Original unedited version of article in the Daily Express today (and extra comment at the end)
One of the most basic things you would hope to get from the NHS is an appointment with a doctor. Yet now a survey suggests that 22 per cent of patients are not able to make an appointment two or more days ahead. It sounds crazy. Usually an appointment is easier to get the further away the date. Diaries are less full up. But in the NHS, it is now impossible to make a future appointment at all with many doctors. It sounds like something out of Alice Through The Looking Glass.
What has brought about this topsy-turvy situation? A target. If a GP agrees to see us more than two days in the future, he increases the risk that he will fill up his appointment book and then break a government target - that all patients should be seen within 48 hours. But for many people, a firm appointment a little further ahead is what they want. Absurdly, as a result of a government target, the service provided by GPs has actually got worse, in this respect, instead of better.
In the view of one senior government adviser, the NHS has two years in which to reach a good standard, otherwise the public is likely to lose faith in the entire system. Since 2000, the government has been putting huge amounts of extra money into the NHS. Many members of the public are willing to allow time for the results to come through. But not unlimited time. By 2007, a decade after Labour came to power, if the NHS has still not become world class, the public might stop believing that the only problem previously was lack of money. They may be ready to believe a state monopoly system is not a good system.
How, then, is the NHS doing? Is it going to deliver a first class service within two years?
Unfortunately the most conclusive statistics will not be available until much later. These are the proportions of people who survive for five years or more after contracting the various kinds of cancer. International comparisons of these 'five-year survival rates' have, in the past, been the most damning and incontrovertible evidence that the NHS has provided medical care that is amongst the worst in the advanced world.
In the absence of such emphatic evidence, though, there is much to suggest that a radical improvement of the NHS is just not happening.
In 2003, 72 per cent of cancer patients were not given curative radiology in a timely way. The figure was actually worse than in 1998, when 32 per cent were not treated acceptably.
There are still serious delays on all sorts of diagnostic work that has to be done for a doctor to establish what a patient is suffering from and how bad it is.
Recently a woman was told that she would have to wait for 18 months for an MRI scan. Many health authorities commonly quote a six month wait for such scans, which are used for assessing cancer, heart disease and damage to the brain among other things.
Many people assume that the NHS will give us the drugs we need, when we need them. This has not been the case for a long time. It still isn't. There is large scale under-prescription of Aricept, for those whose memories are fading, and of Cox-2 inhibitors for those with arthritis. In America there is a drug for colo-rectal cancer called Avastin has been in use for a year. In Britain, it is now possible to get it privately. But NICE, the government quango which assesses new drugs, says it will not decide whether or not NHS patients should have it until more than a year from now. Herceptin, a drug for breast cancer, is only given to about half of the women who would benefit from it. In America, virtually every woman who would benefit gets it.
The Picker Institute recently assessed the progress of the NHS and made the telling observation that it had improved where there had been a lot of political focus. But it had not improved - and in some cases had got worse - in areas that were out of the limelight.
It is not encouraging that so many doctors have recently been expressing disgust at the way the NHS operates. Mike Lavelle, a consultant surgeon, resigned from the NHS earlier this month saying "the delays in operating theatres are quite frankly scandalous".
Another consulant, Milton Pena, an orthopaedic surgeon, said that on his ward a "desperate shortage of nurses is putting patients' lives at risk".
The Government seems to be on a campagin - involving civil servants who are meant to be independent - to convince us that the NHS is getting better and better in every way. But it has reached the point where government claims and statistics are treated as less trustworthy than those from outside bodies. There has been plenty of evidence that waiting lists are manipulated.
Professor Karol Sikora, a leading cancer specialist, said yesterday, "we've got ourselves into a propaganda culture' and said that the government claim that 99 per cent of suspected cancers were seen by a specialist within two weeks is "just lies".
However much the government huffs and puffs about how well it is doing, the true quality - or lack of it - of the NHS can be seen by us all. It will certainly also be analysed by outside bodies. There is no hiding place if the NHS cannot match other systems in the world. And on present form, in two years' time, it still won't. Then we might be thinking quite hard about what sort of system would be better.
On reading through the rest of the Daily Express today, I find, in the very same issue, an example of a public servant - who should be independent of all politics - putting out more pro-NHS propaganda and thus acting, effectively, as a pawn of the Labour Party.
Dr Gill Morgan, the Chief Executive of the NHS Confederation, no less, has found time to write to the letters page of the Daily Express to correct a reader who, in her view misrepresented the true situation in the NHS. (What is the Confederation? "The Confederation brings together the organisations that make up the modern NHS across the UK.")
The reader is quoted as applauding a "surgeon's stand against empire builders". (Perhaps he was referring to Mr Lavelle, mentioned above.) Dr Morgan writes:
Your correspondent David Dowd misuses statistics in his letter.Three per cent of the overall NHS budget is spent on managers.
To claim there is one administrator for every useful member of the NHS is wrong and also incredibly demoralising to the cleaners, porters, IT staff, managers and cooks who don't work directly with patients but without whom the NHS would collapse.
