Slash, Trash, and Privatize – or Transform the NHS?

I’ve been involved with the NHS, mostly but not exclusively on the Island, for at least 15 years now.  I’ve served on the CHC, PPI Forum, LINk (local involvement network); having been pushed pillar to post, I can’t now remember if I had anything to do with HealthWatch, when it was finally established, or not; I was certainly involved with setting it up; and until recently I served on St Mary’s Hospital Patient Council, and attended Trust Board meetings.

In all that time, I became wearily familiar with the stultifying jargon which bedevils the NHS – I’m quite good at forgetting what the various acronyms mean: I jettison them with unfeigned pleasure.  I coined one of my own, though, just to be in the swim of things: I called it Comparing Results Across Platforms, or CRAP for short (I have a million of ‘em), but I’m not sure the Trust thought this was quite in the spirit required.

The latest set of initials sent to delight us isn’t an acronym, though, but a set of initials.   We’ve had Vanguards, My Life a Full Life, and now we’ve got STP – which has earned itself the interpretation which heads this polemic, but actually means …. what the Hell does it mean….?   Bear with me; ah yes – Sustainability and Transformation Plans.  These are being “rolled out”, as the jargon has it, over the entire country in a somewhat piecemeal way and are predicated on the idea that the NHS is not sustainable in its present form, and needs radical change, reorganization, rationalizing, if it’s to survive in future – particularly, it’s said, if it’s to take account of what is sometimes called the demographic time-bomb: i.e., the fact that we’re tending to be living longer, but not necessarily in better health.

Coming as it does from this government, which gifted us Andrew Lansley’s Health and Social Care Act, a set of “reforms” that cost millions to introduce without noticeably benefiting the service at all, these proposals have inevitably created suspicion – particularly since they’ve been smuggled out without full public consultation, and are written in colloquial Venusian.  I have yet to see any document or proposal from the NHS at any level which is clear, comprehensible, has the courage to say what it actually means, or is even intended to be understood – and STP is no exception to that.

Ask any NHS professional, however, and they’ll tell you that the service is complex; it does face huge challenges; it could benefit from some degree of centralization of resources and expertise, because it doesn’t have the trained staff in all areas able to offer an excellent service and better health outcomes.  So, the response has been cautious – is this an indication that the government is actually recognizing there are issues with all the previous re-organizations that have taken place, including Lansley’s?  That there are better ways of doing things, which need to be grasped?  That to oppose all change in the NHS isn’t realistic, or likely to benefit patients?

The answer to all of the above is probably a qualified Yes: on the island, for example, we have a hospital which is under severe strain – while our population would not be sufficient to give us a general hospital like St Mary’s if we were not severed from the mainland by sea, the hospital trust finds it very difficult to recruit specialists in many key areas, e.g. haematology, and the number of beds on the island are not sufficient for the demand made on them.  Hence an emphasis on treating patients “in the community”, at home, or nearer to where they live.

This might make sense.  But the snags are obvious – one is that if this is a genuine attempt by government to solve specific problems, why are the proposals not being properly explained?  Why has NHS England instructed that Trusts should not publish them yet?  How come some local authorities are defying NHS England and publishing them anyway (and incidentally, why didn’t ours?).  And where are these services in the community to which patients can be referred, if not to the hospital? Well … call me suspicious.  The reason, I suggest, is that yes, there’s a need for reorganization – doing away with the present structure of NHS organization would be a start – but the question is whether this need is being used by a cynical government to mask cuts and privatization of services?

Why would anyone, how COULD anyone, trust this government not to use a rationalization plan as a means of cutting funding?  If you want to make a service better, more responsive to users’ needs, more effective and efficient, you start by re-designing the bits that don’t work well – you look at whether services at their present level can be sustained, and if they can’t, how they could be supplemented, transformed, re-built.  Then, if you’ve borne the need for making such change as efficiently as possible in mind throughout, you should find that duplication is avoided, communication is improved, services are integrated, as a result of which there should be economic savings.

What you don’t do – or shouldn’t – is confuse this programme with a cost-cutting exercise, starting out with a desire to slash spending and then slicing services away until they fit the mould you’ve made.  And if you involve the private sector – as the NHS always has, incidentally: all GPs are private contractors to start with – you do so because they can relieve burdens, improve services, increase flexibility.  Not because you want to service your private-enterprise ideology, or worse, reward your friends in that sector.

Anyone who trusts this government to transform the NHS in a way which benefits patients and respects its unique ethos possesses a nature so sublimely forgiving, not to say credulous, that they’re almost too good for this world.  I do not have such a nature, and no one has ever supposed that I command saintly qualities.  My strong recommendation to everyone on the island is that they watch the progress of STP here like hawks, and be ready to pounce the moment cuts are proposed disguised as progress.

Bevan said the NHS would be safe for so long as there were people prepared to fight for it: he knew we’d have to; he knew the nature of the Tory party.  There are those, including some in the NHS, who claim the service is no longer a political matter, that there is broad consensus on protecting and advancing it – I simply don’t believe them.

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