As a GP I have the privileged position of the cradle to grave responsibility for my patients. As you build relationships with patients there are many times where conversations stray from the personal problems to the political challenges faced by the NHS. A 75-year-old patient of mine reminded me the other day how important the NHS is to the public.
As a GP I have the privileged position of the cradle to grave responsibility for my patients. As you build relationships with patients there are many times where conversations stray from the personal problems to the political challenges faced by the NHS. A 75-year-old patient of mine reminded me the other day how important the NHS is to the public.
He told me of the stress his parents were put under in 1947 when he went under a green bus seriously injuring his leg. He remembers with such clarity his mother scrapping around the house to find half a crown – or 12½ old pence – in order to pay the doctor to come out and assess his injuries. He then spent seven months in hospital recovering from his injuries and it almost bankrupted his family – the result of which drove this man to be self-made and able to care for his family. He had another serious leg injury falling off a ladder in Portugal and was flown back to have his leg saved by the NHS. He had to have multiple operations and skin grafts over several years which would not have been covered by an insurance policy, however comprehensive.
He gets very angry at the abuses he perceives of the NHS. People demanding free transport, people suing for compensation and people not looking after themselves and blaming the NHS for deficiencies in their care.
The problem, however, is quite simple – but there is no solution that works. We have a socialist ideology trying to be delivered by capitalist business models. The people who work in the NHS do so to care for people and to try their best to deliver that care in spite of the funding formulas and the political interference.
In 2008 I gave up going to the finance director asking for fair shares. No-one believes their budgets are right and everyone wishes they had more to spend. The Better Care Fund is now waking people up to the inequities in the allocation formulas for both NHS and councils. Health and Wellbeing Boards are trying to define the prime purpose of the care system. Councils and the NHS have worked alongside each other for 65 years and it took a change in the law to get us to work together. We came in different boats but we are all in the same one now. There is only one public pound – be that health social care or county council – and it can only be spent once. Everyone wants to look good so it is important we agree what to measure and how to articulate it.
My friend Mo Girach offers a potential solution in his article on decommissioning. We need to determine with the public what they want and then determine how to get it, and offer the tough choice of what to give up in order to afford it. I am fed up of hearing about schemes to make savings – the reality is there are never any savings, just different spends. With more clinical commissioning groups (CCGs) in deficit than expected, and scathing reports criticising Better Care Fund plans, the cash pile of £4.3 billion in Foundation Trusts shows that the integration agenda has a long way to go.
The business models have to change in order to rekindle the values of the NHS and care system. The focus on money and balancing books is not what drives care workers or gets them up in the morning (or at night). People collaborate and organisations compete. There are over 175 definitions of integration and yet it is the holy grail of the reforms.
Most important are not the organisations, the bricks and mortar and balance sheets but the core values. We must never forget the NHS is the envy of the world because of its universal coverage. We need politicians to be truthful about how much it costs.
