Daily Mail, 8 December 2005

The Health Secretary Patricia Hewitt has caused general outrage by saying airily that hospitals should make patients wait up to two months longer for their operations in order to save money.

Asked if she approved of the decision by Staffordshire primary care trusts to impose a six-month wait for non-emergency surgery, she said it would make sense to delay such operations to help trusts reduce their debts.

This gave every NHS trust a green light to turn what is currently a maximum six-month waiting time into the minimum. Doctors are thus being put under pressure to go against their clinical judgment and deny patients the treatment they need when they need it, all because of gross government incompetence in running the health service.

The more patients that hospitals treat, the more heavily they get into debt. So rather than the health service fulfilling its purpose to treat sick patients, such patients are being used to treat the problems of the health service by being parked on the waiting lists.

Yesterday the NHS Chief Executive Sir Nigel Crisp echoed Ms Hewitt’s comments by admitting that patients might have to wait longer for treatment because a quarter of NHS hospitals and trusts are failing to control their finances. This is surely the economics of the madhouse.

Having treatment on the NHS has become a lottery. You can strike lucky and find speedy treatment, modern facilities and efficient and pleasant care. But far too often standards fall woefully short.

When I broke my wrist a few months ago, I needed an immediate operation to set the bones. If the operation wasn’t done within a couple of days, the bones would have set permanently in the wrong position. Although I was admitted straight away to an NHS teaching hospital, I was bumped off the operating list to make way for more urgent cases because, although there were surgeons ready and willing to set the wrist, not enough operating theatres were in use.

The following morning I was starved and gowned for surgery, and then bumped off the list again as the surgeons fumed. In desperation, I had to have the operation done privately to prevent my wrist from being permanently crippled.

While I was on the NHS ward – by chance I had been put into a side room — I was further discomfited by being woken in the middle of the night and told I would have to move immediately to make room for another patient. Upon further inquiry, it became clear that I would be moved onto a mixed-sex ward — of the kind that the government has said must be phased out. At that point my normal desire to be accommodating deserted me and I simply refused point blank to be moved.

Of course, the vast majority of front-line staff perform a heroic job in trying circumstances. But the impression was of a system that was hopelessly mismanaged, desperately paddling to keep its head above water but sinking with every day that passed.

The fact is that the government has simply lost control of the health service. Chaos appears to be widespread as the money runs out. Trusts in Surrey and Stoke-on-Trent have been postponing patient admissions for up to four months in order to move them into the next financial year, thus saving on this year’s budget.

Surgeons are being told to operate on fewer patients as there is no money to pay for them. Efficiency is penalised. One surgeon in Cornwall was incensed to be told that the problem was that he was working too fast.

Other trusts are saving money by removing patients from waiting lists through a variety of sleights of hand. Now the government crows that the waiting list has dropped to below 800,000 for the first time since the late 1980s. But at what cost to sick people?

Across the country, NHS trusts are in dire trouble. The service as a whole is forecasting a £650m deficit by the end of the financial year. Rescue squads are being formed from management consultancy firms to stop these trusts from going bust altogether.

Virtually every government reform designed to rescue the situation has made things worse. The respected King’s Fund has warned that, far from improving the service, the latest reform package is causing trusts to fail. And in the general panic the targets keep changing, thus adding to the chaos.

Until last May’s general election, NHS managers were under instructions to hit their targets for cutting waiting times at all costs. After the election, as the size of the deficit became clear, the message changed and Ms Hewitt told health managers that balancing the books was the ‘highest priority’.

A new system of payment by results, where hospitals get paid only for treatments they carry out, has been partially suspended or modified by three strategic health authorities because they say it threatens to push their already parlous financial situation into an outright crisis. And so on, and disastrously on.

The crux of the matter is that the NHS’s problem has been consistently misdiagnosed. Its main difficulty is always said to be lack of money. But the amounts being spent on it are simply astronomical. It is now costing us almost £75 billion, compared with a mere £42 billion in 2001.

This vast increase, however, has been poured into a black hole, swallowed up mainly by pay increases and other costs and with only a meagre proportion going into improvements that patients can see.

An analysis by the King’s Fund shows that only 2.4 per cent of this increase has gone into new beds and operations. Ten times as much has gone into funding alterations to NHS pensions.

The next largest share has gone on pay increases for doctors and nurses and on wages for extra staff. The GPs cost more than the government expected, because they achieved more bonus points for getting more patients to have more tests.

This was a classic example of the perverse consequences of NHS management. The Government gave doctors a financial incentive to do more good things for patients. They duly did more – so many more that they ended up costing the NHS too much. And that’s a general paradox – the more efficient the NHS is in treating more patients, the more this costs and so the faster it goes bust.

Lack of money for front-line services is not the cause of the health service’s difficulty, but the result. The cause of the difficulty lies in the fact that it is simply unmanageable. A top-down, centrally run health service is a dinosaur on a dog lead. The Government cannot fix this problem because the Government is the problem. The more it tries to solve it, the worse it gets.

The NHS is too big and monolithic for any government to manage. The reason it is so bureaucratic is because it has to respond to so much control from Whitehall. The reason it wastes so much money is because it has no incentive to be prudent because it has no competition. Attempts to inject competition within the service merely mean Peter constantly robs Paul and debts spiral ever upwards.

On the other hand, European health systems are not crippled by these perverse consequences. They work much better because they are based on social insurance, which combine competition with protection for the poor and raise standards for everyone.

The NHS is still our sacred cow. But until we acknowledge that the system itself needs absolutely fundamental reform, too many sick people will continue to be not the beneficiaries of our health service but its victims.

Posted by melanie at December 8, 2005