Tuesday, 13 January 2015

Solving the NHS crisis: it's the staff, dummy

It’s pretty widely known, even beyond British shores, that the NHS is in crisis (even though the crisis is denied, within these shores, by the government chiefly responsible for provoking i).

A recent NHS England document summed up the problem. An ageing population and the changing conditions the NHS has to treat, generate a 1.3% increase in demand each year. Add to that the arrival of new, often far more effective but significantly more expensive treatments, and the increase is more like 3%. In response to that upward pressure to do more, the government is demanding that the service keep finding ways to save money, by doing things more efficiently.

That’s from a service which has been squeezed on pay for years. In the current year, 2014/15, the independent pay review body set up by government recommended a 1% increase, which was derisory. But the government refused to implement even that: staff have been told to make do with no increase, and therefore a real-terms pay cut.

The staff hit back: sign at Hinchingbrooke Hospital
This isn’t to deny that there are ways the NHS could do things more cheaply. 

The big change is to prevent avoidable admissions to hospitals. Treatment in hospital is much the most expensive way of delivering care, and in the current year – which ends in March – we are already running 4% over plan. Clearly, something’s not right.

Keeping people out of hospital isn’t easy, however. What it requires is the provision of significant levels of care out in the community. For instance, a lot of care could be delivered by district nurses, who travel to patients’ homes, provide some of the care they need as well as helping the patients look after themselves. Since a district nurse visit costs in the region of £50 as opposed to £500 as pretty much the minimum for a hospital stay, it clearly makes sense to push this option – especially as most people prefer to be treated in their own home and often recover far better there than in hospital.

So it seems contradictory that from 12,000 district nurses in 2003, we’re down to 5500 today.

Equally, a lot of hope is being expressed on having some of the burden taken up by social care (care homes, domiciliary visits, social workers, etc.), run not by the NHS but by municipal government. But local councils have been hit particularly hard in the last few years, so social care budgets are down by 26%.

In other words, we know what needs to be done, but we take away the resources to do it. 

Sadly, Labour, while saying it would do more for healthcare, is also trying to cultivate an image of fiscal prudence, claiming that while it might not hammer public service as savagely as the Tories, it is still going to make cuts. Which may help explain why Labour has been haemorrhaging support among the young to the rather more radical Green party.

But let us come back to the question of that pay freeze in the NHS.

Things haven’t been particularly good in the private sector either, where pay rises over the last few years have tended be anything between nothing at all and a couple of percent or so, except at the very top: the people who’ve been loudest in proclaiming the necessity for pay restraint at the bottom have been more than happy to help themselves to 10, 20 or 30% increases in their own pay packets.

But even with small increases, over time the gap in salary between the health service and private industry, for the same skill level, has been growing steadily. Just as the constant increase in demand for healthcare has put staff under increasingly severe pressure. All of which makes a transfer out of the service more and more attractive, year by year.

That’s a step my wife has just made.

The same NHS England document I mentioned before assures us that “Our staff are our most precious and expensive resource, accounting for around two thirds of provider expenditure. There are opportunities to improve efficiency and the quality of care through better retention of our existing staff…”

Indeed. It might be good if the people who control the purse strings heeded that kind of notion.

The Tories will never listen. But Labour: are you listening? The NHS is one of your strongest vote winners. You have to get behind the changes that are needed: extending community care, reversing the decline of social care – and, above all, backing the staff.

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