All entries for Saturday 27 August 2005

The NHS: Crisis looming?

Has Labour's overspending in the NHS pushed it to crisis point?

I've just done two weeks work experience at a regional newspaper in England, where the main stories they featured were three separate exclusives on bed/hospital closures.

Two of these are to do with not enough money for beds to remain open, and another is to do with a complete reorganisation of the NHS (involving the scrapping of Primary Care Trusts – which you may remember are only a few years old).

The first observation to make is that something has clearly gone wrong with the government's health proposals from 1997 onwards.

Primary Care Trusts (their idea) will be replaced so that local primary health services are managed by 'local' groups, which may be private sector, voluntary (a joke according to hospital Leagues of Friends) or run by doctors (again, ha ha ha). But what is wrong with PCTs? Well apparently they're too bureaucratic and splitting them up into smaller bureaucracies will improve efficiency. Umm… worked well with devolution to Scotland and Wales. Also, why didn't they decide to do this when PCTs were invented? And there's big question marks hanging over who actually will want to take over the running of the hospitals. Except of course businesses, who will love the chance to milk the Department of Health dry.

So there still doesn't seem to be a good reason why they're disappearing. Other than 'change is good' being one of the government's mottos.

The second point (relating to bed closures) is why are services being reduced when health funding has rocketed over the past few years? One reason presented itself on a BBC news report the other day. It followed a GP whose income had gone from £60k to £100k because of new 'out-of-hours' contracts the government signed with GPs recently. Basically, Doctors successfully got shed loads of money out of the government for working night shifts. And some have nearly doubled their income.

Good for them, but this along with other pay increases in the NHS means that these increases (in proportion to GDP) in health spending have gone, mostly, on wage increases. If this was the 1980s, then this would have caused chaos, but Gordon Brown is very fortunate that the economy's doing okay at the moment. Important qualification there: at the moment.

But while wages have risen, so have services since 1997. Yet this seems simply to have stored up trouble for the DoH which is beginning to realise it can't keep funding these new services (such as foundation hospitals). So big, new hospitals: very good. Older, smaller, local, essential to rural areas hospitals: very very bad.

And indeed the government is shutting them. If the three proposals found out by the newspaper I was working at happen, then thousands of people would have had to wait 30mins for an ambulance (minimum) before another 30–40min journey to the big new PFI-funded megahospital. A megahospital with overcapacity. But that's fine, because they can close the smaller hospitals to make up the difference.

Essentially, rural areas are going to be kicked squarely in the teeth by these measures. And they're inevitable. Services in the NHS will have to be cut, which sounds pretty worrying considering how much people have been paying in tax over the past 8 years.

And rural areas – which, happily don't contain many Labour voters – will be worst off because big hospitals there are far less economical, and small, local hospitals, while nice, are easier to dispose of.

What surprises me (although it doesn't really) is that the national press haven't picked up on this trend. Because it does seem to be a common theme. Smaller, local hospitals which have better satisfaction ratings – especially with the elderly – face being closed in favour of one-size-fits-all mega-hospitals.

Isn't it time to stop quietly changing the structure of the NHS through non-transparent quangos and think again about what the NHS is and should be about? Because some of the most vulnerable people are going to those worst affected by the changes made inevitable by over-spending in the NHS.

Christopher Doidge : 27 Aug 2005 23:11 |  Tags: Health NHS Politics |  Comments (1) |  Close comments |  Report a problem