Time to get heretical?
This week saw the leaking of minutes from a September meeting of senior NHS Scotland managers in which a serious suggestion was made that the NHS’ founding principle of free at the point of use care for all be abandoned.
The meeting attendees discussed possible ways the system could be transformed in the face of unprecedented pressures and a £1bn hole in the Scottish NHS’ budget. A “two-tier system”, in which those who are able to pay for private services do so, was floated, with reference to the fact that many are already choosing to go private to avoid NHS queues.
Scotland’s first minister Nicola Sturgeon was quick to make clear that any such suggestions are simply out of the question. And she is right. Politically, this would never fly. Despite what large sections of the UK population and media would have you think, Tory governments are more wary than Labour governments of even the most minor tinkering with the NHS. It’s hard enough to get voters and the medical community behind even the most sensible and anodyne reforms, so good luck convincing them that the entire system along with its founding principle should be binned!
It’s a little surprising that the senior NHS managers in this meeting were apparently unaware of this – or not sufficiently dissuaded. It gives you some idea of just how desperate they are for fixes to a system that is reaching unsustainable levels of dysfunctionality.
But if NHS managers are serious about looking for radical solutions, why not get truly radical and think carefully about how to reform the system in a way that would tackle its many operational inefficiencies and misaligned incentives, looking to what has worked in other countries?
This would take more time, care and effort than just looking at what services could be cut or begging the government for a few extra billion to stave off collapse, but the pay-off would also potentially be much greater.
Even without a radical overhaul of the system, there are some relatively low-hanging fruit. In the meeting there was a good, if a little obvious, suggestion that the many patients taking up hospital beds but who are medically able to leave hospital should be discharged earlier. Other frequently touted ideas such as making better use of digital tools, patient data and harmonised IT systems to save doctors’ and nurses’ time, and a move to focusing more resources on prevention, could do wonders if done well.
This week your writer had an appointment with a doctor who, when asked why she wasn’t able to see previous medical records, answered that it was to do with patient privacy, adding: “If you want to design an IT system that harmonises all NHS data, is totally secure and respects patients’ right to privacy, go ahead! But I don’t think it’s what the NHS should be prioritising right now!”
Perhaps. But perhaps it’s precisely this kind of myopia and short-termism which has led the NHS to be in the situation it currently finds itself in.
We would welcome your thoughts on this story. Email your views to Martin De Benito Gellner or call 0207 183 3779.
