Posted by: Tony Copperfield3 May 2017
Spring is sprung, etc. And as the weather warms, the headlines about health service Armageddon go the same way as those winter viruses. You’d be forgiven for thinking that those green bits sprouting in your garden are the first shoots of recovery.
Well, they’re not. They’re actually signs of mould on the NHS’s putrefying corpse. Because our problems have, most emphatically, not gone away. The health service survived the winter by luck rather than judgement, practices remain one puff of wind short of collapse and the pressure on ambulance services and A&E is still a sick joke.
As for the proposed solutions, I can look back on nearly three decades of Bright Ideas, and confirm, with a hollow laugh, that each was as pointless as the last.
On a micromanagement level, we’ve had health promotion clinics to prevent illness in the first place, the QOF to stimulate disease-defying excellence and the Avoiding Unplanned Admissions DES because, if we can’t actually avoid punters getting sick, then least we can stop them dialling 999. And guess what? None of it works.
Nor does the constant churn of macromanagement. Fundholding, commissioning and now MCP contracts: they simply leave us with déjà vu, change fatigue and the same old problems.
Listen, movers and shakers. You can reorganise until you’re blue in the face, you can tempt us with carrots and you can beat us with sticks, but the fact is, we’re already doing the best we can, and always have been. We’re trying to win an unwinnable war, so no wonder there’s an increasing number of deserters and no one signing up. Dreaming up incentives, punishments or illusions of power is just a desperate way of shifting responsibility and avoiding reality.
That reality being, of course, that the NHS is just not sustainable. Nothing new there. What is new, though, is public reaction. OK, the standard consultation opener of, ‘I’ve waited weeks for an appointment’ abides; fair enough, given that waits have gone up on account of there only being 24 hours in the day and about 24 GPs left in the UK. Yet, suddenly, I find this opening gambit isn’t followed by the ‘I pay my taxes’ harangue about my crappy service.
What I get instead, unnervingly, is sympathy. An acknowledgement that the NHS, and general practice in particular, are under the cosh – plus a genuine gratitude that I’m still there to refuse their requests for antibiotics, their demands for scans and their pleas for referral, a service they’ve obviously just started to appreciate.
In other words, at last, the public gets it. They accept the NHS is sinking. That, in turn, removes politicians’ excuse to swerve the real issues: nothing will surprise or alienate voters, because they’ve clicked that something’s got to give.
So it’s time to stop fannying around at the edges – and a snap election provides the ideal opportunity. The Government needs to limit what the NHS can be expected to provide, boost funding through a hypothecated tax, or both. That’s how you resurrect a rotting corpse. Failing that, give it a decent burial.
Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter @DocCopperfield