11 Jul 2013

More talk more NHS action? Really?

For a long time now we have been told it is good to talk and certainly that is what NHS England thinks.  Having warned us that the NHS is facing a £30bn shortfall by 2021, the bosses there have decided that they want a chat with the nation to discuss the future of healthcare.

Sir David Nicholson, the outgoing head of NHS England, said that if the NHS attempted to “muddle through”, there would be more scandals like Stafford.  But the report launched today, “A Call to Action”, is short on detail and long on what the problems are.

They are, of course, familiar.  An ageing population, a flatline budget with little prospect of any immediate boosts in funding, more patients with long-term conditions and the cost of replacing old technologies with new.

So the idea is to ask patients, staff and the public for their ideas.  We have been here before.  Gordon Brown thought a chat would be good and massive sessions were held around the country with various Ministers (occasionally the then PM himself) and NHS managers delegated to go and listen.

Watch the interview: NHS boss in quality care warning

I can’t quite remember what came out of those discussions but it is irrelevant now because there was a change Government and we had a massive reform of the NHS, costing between £2bn and £3bn.

Indeed, the question was quite rightly asked of Sir David (by the Guardian columnist, Polly Toynbee yesterday at the briefing on this national chat) – what was the point of all that upheaval and change and redundancies etc, if they have not addressed these supposedly fundamental issues.

I am not sure I understood the response because there is a tendency for people at the top of the NHS to fall back on bureacratic-speak (I thought I’d passed that particular language course but sometimes I am foiled).  But it remains that we are now being told that on top of the £20bn that needed to be saved by 2015 (called the Nicholson challenge, as it happens), there is further to go.

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So, a few ideas thrown out there were bigger GP surgeries, offering more services.  There will inevitably be a renegotiated GP contract as well.  Better working between health and social care in order to keep people out of hospital and more reconfiguration of services, which tends to mean hospitals closing or being downgraded.

On that last point, there was a hint of frustration or irritation even from Sir David about the snail’s pace at which these changes happen.  He said that he there would need to be a discussion with the department of health and ministers about speeding this up.

I wish him luck.  History is not in his favour.  The downgrading of Lewisham (currently before the High court), Ealing general (legal action planned), reconfiguration of paediatric heart services (no closer now than it was following Bristol and, indeed, postponed last month by the Health Secretary).

What’s more, talking about talking, if you ask patients what they want they will say they want their local hospital to stay open.

And indeed, even as I was writing this a perfect example cropped up. Jeremy Hunt announced that the A&E unit at Trafford General in Greater Manchester will be closed. The campaign to keep it open has been, as ever, passionate. But to no avail. So there was a conversation that resulted in something the local population did not want.

And the added irony is that Trafford General turns out to be the birthplace of the NHS. Sixty-five years ago, that was where the first-ever patient was treated.

Not the best of anniversary presents.

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