New thinking can cure the old NHS problems27 April 2012
The Yorkshire Post
When the National Health Service was established in 1948, its founder Aneurin Bevan said: “We shall never have all we
For more than 60 years, the NHS has been proving him right. The line on the spending chart keeps on soaring. In
1948 we spent three per cent of our GDP on health care.Wenow spend 10 per cent, and by some estimates if we don’t do something pretty drastic we will be spending over 50 per cent of GDP on the health-care system by the end of this century.
Labour doubled spending on the NHS over the past decade, but now the country has lurched into financial crisis.
The coalition’s approach has been to freeze spending, which means the NHS will have to do more and better with less in order to make resources stretch to meet the demand.
With some 1.4 million people employed in the NHS (150,000 of them in Yorkshire and Humber), changing the
NHS means changing the way everyone in the system works.
And since over half of the costs of the NHS budget go on this workforce, there is simply no way that the savings can be achieved without taking a very close look at doctors and nurses (84 per cent of the total headcount).
The number crunchers at the Office for National Statistics, the National Audit Office and the Audit Commission have repeatedly pointed out that the NHS isn’t efficient enough – especially given the wage inflation enjoyed by our doctors,
who are some of the best paid in the world.
Recent signals from the Government indicating they want to take a look at the existing terms and conditions have prompted shroud waving from unions such as Unite. They say that proposals for regional pay negotiations mean that
Yorkshire folk will be paid less than people in rich parts of the country; but they already are paid less than people in
What nobody seems to be arguing for – and what makes most sense, especially when we look at how things
are organised in the private sector – is for employers and managers to be given the power to negotiate contracts with their own staff in their own institution. This would give them freedom to hire the right people to work in the best ways.
The use of flexible terms and conditions and rewards for high performance is common in the best healthcare organisations around the world. In the region of Valencia, Spain, private companies run almostaquarter of the hospitals and related primary care services, covering about 850,000 people.
The Hospital de Manises, for instance, has operating theatres and clinicians working around the clock, supported
by hi-tech systems. Collectively, these hospitals are 25 per cent more productive than publicly owned ones.
Getting more bang for our very many bucks also means being smarter about where services are delivered to
patients. The NHS was set up to deal with emergencies and infections; now the big threat is old age and long-term
Yet, while many other countries have been investing in new services, we have propped up the old, traditional
structures (which are also extremely expensive). Other countries have spent money on stopping people getting ill in
the first place and moving treatments out of hospitals into more cost-effective and convenient settings; we have built
more hospitals and sent more people to those hospitals. From 2000 to 2010, hospital admissions rose in Sweden by 1.6 per cent, but in the UK by 38 per cent (a third of them unnecessary).
For existing staff, this would mean working in different places – such as consultants in GP practices, and more
nurses in the community.
Just over the border, NHS North West has spent 10 years trying to widen what policymakers call the “skill mix”:
for instance, training up “assistant practitioners” to do many of the routine tasks normally carried out by nurses in
order to free up nurses to deal with more complex cases.
Bolton and Salford PCTs have coordinated much more care for old people in their homes, which has reduced hospital admissions and saved money. This is not budget care: this is global best practice and it is recommended byanumber of patient groups here in the UK.
Change is hard, but our system is full of dynamic and committed individuals who want nothing more than to
make patients healthier and happier. Managers need to support them – and government needs to support them.
In the existing NHS rules, hospitals and other employers can innovate with the terms and conditions of their staff,
but that flexibility is rarely used at a local level. The Government should go further in extending local freedoms by removing all kinds of impeding regulations – and it needs to keep pushing power and responsibility down to managers.
The goal of this workforce revolution is the best care that is possible for patients. Patients deserve nothing less.