{"id":801,"date":"2011-05-14T15:09:37","date_gmt":"2011-05-14T15:09:37","guid":{"rendered":"http:\/\/www.saasoft.com\/blog\/?p=801"},"modified":"2011-05-14T15:09:37","modified_gmt":"2011-05-14T15:09:37","slug":"july-5th-2018-the-nhs-is-no-more","status":"publish","type":"post","link":"https:\/\/hcse.blog\/?p=801","title":{"rendered":"July 5th 2018 – The old NHS is dead."},"content":{"rendered":"

\"\"<\/a>Today\u00a0is the last day of the old NHS –\u00a0ironically on the 70th\u00a0anniversary\u00a0of its birth.\u00a0Its 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\u00ae, as it is now called, is a commodity just like food, water, energy, communications, possessions, housing, transport, education and leisure – and the\u00a0the\u00a0only things\u00a0we get free-of-charge are air,\u00a0sunlight, rain and gossip.\u00a0 SickCare\u00ae is now\u00a0only available from fiercely competitive\u00a0service conglomerates – TescoHealth and VirginHealth being the two largest.\u00a0 We now buy SickCare\u00ae like we buy groceries\u00a0– online\u00a0and instore.<\/p>\n

Gone forever is the public-central-tax-funded-commissioner-and-provider market. Gone forever are the\u00a0foundation trusts, the clinical commissioning groups and the social enterprises. Gone is the dream of cradle-to-grave equitable health care\u00a0 – and all in a terrifyingly short time!<\/p>\n

The once proud and independent professionals are now paid employees of profit-seeking private providers. Gone is their\u00a0job-for-life security and gone is their gold-plated index-linked-final-salary-pensions.\u00a0 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<\/em>“.<\/p>\n

So what happened?\u00a0How did the NHS-gravy-train come off the\u00a0taxpayer-funded-track so suddenly?<\/p>\n

It is easy to see with hindsight\u00a0when the cracks started to appear.\u00a0No-one and every-one\u00a0is to blame.<\/p>\n

We did this to ourselves. And by the time we took notice it was too late.<\/p>\n

The final straw was when\u00a0the old NHS became unaffordable because we all took it for granted and we all abused it.\u00a0 Analysts now agree that there were two core\u00a0factors\u00a0that combined to initiate the collapse and they are unflatteringly referred to as “The\u00a0Arrogance of Clinicians<\/em>” and “The Ignorance of Managers<\/em>“.\u00a0 The latter is easier to explain.<\/p>\n

When the global financial crisis struck 10 years ago it destabilised the whole\u00a0economy and\u00a0drastic “austerity” measures had to be introduced by the new coalition government. This opened the\u00a0innards of the NHS to scrutiny\u00a0by commercial organisations with an eager\u00a0eye on the \u00a3100bn annual budget. What they discovered was a\u00a0massive black-hole of management ignorance!<\/p>\n

Protected for decades from reality by their public sector status\u00a0the NHS managers\u00a0had not seen the need to develop their skills and experience in\u00a0Improvement Science and, when the chips were down, they were simply unable to\u00a0compete.<\/p>\n

Thousands of them\u00a0hit the\u00a0growing queues of\u00a0the unemployed or had to settle for\u00a0painful cuts in their pay and conditions before they really knew what had hit them. They were ruthlessly replaced by a smaller number\u00a0of 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.<\/p>\n

The medical profession\u00a0also suffered.<\/p>\n

With the drop in demand for unproven treatments,\u00a0the\u00a0availability of pre-prescribed evidence-based standard\u00a0protocols for 80% of the long-term conditions,\u00a0and\u00a0radically redesigned community-based delivery processes –\u00a0a large number\u00a0of super-specialised doctors were rendered\u00a0“surplus to requirement”. This skill-glut created the perfect buyers market for their specialist knowledge –\u00a0and they were forced to trade autonomy for survival.\u00a0No longer could\u00a0a GP or a Consultant choose when and how they worked; no longer were they\u00a0able to discount\u00a0patient opinion or\u00a0patient expectation; and no longer could they operate autonomous empires within the bloated and bureaucratic\u00a0trusts that were powerless to performance\u00a0manage them effectively. Many doctors tried to swim against the tide and were\u00a0lost – choosing to jump ship and retire early. Many who left it too late to leap failed to be appointed to their previous\u00a0jobs because of “lack of required team-working and human-factor skills”.<\/p>\n

And the public\u00a0have fared\u00a0no\u00a0better than the public-servants. The\u00a0service conglomerates\u00a0have 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\u00a0NHS, medical bankruptcy is not politically palatable.\u00a0 State subsidised insurance payouts provide\u00a0a safety net\u00a0 – but they cover only basic care. The too-poor-to-pay are\u00a0not left to\u00a0expire on the street as in some\u00a0countries – but\u00a0once our immediate care needs are met\u00a0we have to leave or start paying the going rate.\u00a0 Our cashless society and our EzeeMonee cards\u00a0now mean that\u00a0we\u00a0pay-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!<\/p>\n

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\u00a0health of the nation will be better for it. No longer able to afford the luxury of self-abuse through chronic overindulgence\u00a0of food, cigarettes, and alcohol – and faced with the misery of the outcome of their own actions\u00a0–\u00a0\u00a0many people are shepherded\u00a0towards\u00a0healthier lifestyles. Those who comply enjoy lower insurance premiums and attractive no-claims benefits.\u00a0 Healthier in body perhaps\u00a0– but what price have we paid for our\u00a0complacency?\u00a0“<\/p>\n

\n

On July 15th 2012 the following headline appeared in one Sunday paper: “Nurses hired at \u00a31,600 a day to cover shortages<\/em>” 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<\/em>“. \u00a0We were warned and it is not too late.<\/p>\n

\n","protected":false},"excerpt":{"rendered":"

Today\u00a0is the last day of the old NHS –\u00a0ironically on the 70th\u00a0anniversary\u00a0of its birth.\u00a0Its 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\u00ae, as it is now called, is a commodity just like food, water, energy, … <\/p>\n

Continue reading “July 5th 2018 – The old NHS is dead.”<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[22,32,41,48],"tags":[],"class_list":["post-801","post","type-post","status-publish","format-standard","hentry","category-healthcare","category-productivity","category-stories","category-trust"],"_links":{"self":[{"href":"https:\/\/hcse.blog\/index.php?rest_route=\/wp\/v2\/posts\/801","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/hcse.blog\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/hcse.blog\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/hcse.blog\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/hcse.blog\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=801"}],"version-history":[{"count":0,"href":"https:\/\/hcse.blog\/index.php?rest_route=\/wp\/v2\/posts\/801\/revisions"}],"wp:attachment":[{"href":"https:\/\/hcse.blog\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=801"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/hcse.blog\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=801"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/hcse.blog\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=801"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}