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NHS Networks Blog November 2012

Daz isn’t the answer to stubborn, dried-in NHS thinking

Perhaps it’s the weather, the gloomy afternoons, the onset of Christmas only a few months after the last one, Jimmy Savile, another grubby little wave of expense fiddling MPs or the exposure of the world’s greatest cyclist as a cheat, but there is very little to lift the spirits. 

So many reputations have unravelled since the phone hacking scandal, surely there are no nasty surprises left unless it turns out that Sooty and Sweep regularly exposed themselves to young fans in their dressing room while Soo chopped up lines of coke and took pictures. 

Mid Staffs and Winterbourne View demonstrate how the well-meaning 65 year old NHS can still get it horribly wrong. The worry is that the disgrace, like Jimmy Savile’s, may be posthumous. 

If the runaway train of the reforms doesn’t see to it, another couple of decades of rising life expectancy, increasingly prevalent long-term conditions, persistent health inequalities and rising healthcare costs will make it impossible to run a tax-funded health system – or any system that delivers universal healthcare irrespective of the funding arrangements. 

John Appleby, chief economist at the King’s Fund shows a graph illustrating how the cost of the US healthcare system will eventually reach 99% of GDP.

It is not like climate change – there is no real debate about the fundamental economics and no deniers. There are only people who wish it were not so, who blame the government of the day and believe that moral imperatives should dispel inconvenient economic truths just as modern detergents wash out unpleasant and embarrassing stains. 

Cutting health funding while you bale out banks is a moral no-contest, but how about cutting social care or education budgets to protect NHS funding?  That’s a harder one unless you have Daz for brain cells in which case the answer is to just keep funding everything. It’s fairer, kinder and the only drawback is that you turn into Greece. 

Remedial programmes like QIPP are not enough. As conceived QIPP is a force for good, but as implemented to date it has been too narrowly focused on efficiency. There have been hints that the efficiency drive will need to be extended or made permanent like a horribly inverted version of Christmas every day. The idea that rising costs can be contained by an endless cycle of saving and reinvestment is absurd.  Calling it innovation doesn’t make it any more likely to work. 

The things that will save the NHS are the things that politicians glibly promote and only supreme optimists really believe in – mass adoption of healthy lifestyles, a step-change in treatment of long-term conditions, an overnight revolution in telecare and self-care, a transformation of clinical practice (“right care”), a huge shift from expensive hospital-based care to less expensive care somewhere else, revolutions in leadership and management practice, radical improvements in education of people to use the right service at the right time,  a decent standard of care of the frail elderly population, modern IT and vastly improved information management, accelerated training to address the shortage of clinicians, eradication of inefficient and barely legal procurement practice, integration of services, co-operation of health and other agencies…add your own favourites.

The NHS is “committed” to every one of the things on the list. They are all happening slowly and in various parts of the system.  If they happened everywhere tomorrow perhaps the catastrophe could be averted. “Everywhere tomorrow” may be an unrealistic scenario but it’s the last one available. Even if we don’t believe it, behaving as if we do is our best shot. 

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You can find John Appleby's presentation on the sustainability of the NHS here.

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