Guest post: Slice away a tiny bit at a time

Originally a comment by Steamshovelmama on The NHS may not survive as we know it.

As someone with a 20 year background of working for the NHS I agree almost completely.

Ignore the four hour waiting thing – it’s a red herring, a target that was centrally imposed by a government wanting something tangible they could use to “measure” performance. It is not appropriate for every patient to be shunted to a ward bed within four hours of admission to A&E – sometimes better care will be had in A&E from appropriately specialised doctors and nurses who are actually on the spot. Stabilisation of an emergency condition does not always follow a nice consistent pathway. Sometimes weird shit happens and the process of making the patient safe takes longer than four hours.

The junior doctors problem, on the other hand, is a real issue. Jeremy Hunt (who has taken over in the UK from the irritating but generally harmless James Blunt as “the only man alive who is his own rhyming slang,”*) has decided that hospitals should offer a full seven day service as opposed to a full five day service and emergency cover at weekends. That’s fine. I actually agree. So he’s increasing NHS funding to cover the costs?

Well, no.

The things is, employing more junior doctors is expensive, but it doesn’t stop there. You also have to increase the numbers of the 9-5 plus on-call services – radiographers and X Ray techs, phlebotamists, Scientific Officers to staff the labs and process samples, Endoscopists, Transplant Coordinators, Dieticians, physiotherapists, occupational therapists – the list goes on and on.

It doesn’t include the nurses. We’ve been providing a full 24/7 service since forever. We’re the only group that does so.

For those of us who do or have worked in the NHS it is very, very clear that the service is under political attack. Funding is being cut, services are being whittled down. In the words of the great “Yes, Minister”, “salami tactics” are being employed. Slice away a tiny bit at a time, a bit so small, so insignificant that no reasonable person could really object. Then slice again and again. Argue that private companies run things more efficiently (I’ve worked in the private and public sectors in the UK and my response to this is a stunned, “Buh? Wha?”) so bring in private companies to manage sections of the NHS. Amazingly enough, these sections rapidly run into problems when a style of management is installed that is more used to measuring performance by profit.

Study after study has shown that clinically the NHS is actually extremely efficient. That’s been the case since the late 1970s when an efficiency rating of over 90% was calculated. Money has been wasted by being diverted to a plethora of “management consultants” and senior managers sucking down what is, by NHS standards, huge amounts of money. Of course, they aren’t actually good managers – if they were they’d be earning at least twice the amount in industry.

We spend less per capita on health care than any other western European nation. The big problem we have is that we have just lost the last generation to remember what things were like before nationalised health care, where if you were ill you just got on with stuff (and got iller and iller and sometimes died) because medicine and hospital care was for the privileged classes. People now have quite literally no idea how much their birth control, antibiotics, insulin and surgery will cost them in insurance if we move towards (god help us) a US style (lack of a) health care system.

The politicians don’t care (except for Corbyn) because they are all rich boys with Daddy’s money to fall back on. In their eyes the NHS is just a drain on the national purse. Think of all the handouts they could give to their cronies with that cash!

The depressing thing is that the media folks, being generally from a privileged background themselves, are uninclined to question this too deeply. No one is looking at what the dissolution of the NHS would mean for ordinary people. There is a sad lack of incisive investigative journalism.

So, yes, those of us who recognise this covert attack on the NHS are deeply worried.

*yes, I know, but it’s a common UK joke.

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