Sunday, 15 January 2017

Dear Mrs May ... We need to talk about the NHS

 This letter is sent to you with good intent, with no political bias. Although I have been a Tory voter for most of my adult life, when I was working in the NHS during the 2010 election, I felt that a labour victory would have been poor for the economy but preferable for the NHS. I believe that the two previous Labour Health Secretaries, Alan Johnson and Andy Burnham understood our state funded health system while their two Tory successors, Andrew Lansley and Jeremy Hunt, have done more harm than good.
I fear that during your short tenure as Prime Minister so far, you are getting it terribly wrong when it comes to a service genuinely under severe pressure and I have some very simple advice for you – so please take note:
Avoid mixed messages: In your first speech outside No.10 just after accepting the Queen’s direction to form a new government you channelled a mix of Mother Teresa and the three musketeers with your commitment to make Britain a ‘country that works for everyone…. Do everything we can to help anybody, whatever your background..’ Maybe you were trying to emulate Margaret Thatcher as she quoted St Francis of Assisi’s prayer when she came to power, but like Maggie, you appear to have quickly turned from school welfare officer to Headmistress. This is not always a bad thing – as long as you still have the welfare of our community well in hand but this doesn’t seem to be the case.
There is no quick fix for the NHS: But something does need to be done as a matter of urgency. You need a short, medium and long term plan. It is vital that primary, secondary, tertiary care and social services are all linked but we know this is a highly complex process that will take time. Resources need to be increased at every stage of the patient pathway (including prevention to stop them becoming a patient in the first place) as each area is of equal importance. In the short term you must..
Admit there is a crisis: If you don’t believe doctors, nurses, NHS managers or even patients and their relatives – look at the statistics. The targets for  Accident and Emergency departments and hospital waiting lists are reasonable and achievable in an appropriately resourced facility  but if a hospital is short of staff (clinical and administrative), beds, equipment or places to safely transfer patients within the community, they will start to miss targets as a matter of routine and this is happening. Now.
   Austerity and a state funded health system don’t mix:  Service improvement and efficiency
   measures can help but they are not enough. Choose your metaphor – the dead horse has been   
   flogged, the blood has been squeezed out of the stone, the NHS has streamlined its services and
   yes there is room for further improvement, but additional resource (funding) must be made
   available. We are already lagging behind many of our neighbours on % GDP spent on health and
   last year in his article on health spending the Kings Fund’s Chief Economist, John Appleby placed
   the UK at 13th out of the original 15 EU members. Like it or not – we may have to accept an
   increase in tax to allocate additional resource where it is vitally needed.
   Don’t ignore private healthcare: Subcontracting to local private facilities is already assisting
   some NHS Trusts with capacity issues and are a realistic option to be considered by clinical
   commissioning groups. As I am sure you are aware, for example, hip replacements undertaken in
   a nearby private hospital with spare capacity can be a cost effective way of freeing up local NHS
   beds  for trauma cases and ease pressure on A&E. This is not privatising the NHS and is not a long
   term fix but it can certainly help in the short term. And how about reducing insurance premium
   tax on health insurance subscriptions – do you really want some of the 10.6 million people with
   private health insurance to relinquish their cover and put even more pressure on the NHS? It is
   their right after all.
If you don’t trust your Health Secretary, choose a new one: It seemed strange that when forming your cabinet last year you missed an opportunity to remove an unpopular Health Minister and introduce a new era of cooperation with a carefully selected individual who could build bridges and work with key decision makers within the NHS. Instead you seem to have taken on the role of health spokesperson yourself, unhelpfully berating GPs and making sweeping statements that suggest that you don’t really understand the key elements of the service. I would assume that you will be pretty busy with ‘Brexit means Brexit’ and would respectfully suggest that you either give Jeremy Hunt back his mandate or pick a new Minister. If you are going to continue to make statements about the NHS then please…
Listen: …To those that are in the know, even if you don’t like what you hear. Organisations like the independent think tank, Kings Fund, people like Simon Stevens, Head of NHS England, Clare Gerada, and Helen Stokes Lampard, former and current chairs of the Royal College of General Practitioners, Janet Davies, Chief Executive of the Royal College of Nursing. The list is endless – and these people know what they are talking about. Trust them
Watch: Forget Sherlock or Call the Midwife, if you only watch one series this year I beseech you to tune in to BBC2’s exceptional documentary, Hospital. The first programme provided a level, calm but absolutely no-holds-barred view of what it really is like to work in a major Hospital Trust. After I watched the programme, I wept tears for not the patients – who without doubt received excellent care, but for the wonderful clinical staff, managers and administrators who work under almost unbearable pressure every day. On second thoughts – maybe you should watch Call the Midwife which shows how health and social care was before the state system was properly funded..
And finally…
Apparently you want your legacy as PM to be more than overseeing Brexit. Please make sure that your legacy is not that you were in charge when the NHS finally ceased to be fit for purpose.