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Gold, incentives and meh

We must tell people the truth - the Tories are deliberately wrecking the NHS

Dr Kailash Chand

Dr Kailash Chand

Last week national media reported the BMA’s warning that the NHS ‘winter crisis’ is now a year-round crisis.

Hospital doctors, GPs and patients have just endured one of the worst winters on record, with thousands of cancelled operations, unacceptably long waits to be seen and people who are already at their most vulnerable having to face the indignity of being treated in hospital corridors.

This Government has been in denial throughout the crisis; their arrogance shows this is the level of service they want the public to accept as the norm.

The NHS in general and primary care in particular entered this, the worst crisis of its 70-year history, since Jeremy Hunt became the health secretary. And how can Hunt’s performance be rated? All the key indicators within the NHS worsened, with waiting lists reaching 10-year highs.

Politicians’ reckless exploitation of goodwill means the NHS and its staff have come to end of their tether

A shortage of doctors, nurses, beds and care packages for elderly patients means that black alerts, trolleys in corridors and dangerous safety levels for patients are at a peak. NHS England has cancelled tens of ­thousands of hospital operations, which is creating the biggest backlog in the health service’s history.

A&E services are in a permanent state of chaos. Despite Hunt’s boasting, mental health services are still woefully underfunded. We have seen more than 4,000 mental health beds close since 2012. Social care services are in a state of paralysis. All these indicators mean more work in primary care without resources and funding.

The pressure on secondary care directly increases workload in primary care. Many GPs believe that however much capacity is provided, whether by telephone, in person or over the internet, this capacity is rapidly filled. GP services are in a perilous state. There were 70.1 GPs per 100,000 population in 2017 compared with 75.7 in 2014 – a drop of 7%. Almost 4,000 GPs have retired early in the past five years – nearly one in 10 of the profession. New figures show the number of GPs per head of the population has fallen for each of the last four years. The GP workforce really is in dire straits across the country.

Factoring in inflation, we know the NHS is suffering the longest budget squeeze in its history. From 1948 when it was formed, through to 2010, the NHS has received an annual funding uplift of around 4% each year. By contrast, from 2010 to 2020, this increase has more than halved, working out at just under 2% per annum. In England, NHS trusts are on track to overspend by more than a billion pounds this year.

We are the sixth wealthiest country on the planet and it is indefensible to starve the NHS of the funds it so desperately needs. To make things worse, billions of pounds of health service funding have passed to non-NHS providers under the Tories. That sum will continue to grow.

Jeremy Hunt may be the longest serving health secretary ever, but he will in my view primarily be remembered as the worst. The only ‘progress’ Hunt has made over the past five and half years is to turn the NHS into NHS plc, increasingly drawing on public funds to line the pockets of wealthy venture capitalists or multinationals.

My verdict, as a doctor working in and for the NHS for almost 40 years, is that history will judge this administration’s record as one characterised by broken promises, reductions in necessary funding and destructive legislation, leaving health services weaker, more fragmented and less able to perform their vital role than at any time in the NHS’s history.

And despite the best efforts of doctors and nurses, many patients are receiving ‘very poor care’ within the NHS. The core infrastructure of the NHS is also being eroded with the closure of many GP surgeries, hospitals and thousands of NHS beds since 2010.

Our NHS is being placed in the hands of accountants and businessmen who make financially driven decisions on which profitable future contracts should be awarded to what provider, including GP support services. Politicians’ reckless exploitation of goodwill and its product – low morale – means the NHS and its staff have now come to end of their tether. There is no doubt in my mind it is Jeremy Hunt and the Tories’ ideological dislike of a publically funded health service that has reduced our NHS to its knees.

We must let the public know what is being done to their NHS and general practice. And the public needs to stand up for the NHS; otherwise it is finished.

The NHS is 70 this year – defend it or lose it.

Dr Kailash Chand is a retired GP in Tameside

 

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Readers' comments (18)

  • We need the Nhs funding and management taking out of the hands of a government - rather like MPs pay so that a cross party or independent body organises appropriate resources and the taxpayers pay
    Politics in the NHS costs lives and the current funding and management model are unfit for purpose
    Let’s truly make the NHS the envy of the world and a great place to work in

