Government mismanagement is the only cause of NHS failings

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Comment Editor


Headlines over the past week have repeatedly indicated the crisis that is growing to envelop the NHS, as A&E reaches breaking point and services are repeatedly shut down. Except this isn’t the dead of winter, but barely the end of summer. It seems the NHS is now in perpetual crisis.

Of course it didn’t become this way overnight, but the NHS has been receiving a lot of bad press recently, strangely coinciding with the BMA decision to go on strike, as safety concerns have begun to escalate. The reality is of course that the NHS has been struggling for years, with the balance now finally tipping over the edge. This is not a problem that Junior doctor pay is going to solve.

First of all, it is notable that the NHS satisfaction rating as surveyed by the King’s fund peaked in 2010:

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This is notably the last year Labour were in power and the coalition government took over. What suddenly changed alongside the governments at this point? One key factor here is funding. As many issues as Tony Blair’s premiership caused, NHS funding was most certainly not one of them. The NHS budget rose in real terms to become in line with other European countries and this is reflected by the satisfaction ratings. In contrast, whilst the Tories have also ‘increased’ the NHS budget, they have also reduced the amount going to hospitals, as indicated in this graph showing the financial losses being incurred by trusts.

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The massive deficits have been due to ‘efficiency savings’ imposed on trusts which is really nothing more than a fancy way of saying budget cuts.

However, funding is not the only part of this story, there have also been structural changes in the way the NHS functions which has caused further issues. Blair also instituted a series of managerial reforms, most notably using targets as a performance indicator. Using a simple statistic is never going to be sufficient to represent the vast complexities of healthcare, but it can focus resources towards specific standards. This led to the fall in A&E waiting times seen over the 2000s. This also allowed the press to easily report on the apparent state of the NHS, by simply comparing these figures. In recent years, these targets have been missed, no doubt causing a fall in satisfaction.

But these two factors are also related in a much more complex manner, best indicated by the concept of physiological reserve. This is the concept where organs do not in fact need to be working at maximum capacity in order to fulfil the needs of the body. This means that we can sustain a lot of damage to our organs without becoming critically unwell. However, beyond a critical point, organs finally falter and intervention is necessary. This excess function that an organ can lose is the physiological reserve.

The NHS can be viewed in this way. Whilst it was funded well and had a lot of reserve, strains like targets can be met with no detriment to the overall function. However once funding begins to cut away at this, there reaches a point where even superficial markers like targets can no longer be met.

The NHS needs life support.

Targets were not the only strain that has been placed on the NHS. Blair also instituted an infrastructure program which in principle was good. New, modern hospitals to service the population. The issue is that he used Private Finance Initiatives (PFI) to finance them. This meant that instead of simply using government funding, private providers were brought in to build these hospitals. Whilst there is nothing necessarily wrong with using private providers, the issue is that the contracts have such extortionate costs, that mean that the price of one hospital could have paid for two. These costs have been crippling trusts that used PFI to finance their hospitals.

Further issues are the fact that England uses an internal market that allows competition for service provision between public and private providers. Whilst a market could seemingly improve services via competition, the reality is a price tag of several billion. This process is continuing with numerous providers now operating under the banner of the NHS, including Virgin Care. This is worsened with decision makers that have vested interests in their own companies opting to them instead of cheaper alternatives.

The NHS is in a dire straits, of which the contract dispute is only light window dressing, Striking doctors must not pretend that their contract is the only problem here. The NHS is being starved of vital funds whilst completely artificial costs are imposed upon it. Junior doctors must highlight these risks to the public so that the real issues that are causing the NHS’ collapse can come to light. Otherwise, there will be more of the same as politicians play football whilst services close.

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