Patients before paperwork and medics before managers. It may be a different political party, but the National Health Service tune is the same: Cut red tape and reduce bureaucracy and give it to frontline services. Save money and increase efficiency by reducing the costs of running the health service. Streamline systems, reduce the armies of pen-pushers, cut back on the mass of managers. Tory Health Secretary Andrew Lansley has pledged to cut the cost of NHS administration by a third. His party has identified £4.4 billion of annual administrative costs which it plans to slash by a third by 2014-15.
Thirteen years ago, Frank Dobson pledged much the same thing when he became the first Health secretary in the new Tony Blair Government. In fact, he wasn’t quite so ambitious – his pledge was to cut admin costs by £100 million. Booming bureaucracy was “strangling” the health service, according to Dobson. Lansley accuses it of being “weighed down by a bloated bureaucracy”. Different expressions, but the same meaning.
Yet sadly, however well-intentioned these promises of efficiency savings may be, they never seem to happen. Each government wants to run the NHS in its own way. And getting rid of existing systems and introducing new ones cost time, money and a multitude of staff.
Lansley appears genuinely to want to put the NHS on the pedestal it deserves. To raise morale of staff who are disillusioned and dejected at the continual changes and overwhelmed by the mass of targets and paperwork. To improve patient satisfaction ensuring everyone gets gold standard care wherever they live. But has the new Government taken on too much? One of the most ambitious and potentially expensive pledges is to pay for all new cancer drugs. Is it realistic of them to say they will create a £200 million fund for this by April 2011?
What of the plans to halt the “forced closure” of maternity and casualty units? It’s highly popular stance. Everyone wants to save “their” local hospital. Yet only last month, a group of senior doctors wrote to The Guardian insisting that widespread rationalisation of hospital services, including the closure of some accident and emergency units, is the only way forward and would not only save money but patients’ lives.
For too long, politically-motivated targets – the major focus of the NHS under Labour – have encouraged duplicity and statistical juggling. Staff can only be delighted that these are being abandoned by the Tory-Liberal Democrat coalition. Will the focus on health results such as stroke and cancer survival rates be easier to monitor and free up frontline staff to concentrate on patients rather than paperwork? Despite a manifesto commitment to protect NHS spending in real terms, the new Government has admitted they may have to make more savings than the previously announced £20 billion in efficiency cuts. Lansley has admitted that, although the NHS budget would rise above inflation each year, there was a case for making greater savings because of increases in demand such as keeping up with new drugs, the ageing population and lifestyle issues such as obesity.
It is early days and over the next few months, maybe years, we will be able to see whether the Government succeeds in removing the expensive layers of bureaucracy, slashing the cost of NHS administration, and putting patients first. But while the Government may have got off to a positive start as far as the public is concerned, it has already fallen foul of GPs. It is heading for a long and bloody battle with what are traditionally some of its soundest supporters. In one of his first interviews after taking office, Lansley said he would force GPs to take back responsibility for out-of-hours care, tearing up the 2004 contract devised by Labour that allowed them to opt out of providing care in the evenings and at weekends.
Unsurprisingly, GPs have not reacted favourably. They value their evening and weekend freedom and will not surrender it without a fight. Although it is not as if they are being asked to be on call round the clock, as many single handed GPs used to be. Instead under new plans, responsibility will be handed back to GPs working in local groups, who will commission services or provide them by working in rotas through co-operatives.
Out-of-hours care has become a shambles since Labour allowed GPs to work from 8am to 6.30pm. Cash-strapped primary care trusts, which took on the responsibility of organising evening and weekend GP cover, often cut corners and employed too few doctors. When the on-call medic did answer a phone call or make a night visit they often knew nothing about the patient’s condition or care.
In the worst-case scenario, private companies have taken over the provision of cover and in many cases have employed foreign doctors, often with little grasp of English. Complaints from the public have soared. But as self-employed people, not NHS salaried staff, family doctors would have to agree to any major contract changes. Opting out of out-of-hours was one of the main reasons GP voted for their new contract in 2004. Their bargaining power is that they can walk out of the NHS and only treat private patients, as many dentists quit when they did not like their contract.
Two years ago, Labour tried to get GPs to extend their opening hours for patients and the vast majority refused, claiming working longer hours would adversely affect their ability to give their best to patients. I can’t see why. In most GP practices, there are several doctors and they are never all on duty at the same time. Why not have a shift system? Hospital doctors, indeed the vast majority of NHS medical staff, work a shift system. Why not GPs?
But in a way I do feel sorry for GPs and all other NHS staff. Another Government, another NHS agenda and another reform.
