FOR retired Royal Marines General Sir Gordon Messenger, reviewing the leadership of NHS management is a somewhat vague job description, and there is a whole lot more that needs radical reform than just management.
As economists will tell you, any product or service that is free of charge will be abused. In homes that are not on a water meter no one worries about leaving the tap running while brushing their teeth. When the 5p charge for supermarket plastic bags was introduced, use immediately dropped by 90 percent. The NHS is an egregious example of this. People visit their doctor (if they are fortunate enough to have a doctor who will see them) for trivial ailments such as a cold which will soon pass or can be treated by an over-the-counter medicine. They skip appointments without cancelling them. They demand prescriptions for medicines that they could easily afford to pay for. Stoicism and grin-and-bear-it have all but disappeared in today’s Britain where the ever growing creep of nanny statism has made people permanently fearful and with a state-will-provide mindset.
My wife and I would be the first to agree that the NHS is brilliant once you are in the system, when you have been admitted to hospital and your operation scheduled. But getting to that point is far from simple.
When the NHS was established after the Second World War it was suited to a time when life expectancy was 65 for men and 70 for women. Today the health and healthcare of the nation are totally different; people are living much longer due to better food, air quality, smoking bans and huge advances in medical science, all of which are increasingly costly. Government spending on the NHS could soon reach 40 per cent of revenue.
The task of reform is daunting and it will take a long time. There are essentially three issues: an acute shortage of doctors and nurses, an acute shortage of hospitals and a bloated and wasteful bureaucracy.
Let us go back to first principles. Britain has 1.9 hospital beds per 1,000 population. Japan has 13, Germany 8 and France 6. This would appear to show that there are not enough hospitals for the population.
The shortage of doctors and nurses is already well known. This has three origins. Too few new doctors are entering the profession, largely because there are insufficient places on medical faculties at universities and junior doctors’ training positions in hospitals. For the nursing shortage much can be attributed to the erroneous Tony Blair decision to recruit nurses with university degrees, thereby depriving the profession of vocational nurses without degrees but with equal or greater desire and ability to care for patients. The third origin is the early retirement of doctors so the NHS loses the most experienced cohort of medical professionals. Why? The large salaries for reduced workloads cleverly negotiated by doctors during the Blair government have enabled them to retire early on satisfactory pensions. So, driven to dissatisfaction by the volume of paperwork, much of it unnecessary, they decide they’ve had enough.
The first two origins will take a long time to improve (if tackled), the third could quickly be ameliorated by a sweeping and ruthless cull of unnecessary paperwork, not to mention daft diversity training, awareness seminars and the numerous other woke activities which take up time better spent on treating patients. Already £9million of the new National Insurance increase to fund the NHS has been allocated to 42 new ‘Integrated Care Specialists’ with salaries of up to £270,000 whose job descriptions include the requirement actively to promote diversity and inclusion. Wouldn’t this be better spent on employing more nurses?
Tackling the abuse of the free-at-the-point-of-delivery service could be quite easy, but the breaking of the taboo of not having to pay is difficult if not impossible. Even a modest charge to visit a GP would deter most time-wasters and people who simply fail to turn up for appointments should have to pay this charge. Prescriptions should be paid for also, up to a certain capped amount.
Another extraordinary free service concerns non-ailments. Why should taxpayers pay for tattoo removal or any cosmetic procedure? Women who fail to take responsibility for contraception should pay for their abortions, which would probably reduce their huge numbers. (Although I personally believe that the ending of the life of an unborn baby is wicked and wrong).
Turning to general practice, hasn’t the pandemic exposed weaknesses here? There are many doctors, perhaps the majority, who are dedicated, hard-working and highly knowledgeable but unfortunately there are too many who are, to put it tactfully, less dedicated. Shorter surgery hours, long holidays, reliance on locums and avoidance of face-to-face appointments are all too common. Some GP procedures are no longer even available. A recent example: a GP surgery no longer doing ear syringing referred a patient to a chemist who charged £80. Mind you, the pressures of targets (Tony Blair’s favourites) and monumental form-filling and box-ticking does arouse some sympathy.
So what is to be done? There will be many senior consultant surgeons and commercial big business directors who will have some brilliant ideas (and should be tapped), but here are some of my suggestions.
· Some form of customer part-payment must be introduced, which would need to be means tested.
· Medical insurance should be actively encouraged and premiums should be tax deductible.
· I’m sure all nurses and doctors would be able to provide lists of paperwork forms that could be streamlined or binned.
· As a trial run, a senior manager of a medium to large business sor a senior ex-service officer hould be appointed as CEO of a large hospital with a brief to improve efficiency and cut costs. It’s all about leadership and it always comes from the top.
· A more competitive system of procurement of drugs by the NHS should be introduced. It is all too easy for pharmaceutical companies to charge sky-high prices for medicines when they know that the customer has a bottomless pocket.
· Study and learn from other nations’ medical services which have better outcomes and bearable (by the patient) costs, such as Australia, Germany, France, Italy and several others.
· Shut down diversity departments and all the other woke activities and departments which vacuum money from budgets.
· Non-frontline manpower needs to be reduced drastically by layers of bureaucracy being eliminated. Redundancies will ensue but people doing non-jobs should not expect to continue riding on the gravy train. There are an unbelievable 27 quangos directly associated with the NHS. Getting rid of at least three-quarters of them would save a lot of money. And who would miss them?
· Restructure nursing in hospitals by reintroducing matrons, a proven success story.
· Allow some medical procedures currently performed only by doctors to be carried out by nurses. This would increase productivity and greatly enhance the self esteem of nurses with the consequent boost to recruitment.
The Conservative government has an unassailable 80-seat majority and three years until another general election, so it is in a very strong position to implement across the board reform way beyond Sir Gordon’s leadership review proposals. It can be done. Will this government do it or even apply more than a few of Sir Gordon’s recommendations? No.