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The NHS can't do more work for less money

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As a registrar and a parent I learnt how to frame questions. Instead of asking my daughter if she wants to go for a nap, I ask her, ‘Do you want Mummy or Daddy to put you down for a nap?’ The assumption is made already by the framing of the question that she is going for a nap. 

What I should be asking my patients who still smoke is, ‘How do you think you can best give up smoking?’, instead of, ‘Do you want to give up smoking?’

But it’s not just parents and doctors that use framing of questions to help achieve their aims. NHS England has recently done it too.

Before the election, press reports focused on whether political parties would pledge to fund the predicted £8 billion shortfall expected in the NHS by 2020. The framing of the question offered over this shortfall, posed by NHS England in the Five Year Forward plan, was that there will be this amount of money to be made up once efficiency savings of 2-3% have been made between now and 2020. That is a saving of £22 billion, according to them.

The NHS will have to find efficiencies and cut the amount of expenditure for the first time in its lifetime, at a time when the population is getting older, frailer, with more complex health problems. At a time when emergency admissions are on the increase and frail, complex elderly patients get stuck in acute beds due to lack of social care capacity. At a time when drug companies can threaten to sue if branded versions of their drug are not prescribed, instead of cheaper generic forms. At a time when demand for GP consultations is rising, the new government have pledged to increase the primary care doctor workforce by 5,000, providing a seven-day service and guaranteed quick access for over-75s.

At a time when the Commonwealth Fund has ranked the NHS as being the best value for money health service, it is being asked to do more and become even more efficient.

To me it simply doesn’t add up. I’m aware, despite its rating, that an organisation as big as the NHS is probably, even likely, to be inefficient, but I’m not sure that the savings sought will be easily found. All the pressures on the NHS seem set to inflate costs, not cut them.

The only conclusion I can reach is that at some point there will be a crunch and - forgetting the £8 billion shortfall - there will be a counting of the pennies.

If the £22 billion is not saved, or being saved, then something will have to give. Nurses? Doctors? Hospitals? Drugs? Socialised healthcare itself?

Dr Samir Dawlatly is a former secretary of the RCGP’s adolescent health group and a GP in Birmingham.

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Readers' comments (5)

  • I would bet something will give in the next 5 years if they are anywhere near like the last 5 years.NOT GOOD!

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  • The operative questions are (1) Is the existing funding being utilised efficiently? (2) Is enough being done by the patients to avoid unhealthy lifestyles? (3) Is the system too Top (as in management ) heavy? (4) Should physicians not train and be more involved in management?

    Perhaps, the author will try expand on the bit about 'Drug companies threatening to sue IF their brand name medications are not prescribed'. I believe that anyone can threaten to sue but I do not envisage the basis upon which such a law suit can succeed.

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  • I have to laugh at the previous comment, "is enough been done to avoid patients living unhealthy lifestyles?" You cannot be with a patient 24/7 so just how do you propose to marshal their lifestyle??? The ONLY way to do this is to , dare I say it, make people responsible for their own body and their own health and by this I mean fully accountable in terms of their health itself and fully financially accountable for the consequences of their gluttony and sloth. Money is the only language people understand and until we stop mollycoddling patients and allowing them to eat themselves into obesity and diabetes and then allow them to have treatment all at the taxpayers expense, we are all totally doomed

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  • Anonymous | 16 May 2015 9:25am

    Well said!!
    That is the stark truth that no politician (or left leaning Manager) will face up to.

    While ever there is this massive "free" safety net (NHS) we will always have people abusing themselves be that through overeating, overindulging in alcohol, smoking, taking drugs etc. etc. etc. Even a fight on a friday night is OK "cause if I get hurt the ambulance will take me to A&E where I will be patched up for free,"

    Stop bailing people out and watch the abuse reduce.

    I think they used to call it "Tough Love!!"

    Remember "point of need" not want nor desire.

    Simple brief such as, Stop Smoking or die........., Stop drinking or die........, Stop over eating or die........., Stop taking drugs or die......... would soon get the message across. Addiction becomes more rife when we try to medicalize it and "understand." We should just be pointing out and reiterating that it is wrong and the consequences will be death. We cannot and will not help you if you are not prepared to help yourself.

    Instead what do we do? we give "free" drugs to drug addicts, more benefits to alcoholics, "free" bariatric surgery to the obese............ it's time to stop.

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  • Well said again. Trouble is, none of these ideas would ever get past the trendy liberals in our midst

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