Saturday, 17 May 2008

Will there be life after 60 for the NHS?

Posted on Bevan Foundation blog on 11 May 2008

In a couple of months time the NHS will celebrate its 60th anniversary. The memory of Nye Bevan will evoked again and again as as the crowning achievement of the 1945 Government is celebrated.

But as I've found out over the last few months, the Health Service is in turmoil.

Like most people who consider themselves to be on the centre left I strongly believe in the founding principles of the NHS. When presented with anecdotal evidence of failings by the Health Service and its staff I have been amongst the first to make an excuse.

But my grim experience of the NHS maternity service in the last few months has left me pondering some very uncomfortable questions.

Perhaps I have been naive in not realising the depth of the difficulties facing the NHS (after all there have been no shortage of warnings), but I was deeply shocked by the resignation of the staff towards the sub-standard nature of the care that is all too often administered.

When I was a journalist I was wary of over using the word crisis, but I can think of no better way of describing the state of the NHS. Not simply in operational terms, but strategically.

In the face of an ever demanding consumer mindset, can the NHS adapt quickly enough to rising expectations to prevent middle class flight? That I think is one of the biggest challenges.

Those who can afford it (at a push) are routinely going elsewhere for care when they can.

For example, to avoid the prospect of an amniocentesis test for Down Syndrome, couples are increasingly prepared to pay £180 for the less invasive and more accurate nuchal scan at private health care centres. Once introduced to the world of private medicine many return to it in times of uncertainty when the NHS is found wanting. Meanwhile those who cannot afford it are effectively left with no choice.

It is not simply a matter of a gap in provision. I won't self-indulgently list my own gripes but I doubt very much the problems I encountered are restricted to Cardiff and Vale (clearly they are not), or indeed to maternity services. Some of the problems I encoutered were localised, others suggest there a deeper systemic malaise. In fact, a senior nurse in Wales' leading hospital told me recently that patients routinely 'slip through the net'.

The flow to private providers may only be a trickle now, but there's a danger that it will become a hemorrhage if the support of middle income groups for the NHS is eroded.

Let us not fall back into the familiar narrative here, it is not simply a matter of the rich having choice and the poor having none, many of the people turning the private sector have to borrow money but in desperation feel they have no choice.

It will become increasingly difficult to protect the services relied upon by the poorest if the allure of the Private Sector and the opportunism of the Right undermine the broad consensus which sustains the NHS.

As the NHS reaches its 60th birthday some unpalatable questions need addressing.

It is not just a matter of funding:

Doctors, nurses and midwives must ask themselves if they always give the best care that they can;

professional bodies and trade unions must examine whether their stranglehold on the
NHS is in the long-term interests of their members or the public;

politicians who enjoyed the easy kill of the internal market must show how in its absence the NHS can respond to patient demand;

and voters must confront the uncomfortable reality that if we want public services to meet our demands as modern consumers we cannot rely on solidarity alone to be sustain them.

I don't pretend to have the answers. But if the NHS is to be more than a fall back service for those who cannot afford to go private, the Welsh political elite must acknowledge the problem and engage with the search for solutions.

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