fact.
Thanks Paula
Great article as usual Penny (through WordPress). You’ve made the solution sound so simple. I sincerely hope things change in the not too distant future.
Thank you so much Christine – and yes we need to do another tweak so the WordPress email looks like it’s from me!
I could have written the nearly the same post about the U.S. despite our different healthcare structures. In a nutshell: the greedy, rich people have taken control of our governments and want to squeeze yet more from the workers who create their wealth in their never-ending quest to satisfy the emptiness inside their soul.
Michelle
https://followingmymuse.space