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  • Unfortunately Nick Mann is correct on this and Cobblers needs to double check the figures. This isn't a trope; we are third from the bottom in terms of GDP spend in Europe, we spend 25% less per head of population than the Netherlands, Germany, Sweden, Denmark who have better outcomes data. If you look at key performance indicators plotted against spending, they mirror very closely. That's not being a lefty - just observation of facts, and unfortunately traditionally NHS spending has been significantly better under Labour. Post Blair when spending increased from 6.8 % GDP to 8.8% (still way below the European average of 10.5%) the NHS waiting times, A&E waits, patient satisfaction all increased markedly, and now are the worst since the millennium, with patient satisfaction declining rapidly. Not coincidence.
    Suggested reading:
    https://www.kingsfund.org.uk/publications/nhs-myth-busters
    https://www.kingsfund.org.uk/publications/articles/does-nhs-need-more-money
    https://www.kingsfund.org.uk/blog/2016/01/how-does-nhs-spending-compare-health-spending-internationally

    Unfortunately Jeremy Hunt, either personally or as the figurehead of the current government, is in the process of systematically destroying the NHS, and has the audacity to lie through his teeth quting false statistics (anyone remember the 60,000 new mental health workers which actually when analysed was about 600??)
    Unfortunately the NHS is propped up by goodwill and hard work, and it's no wonder the new breed of GPs are wanting a salried life with a defined workload. It's all going to hell in a handcart!

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  • I believe the funding of a health care system is not Drs job to decide , only as far as we have vote in elections. It is for the electorate to decide.
    We must simply demand the correct pay and conditions to do our job to a minimum acceptable standard. Who pays for it is irrelevant.
    The NHS is currently not really fit to work in.We are not safe with the volume and complexity of work we have to do .Our union should simply state this and we should all refuse to work until this is sorted out.
    The current system in which if you are unlucky enough to be involved in an error that causes significant harm to someone you can get a criminal conviction is, to my way of thinking, the last straw. I am definitely leaving.

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  • https://www.gmc-uk.org/-/media/documents/Personal_beliefs_and_medical_practice.pdf_58833376.pdf

    Dear editor;

    With regard to your columnist,may I express the hope that at least one of you can read.

    https://www.gmc-uk.org/-/media/documents/Personal_beliefs_and_medical_practice.pdf_58833376.pdf

    I would certainly agree that explaining the limitations of the NHS is valid,what the college used to call ideas,concerns,and expectations and sane people call a reality check.

    However extrapolating to a guarantee that a future government of a particular political persuasion,with a track record of bankruptcy will raise taxes sufficiently to fund their personal needs is I think overstepping the mark.

    The limitations are on occasion frightening,personally I think patients understand this already,but whether they make personal arrangements to mitigate the problem, or place their hope, faith ,future and ,earning in the hands of politicians is their personal choice

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  • The NHS is NOT expensive! It manages a great deal better care even now on much less per capita budget than countries based on insurance, especially america, where many have no cover at all.
    Yes, we need some debate about the 'luxuries', but the basics need to be adequately funded like in other countries.
    And we need a change in public attitude to suing and compensation - take it out of the corrupt legal system and follow the Kiwi lead of ARCIC, it is much cheaper in the long run, and starves out the corrupt and dishonest lawyers.

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  • If we want European levels of funding then we should also want the European mechanisms of funding. Not acknowledging this is being dishonest.

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  • It's rubbish that there is Malign Intent by Tories grappling with the NHS, and that all other parties are goody two shoes. Any politican has to face the real problems. The NHS needs a big rethink now other models of health service around the world are surpassing the NHS. Perhaps we need a non party Royal Commission to come up with ideas and take evidence from around the word and so we have a proper debate. This is not 1948, trhe current system has done its job and now past its sell by date. What's interesing is that 20-40 years olds are signing up to GP at Hand and Babylon, and they are supposed all to by Cobynistas.

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  • After 20 years as a Partner this is what I see. The number of patients I see in the surgery and at home has not changed very much. The morale within the Practice is the worst I have ever known. The number of hoops to jump through each day has now tipped over the critical line so that work is incomplete each day.

    There are no new GP Partners coming through. The existing Partners are frazzled and worn out. We are holding on grimly until retirement. Although not as long as previous generations as the pension no longer entices us in.

    The Locum costs are too expensive to keep the operation profitable. There are a lack of salaried doctors. We are trying to recruit paramedics, nurses, PAs and pharmacists to do the work of doctors. Not sure what are social prescriber does--but she is at least one happy face in the building.

    I think we will probably close down soon. Whilst I feel sad for the patients and staff I feel relief for myself. I think I will be a locum and do some OOHs work. I will no longer be a Trainer which is a shame--but I may have some freedom back.

    I think the locum gravy boat will eventually dry up.

    Suggested reading

    "Things fall apart" Chinua Achebe

    Inspired by WB Yeats

    " Turning and turning in the widening gyre
    The falcon cannot hear the falconer;
    Things fall apart; the center cannot hold;
    Mere anarchy is loosed upon the world."

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