Today is the last day of the old NHS – ironically on the 70th anniversary of its birth. Its founding principles are no more – care is no longer free at the point of delivery and is no longer provided according to needs rather than means. SickCare®, as it is now called, is a commodity just like food, water, energy, communications, possessions, housing, transport, education and leisure – and the the only things we get free-of-charge are air, sunlight, rain and gossip. SickCare® is now only available from fiercely competitive service conglomerates – TescoHealth and VirginHealth being the two largest. We now buy SickCare® like we buy groceries – online and instore.
Gone forever is the public-central-tax-funded-commissioner-and-provider market. Gone forever are the foundation trusts, the clinical commissioning groups and the social enterprises. Gone is the dream of cradle-to-grave equitable health care – and all in a terrifyingly short time!
The once proud and independent professionals are now paid employees of profit-seeking private providers. Gone is their job-for-life security and gone is their gold-plated index-linked-final-salary-pensions. Everyone is now hired and fired on the basis of performance, productivity and profit. Step out of line or go outside the limits of acceptability and it is “Sorry but you have breached your contract and we have to let you go“.
So what happened? How did the NHS-gravy-train come off the taxpayer-funded-track so suddenly?
It is easy to see with hindsight when the cracks started to appear. No-one and every-one is to blame.
We did this to ourselves. And by the time we took notice it was too late.
The final straw was when the old NHS became unaffordable because we all took it for granted and we all abused it. Analysts now agree that there were two core factors that combined to initiate the collapse and they are unflatteringly referred to as “The Arrogance of Clinicians” and “The Ignorance of Managers“. The latter is easier to explain.
When the global financial crisis struck 10 years ago it destabilised the whole economy and drastic “austerity” measures had to be introduced by the new coalition government. This opened the innards of the NHS to scrutiny by commercial organisations with an eager eye on the £100bn annual budget. What they discovered was a massive black-hole of management ignorance!
Protected for decades from reality by their public sector status the NHS managers had not seen the need to develop their skills and experience in Improvement Science and, when the chips were down, they were simply unable to compete.
Thousands of them hit the growing queues of the unemployed or had to settle for painful cuts in their pay and conditions before they really knew what had hit them. They were ruthlessly replaced by a smaller number of more skilled and more experienced managers from successful commercial service companies – managers who understood how systems worked and how to design them to deliver quality, productivity and profit.
The medical profession also suffered.
With the drop in demand for unproven treatments, the availability of pre-prescribed evidence-based standard protocols for 80% of the long-term conditions, and radically redesigned community-based delivery processes – a large number of super-specialised doctors were rendered “surplus to requirement”. This skill-glut created the perfect buyers market for their specialist knowledge – and they were forced to trade autonomy for survival. No longer could a GP or a Consultant choose when and how they worked; no longer were they able to discount patient opinion or patient expectation; and no longer could they operate autonomous empires within the bloated and bureaucratic trusts that were powerless to performance manage them effectively. Many doctors tried to swim against the tide and were lost – choosing to jump ship and retire early. Many who left it too late to leap failed to be appointed to their previous jobs because of “lack of required team-working and human-factor skills”.
And the public have fared no better than the public-servants. The service conglomerates have exercised their considerable financial muscle to create low-cost insurance schemes that cover only the most expensive and urgent treatments because, even in our Brave New NHS, medical bankruptcy is not politically palatable. State subsidised insurance payouts provide a safety net – but they cover only basic care. The too-poor-to-pay are not left to expire on the street as in some countries – but once our immediate care needs are met we have to leave or start paying the going rate. Our cashless society and our EzeeMonee cards now mean that we pay-as-we-go for everything. The cash is transferred out of our accounts before the buy-as-you-need drug has even started to work!
A small yet strident band of evangelical advocates of the Brave New NHS say it is long overdue and that, in the long term, the health of the nation will be better for it. No longer able to afford the luxury of self-abuse through chronic overindulgence of food, cigarettes, and alcohol – and faced with the misery of the outcome of their own actions – many people are shepherded towards healthier lifestyles. Those who comply enjoy lower insurance premiums and attractive no-claims benefits. Healthier in body perhaps – but what price have we paid for our complacency? “
On July 15th 2012 the following headline appeared in one Sunday paper: “Nurses hired at £1,600 a day to cover shortages” and in another “Thousands of doctors face sack: NHS staff contracts could be terminated unless they agree to drastic changes to their pay and conditions“. We were warned and it is not too late.