NHS - They're all in it together

The National Health Service is daily news fodder. The ex Labour cabinet minister John Reid exclaimed “oh fxxk not health,” when Tony Blair appointed him Health Secretary in 2003. As junior doctors mull over a pay and rations strike, the current incumbent, Jeremy Hunt, is probably thinking the same thing.  The NHS swallows up more than £120bn each year, and even though the Government has ringfenced the service from swingeing cuts, the service seems to be on a permanent tipping point.

The truth is that the NHS really is in a mess. Maybe the public knows this. The doctors and nurses, the managers, and the politicians must know this too, yet exhibiting political leadership to bring about change for the better is high risk. And our ageing population means healthcare under the current system is not sustainable: 10 million people currently living in the UK will live to be 100 years old.

A senior manager in a North West hospital, which specialises in trauma care, told me 40% of beds in his hospital are taken by elderly people who should not be there. The hospital is in special measures after a multi million pound funding shortfall, and management knows that investment needs to be made in ‘half way houses,’ freeing up beds while enabling elderly patients to be cared for prior to their returning home. Yet there is not sufficient cash available for this to happen.

Perhaps consultants themselves can lead the NHS into a brighter future. Those heirs to Sir Lancelot Spratt want to care for the sick, they don’t have a self-interested agenda, do they? Actually they do. Their wallets are their agenda. Let me give you an example. 

Most Hospital Trusts have a big problem with medical recruitment. Some parts of the country are worse than others. When recruiting a new consultant or middle grade consultants, all the consultants in the Department have an opportunity to look through the application forms and make comments before a short list is drawn up. As fellow professionals and/or members of the Royal Colleges they may have worked with applicants themselves or know people who have so this process underscores the collegiate nature of the profession.

When departments are short staffed gaps are plugged with locums. They are usually supplied by agencies and earn considerably more than substantive appointees. When capacity is stretched and the Trust is missing their targets management is obliged to undertake Waiting List Initiatives (WLIs) – extra clinical sessions to get rid of the backlog. These are remunerated at special rates which can substantially increase a consultant’s income. That extends to all the support staff who earn overtime. So there is a considerable financial interest for substantives and locums to maintain lower levels of staffing to ensure that capacity is always stretched.

It is common practice for applications to be routinely delayed by several weeks and even months by consultants sitting on application forms, failing to send in their comments on time and in some cases, failing to turn up for appointment panels. The impact is to build further delays into an already cumbersome process and lose potential appointees who get fed up with waiting and go elsewhere. For sure, the Medical Director can attempt to discipline offenders but this is not easy as they are contractors as opposed to employees.

Consultants may feel hard done by, but it explains how very difficult it is to create a more efficient service if all its practitioners are sucking off a £120bn taxpayer teat.  What matters in the end is that sick people are well looked after in an efficient manner.  Just as consultants delay appointments to bump up their bank balances, so politicians kick the can down the road. They really are all in it together.