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Is flu really the winter ruin of the NHS?

11 January, 2018

Author: Warren Town, director of industrial strategy

Influenza

As we slowly drift into the new year, the political landscape changes but by not a lot. The reshuffle of the Conservative front bench that never was is now complete (we assume) with that nice Mr Hunt remaining as Secretary of State for Health, with an extended role to include responsibility for social care.

Because he has already made a pig’s ear of managing health, we can only assume that the ‘Peter principle’ applies where an individual will eventually be promoted into a position for which they are completely incompetent, as opposed to moderately so.

Much has been made of the Health Service crisis over the winter, which incidentally is still with us, and the fact that the NHS struggles to cope with the flu epidemic that allegedly originated in Oz. An epidemic that has been a major headache for healthcare, according to the press.

But as the ‘flu’ is a virus which must run its course, there is no magic cure, I struggle to see how this one condition is responsible for the decline of the NHS. Obviously vulnerable individuals need particular attention but this will be the same for any winter. The press link failures within the NHS with an illness that can debilitate, but for the fit and healthy should last no more than 8-10 days.

If you look dispassionately at sensationalist news of the NHS's steady fall from grace, there is little that has anything to do with flu and lots to do with poor investment, staffing and planning. But this is nothing more than old news.

It does not help that we are told that urgent care and operations are cancelled without assessment of the real effects that winter has compared to other periods in the year. Are we to assume that come spring/summer we all have magical remission and frolic in the sun?

Cue a return to normal and all is well except that we still have poor investment, staffing and planning.

I am also confused why politicians in England and Wales feel the need to apologise for cancelled operations over winter when they occur throughout the year. Does winter have some magical meaning? If it does, what is it and where is the evidence that there have been more cancellations in winter than summer?

Leaving aside sensational headlines in the press that have no other value than to sell papers, the root cause for the ‘crisis’ in the NHS remains.

Since 1955 spending in the NHS has increased. The greatest period of investment occurred from about 2002 and continues today, although it is beginning to flatten out.

In 1955/56 health accounted for 11.2% of public sector expenditure. In 2015/16 this had grown to 29.7%. This growth has not been managed to meet need but to balance the books in line with economic growth and what the government at the time thought might get them 'brownie’ points with the electorate.

And then we have targets! A phenomenon of the 2000s. The idea is that if you have targets you can measure performance and efficiency. Or ‘never mind the quality, feel the width’.  Quantity is more important that quality. For a profession that takes pride in the quality of healthcare members provide, the notion that throughput is the only realistic measure of performance is insulting.

We can also compare levels of healthcare expenditure with age. And so if you are 85, you will cost five times as much to keep fit and well compared to a 30 year old.

But as the bulk of healthcare is to address long term conditions such as heart disease, diabetes, illness related to obesity and dementia, many of which are not confined to the older population, you have to wonder how accurate this assessment of health expenditure reflects reality?

What is true is that historically investment has not matched the needs, or the march of developments in healthcare. Had it done so, would we now have the debates about how best to spend the dosh and not about the lack of it?

There have been equally strong debates about comparisons between UK expenditure on healthcare and Europe where, it is alleged, healthcare receives a greater share of the pot. The models for costing are not universal and comparing an insurance based system with direct taxation is like comparing chalk with cheese.

Successive governments have recognised that with the bulk of funding being spent on long term conditions and care and not on urgent treatments - although this is also on the increase but probably because of a decline in key services - there is a need to rethink the healthcare model. So let’s have a debate about more integrated healthcare with the bulk being delivered at home or in the community.

Of course this is also an old debate that has never been fully developed. Labour tinkered with it and the Tories paid it lip service but not one party was willing to look at how such a system would work other than to say how costly it would be to develop. So once again we get a lot of hand-wringing and furrowed brows and pay lots of money for consultants to do very little.

But the NHS is not just about buildings, patients and equipment, it is also about staff to make it work. And it is here that all governments fall down. Healthcare on the cheap and a reliance on goodwill is not a catchphrase, it is a reality.

The NHS Pay Review Body will release a report in March/April. They have sufficient evidence from the staff organisations to justify a sensible uplift. From NHS employers they have a three liner: We are broke!

As the NHS begins to fragment by country and need, the real questions about how best to provide a service for long term conditions and for urgent needs will resurface.

Will we see some intelligent thinking from Labour? Probably not as they appear to have even less of a clue then the government.

Will we see an intelligent conversation from the Tories? Perhaps we should ask Mr Hunt for his view. After all, he is now the minister for health and social care.

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