It is marvellous to behold Dr Morgan accusing a member of the public of "misusing statistics". Note her own careful use of the phrase "three per cent of the overall NHS budget is spent on managers". It is up to the NHS of course, what it defines as a 'manager'. If she is really willing to break down the entire budget, let us hear what percentage is spent on every other category of staff including 'administrators','office clerks' and suchlike who are not 'managers'. And when she says "overall" NHS budget, what is she including? Everything? In which case, let us have the relevant statistics just for hospitals.
I wonder if she herself counts as a 'manager' or whether her job description is something else, perhaps 'special adviser for refuting any criticism of the NHS'.
I fully expect that she, or Nigel Crisp, will be writing to the Daily Express again today to 'refute' my article. I wonder whether there will be meetings and consultations, perhaps with ministers, on how best to do it. (Well, as a way of spending taxpayers' money, it is alternative to hiring a nurse.) Will they go round to see the editor to re-educate him?
How sad it is, indeed, that public servants have become like this. I suppose it is simply that nowadya they will not given the top jobs unless they are willing to toe the (political) party line. It is a kind of corruption of the body politic.
Posted by James Bartholomew • Indexed in NHS
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I can answer that.
Most people in this country (and Europe) are under the erroneous impression that Americans don't get healthcare if they can't afford health insurance.
The US system has many faults, but generally (as James points out in his book) it looks after the poor better than here.
I think most people here also don't realise how producer-interest dominated the system is here. In fact, most people are really familiar with the concept of producer interest. How often do you hear people saying that medical staff are underpaid, when in fact they're the best paid in Europe with cushy pensions etc.
Posted by: HJHJ at June 22, 2005 03:53 PM
None of this is really surprising. Targets distort clinical priorities, because in the absence of customer focussed care, meeting targets becomes the aim of the bureaucrat.
It's hard to imagine this happening in a private or charitable system where the patient was a source of revenue rather than expense. Then it would be a simple matter to take your custom elsewhere if your doctors weren't focussed on your needs.
Posted by: James Hellyer at June 22, 2005 04:57 PM
it's overspending. it'll need more of our taxes. disgusting...
http://news.bbc.co.uk/1/hi/health/4314399.stm
£340m deficit predicted for NHS
Some trusts have cut back on theatre lists to save money
The NHS in England could emerge with a deficit of more than £340 million at the end of this financial year, a report has suggested.
A survey of the 28 strategic health authorities (SHAs) by the Health Service Journal revealed the forecast.
It is over £100 million more than the NHS was predicting in January.
But health ministers said past experience had shown that the position would improve by the end of the financial year.
The problem is one of ambition running ahead of spending plans
Nigel Edwards, NHS Confederation
However, the HSJ said the level of current deficit had risen from £500 million in January to £554 million, indicating the current position of acute and primary care trusts had worsened substantially in that period.
The journal said it demonstrated "the extent of the financial troubles dogging the NHS".
North West London SHA reported the highest deficit - currently £49.5 million, and a predicted end-of-year figure of £47.5 million.
SHAs have introduced various measures in an attempt to cut deficits, including cutting back on services, closing beds and theatre lists and freezing recruitment.
'Not unusual'
The HSJ said that, while many trusts would find ways of reducing their debt, there could be problems in the future if trusts did not solve their financial problems this year.
Nigel Edwards, policy director at the NHS Confederation, told the magazine that achieving financial balance would prove "very, very difficult next year" and subsequently.
"Some large acute trusts have already taken drastic action shutting wards and laying off staff and others are likely to follow suit next year.
"The problem is one of ambition running ahead of spending plans. We need a prioritisation of what we really want to do in the NHS."
But Health Minister John Hutton said: "It is not unusual for the NHS to be reporting deficits at this time in the financial year.
"Past experience has shown that the overall position has improved by year end and the NHS has achieved overall financial balance for the last four successive financial years."
He added: "Since 2002-03, expenditure on the NHS in England has increased 7.4% a year over and above inflation and we recently announced a further £135 billion for primary care trusts covering the next two financial years.
"This is the longest and most sustained period of investment in the history of the NHS."
Posted by: Matthew J Jones at June 24, 2005 09:56 AM
It probably is the longest and most sustained period of investment in the NHS.
But, so what. It's wasted on .... anything except actual Doctors, Nurses and treatment.
What was that figure ; expenditure up 72%, treatment up 2% ?
Posted by: Paul at June 25, 2005 11:58 AM
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I have been wondering why it is that the NHS has as much public support as it does. Some of my American friends who have now been in England for about 9 months think that the NHS is a national scandal, but of course they are comparing it to American (middle class) health care. I believe that public support for the NHS exists because we compare the NHS with no treatment at all. On this comparison the NHS is actually quite good (even when you take MRSA in to account). To win this argument we have to persuade people to compare the NHS with a world class healthcare system, which we used to have. On a similar line when you do persuade people to compare the NHS with (say) American health care, their instinct is that high quality health care is only for the few. This may be because we only have high quality health care for the few, and there is a national perception of that is all that is possible?
Posted by: Jack Peter Gunning at June 22, 2005 10:51 AM