9 September 2021
“The Pride of Our Whole UK”
Desperately needs reform.
By Lynda Goetz
The NHS is something of a puzzle. It clearly needs adapting to the needs of the 21stC and yet we are constantly being told by politicians, the media and apparently the general public that it is ‘iconic’, ‘precious’ and effectively sacred. None of the political parties appears to have the courage to grasp the nettle and implement the necessary ground-breaking changes. Instead, in a miserable attempt to ingratiate himself with the electorate (which may yet of course backfire), our Prime Minister, in his wisdom, has decided to take the gamble of breaking manifesto promises (yes, definitely plural) and once again throwing more money at this insatiable monster.
It will never be satisfied. Money has been thrown at it time and time again. It has been tinkered with endlessly, but the mantra of ‘free’ at the point of delivery continues to defeat any real attempt at reform. Other systems in Australia, New Zealand and in Europe, which all include an element of insurance, continue to show their superiority and yet in this country we persist in our delusion that we have a system which is ‘the envy of the world’. It is not. It may have been in the past, but time and events have overtaken it. It is now a huge bureaucratic nightmare which no longer functions properly either for those who work for it or those it is designed to work for.
Many have their own stories of how the NHS has either worked or failed for them. At its best, it is brilliant. At its worst it is useless and abysmal. We neither need nor want these extremes. Tales of the impossibility of getting to see a GP; of the complete inability of hospital departments to coordinate with each other; of cancelled and re-scheduled appointments; of muddle, confusion and delay are endless. From the point of view of doctors, nurses, physios and other support staff, the stories are equally dispiriting. Morale may not be at ‘an all-time low’, but there is no doubt at all that it is low. Independence and initiative are ignored at the expense of rigid hierarchy. As a Band 5 physio you get £x and are allowed to do y. Should we need you to step up and fulfil the role of a Band 6, we cannot reward you in any way financially, nor speed your promotion, which will of course come in due time and when you have ticked all the boxes. As a junior doctor who has not yet decided on your speciality, we will not increase your salary until you are on a recognised training course and will ignore any locum or overseas experience you may gain as completely irrelevant.
This bureaucratic, tick-box approach to career progression is uninspiring and morale-sapping and yet our doctors and nurses have little choice but to put up with this (or go abroad, mostly to Australia or New Zealand, as many do) as well as keep paying for the endless exams required. They also have to accept the haphazard approach to HR, which no-one in the private sector would put up with for a second. ‘You’d like two weeks off for your wedding and honeymoon in a year’s time? Sorry, we can’t timetable that. We suggest you arrange a swap with a colleague.’ GPs may average £100,000 a year, but the job these days lacks intellectual stimulus or challenge and has been diminished to a role of triage for those ‘real’ experts in the hospital specialties. Gone are the days when the local GP did minor ops and dealt with minor emergencies or was responsible for patients whose families and circumstances they knew and understood. Now, after spending at least a half an hour trying to get through to the surgery reception, you might get a phone call from the duty doctor (whom you usually do not know and has probably never spoken to you or a member of your family) and, if you are lucky, a follow-up appointment a week or so later with whichever doctor is working on that day. Perhaps that is the way we have necessarily ‘progressed’, so maybe it is harsh to criticise if there is little personal touch now involved in the GP relationship. It should nevertheless not be as difficult as it mostly appears to be currently to gain access to the system.
Junior doctors in hospitals receive only around a third of that amount in the first few years after initial qualification and yet their hours are long (some departments have 13 hour shifts) and the connection with patients limited. Training posts require relocation to whichever part of the country they arise in, so relationships and roots can be difficult to establish. The general public, many of whom know nothing of this and understand little of costs and staffing, are ever more entitled and demanding. No longer are so many grateful for their treatment, but annoyed by delays, muddles and bureaucracy which get in the way of their treatment. For many people there is no link between the treatment they receive and the costs they pay; it is simply an unsatisfactory (or satisfactory) service paid for by their taxes. Taxes, of course, includes the National Insurance Contributions (NICs), which contrary to general misconception are not hypothecated or ring-fenced in any way.
In his announcement on Tuesday, Boris Johnson decided that he would have the support of the general public, who felt ‘in their bones’ the rightness of what he was doing, in increasing NICs by 1.25 percent to enable the NHS to deal with the backlog of patients untreated during the Covid pandemic and thereafter to enable a government contribution to social care. This may be the case, but as so many commentators and pundits have pointed out, even after Tory party opposition in the Commons disintegrated, this is not a Conservative party way of doing things. This is a high tax, high spend move and more reminiscent of the Labour Party.
Given the public reaction to the pandemic and the measures taken to protect people and businesses from the worst effects of lockdowns, it could be that there is a general shrug of the shoulders and an acceptance of the necessity for the tax increase (oops, sorry, Health and Social Care Levy), but if/when all the money raised is yet again absorbed by the NHS, before any change or improvement in social care is witnessed, will this move be forgiven at the ballot box? The answer is, it could be, because in spite of rebellion within the political party and within the ranks out in the country, there currently appears to be little alternative – either to the NHS or the Conservative party. Perhaps in three years’ time, the landscape may have changed?
Cover page image: Ehimetalor Akhere Unuabona (Unsplash)