Jeremy Hunt, Secretary of State for Health, has, I hear, agreed to go (or send his minions) to talk to the junior hospital doctors at ACAS, the reconciliation service - at last. It takes a long time, it seems, for ministers to listen. So it was with a certain amount of scepticism that last week I read and tried to understand the Government's consultation document on the future of the NHS, and then filled in the response form. I found out about the consultation only after reading about a Guardian article on the subject by Ann Robinson, not thanks to the Government making it known. I received an automated acknowledgement after I'd submitted my response. I wonder, actually I very much doubt, whether any human being, besides you will bother to read it, let alone take any notice of it. Already Mr Osborne's Autumn Statement has had implications for health and social care provision in the local government settlement, which close down investment.Anyway, here is is my response:
1) Do you agree with
our aims for the mandate to NHS England?
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I disagree with a number of implications in the priorities
and aims:
1.
That ‘preventing ill health and supporting
people to live healthier lives’ is only the remit of the NHS. If other
budgets are cut, e.g. education and social care, than that aim cannot be
achieved.
2.
That the present GP system does not provide
good 24/7 care. As a patient with a chronic illness, this has been far from
my experience. This aim appears to militate against small GP practices.
3.
Defining as ‘long-term’ a mandate lasting ‘three
or more years’ invites the possibility of continual uncertainty and upheaval
to the service. It needs guaranteed stability.
I would question also the assumption that the patient knows best
implied in the priority: ‘People
should be given more power and control over the care that is provided to
them’ whilst agreeing that it should be that ‘services are arranged around
their needs and they are supported to manage their own health.’
I agree that the mandate should be
clearer and more accessible to the public.
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2) Is there anything
else we should be considering in producing the mandate to NHS England?
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Clarity and accessibility means avoiding language
incomprehensible to the public, such as: ‘in-year deliverables and metrics to
measure progress’ whose meaning eludes an English graduate.
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3) What views do you
have on our overarching objective of improving outcomes and reducing health
inequalities, including by using new measures of comparative quality for local
CCG populations to complement the national outcomes measures in the NHS
Outcomes Framework?
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The aim of increased transparency is a laudable one, but
it needs to be accompanied by increased trust, particularly of health professionals.
The aim of delivering equally good service nationwide is also clearly
desirable.
There is a danger in this target-driven objective of
unfairly stigmatizing skilled professionals in challenging situations and
driving them away from where they are most needed.
There is a further danger of diverting professionals from
their primary calling of care into a culture of form-filling. This is
counterproductive in the pursuit of excellence.
There is also a danger of league tables being used as
ammunition in political argument, which ultimately demoralises rather than
encourages. This is the stuff of bad management.
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4) What views do you have on our priorities for the health and care system?
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In headline terms, your priorities are ‘motherhood and
apple pie’
You want to create a healthier society, particularly
focusing on younger people. However, this seems less a function of the NHS
than of Education and recreation.
Dementia care and research is clearly an increased
priority. I am glad the government wants to put effort into those – as well
as other areas of mental health. The neglect of mental health ought to be
redressed; but this will need considerable financial investment both in the
NHS and in community social care.
Transparency and simplicity from the patient’s perspective
is desirable. However the security of digital records also needs to be
paramount. The government’s principle should be to rein back on centralised
record-keeping, rather than extending it. The citizen’s privacy should
normally trump efficiency. Retelling one’s symptoms is a small price to pay
for individual liberty.
However, creating new rights, such as the ‘right to a
specific named GP’, runs the risk increasing the burden of litigiousness
surrounding the medical profession as does the comparison of the health
service with the airline industry – with the possibility of suing for late
appointments for example. The healthcare industry is entirely different from
a commercial enterprise, and should not be shoehorned into becoming one.
Whilst I am in full agreement with the aim of preventing
‘avoidable ill health and premature mortality’, I think the assumption that
increasing longevity is a desirable aim should be questioned. Officiously
prolonging life is not a great good and should not be ‘a metric to measure
progress’. Good end of life care, however, should always be a top priority.
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5) What views do you
have on how we set objectives for NHS England to reflect their contribution to
achieving our priorities?
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As already indicated, I have some reservations about the
possible implications of where the objectives are specific. Otherwise they
seem general enough to be open to whatever interpretation is required by
policy makers. I do notice the final objective for the NHS to make money, or
to be involved in its generation.
Finally it needs to be said that this consultation process
is particularly opaque. The consultation document is not easy to follow, what
the questions are asking isn’t obvious and where to send this response form is equally unclear. You could for example simply say, ‘Thank you for taking the
trouble to complete this form. Please now send it to mandate-team@dh.gsi.gov.uk.’
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