Friday, July 5, 2013

Happy Birthday NHS Scotland

Happy Birthday to the NHS, 65 years young today. Probably Labour's greatest political achievement and as essential today as it was after the Second World War. There is no question of retirement, at least not in Scotland. We can be grateful for a broad political consensus that recognises the value of public service delivery.

Not so in England. As Polly Toynbee highlights in the Guardian today, health competition is hugely inefficient and comes at a cost. Queues of ambulances stack up outside bursting A&Es, with emergency admissions up by 35%. 4,000 nurses gone and patients waiting over six weeks for diagnostic tests that are up by 88%. GPs are seeing 40 patients a day with their appointments systems gridlocked.

Almost everything can be tendered out to Any Qualified Provider. NHS Direct is broken up among 46 bidders for local services, paid only 30% of the old cost per call, so already many contracts are going bust. The result is unqualified call-centre operators pouring extra patients into A&E with trivial complaints. The London ambulance service is using 10 times more private ambulances, at a cost of £4m a year. Between a quarter and a half of all community services are now run by VirginCare.

The most outrageous example quoted by Toynbee, is two hospitals trying to merge in Poole and Bournemouth have spent £1.67m on legal advice from costly competition lawyers. It reminds me of when Scottish hospitals were structured into trusts, employing marketing managers before doctors.

Of course all is not well with NHS Scotland. Despite some protection from the cuts, around 6000 staff have been lost since the financial crash. This has resulted in real pressures on the service.  Emergency beds made available to help the NHS cope with a flood of patients last winter are still being used because regular wards are overflowing. The average number of available staffed beds in Scotland's acute hospitals have fallen by 1400 since 2003, with a big increase in private bed spending as a consequence. A&E waiting times have trebled in some boards and MSPs are calling for patient records to be checked for waiting time manipulation. These are largely the consequences of financial cuts, but at least we are not wasting resources on an ideological drive to competition.

Financial and demographic pressures have started a debate on what should be provided by the NHS. The latest is Hugh McLachlan in today's Scotsman. He argues: "If we tried to provide on the NHS all that might reasonably be thought of as appropriate medical treatment, it is likely that we would be unable to pay for services such as pensions or free primary, secondary and higher education without raising significantly more money in taxation."

He follows and supports Professor Frazer's view that we should consider discrimination on the basis of age in the allocation of NHS health care. He argued that: “We have to be realistic and say if you spend the resources on treating an 85-year-old with pneumonia, then you won’t be able to treat a 35-year-old who’s had a car crash. It is as simple as that.”

While there is a valid debate to be had about what NHS Scotland should do, we must remember that the NHS is primarily a treatment service. The biggest challenge for health in Scotland is not the NHS, but health inequality. In Glasgow alone we can still see differences in life expectancy as extreme as 54 years in the poorest communities and 82 years in the most affluent, a near 30 year difference. David Conway's post on this site outlines what we need to do, recognising that this is not a matter for NHS Scotland alone and requires a comprehensive policy response across all government departments.

A new drive to tackle health inequality would be a fitting way to celebrate the NHS in Scotland's birthday.

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