Allowing the future to change us

A culture in the NHS of risk aversion and maintaining
the status quo stops Britain adopting new te

If necessity really is the mother of invention, then the NHS must be entering its second trimester. By the time the general election is over in May, we can hope to see a crib full of bouncing baby ideas, ­although the wails could be coming from the doctors. Spending on health care has tripled in Britain since Labour came to power, rising from £40bn in 1997 to £120bn last year - a rise that has taken it from 6 per cent of GDP to 10 per cent. Some 60 per cent of that budget is paid to staff, including 180,000 doctors, whose salaries have also tripled.

Does this generosity at the taxpayers' expense mean we are getting treated three times better? Sadly, no. The Office for National Statistics calculated that NHS productivity fell 0.4 per cent a year during Labour's first decade, compared with a 2 per cent annual rise in private-sector productivity. Despite bushels of cash and a plethora of targets, the health service has, on average, been getting worse.

If throwing money at the NHS hasn't improved things, perhaps a bout of austerity will. Although both Tories and Labour have pledged to maintain NHS funding in real terms, it might be difficult, given the huge deficit - the largest ever in peacetime - racked up since the start of the financial crisis. John Appleby, chief economist at the King's Fund, a medical think tank, said last year that “the NHS is facing the most significant financial challenge in its history". Faced with an ageing population and a frozen or shrinking budget, NHS managers will have no choice but to look - possibly at the risk of discomfiting a few consultants - for innovative ways to be more efficient.

And ways do exist. Take waiting times in emergency departments. The government's target is four hours, and some hospitals have come up with a variety of ruses - such as the 765 records that were reportedly falsified at Queen's Medical Centre in Nottingham - to hit it. In principle, the idea of setting a goal and letting hospitals experiment with solutions sounds like a good way to solve a problem. In practice, though, long waiting times are not the cause but a symptom. And symptoms, as the purveyors of patent cold remedies can attest, are easily masked without curing the underlying illness.

The Washington Hospital Centre in DC had a similar problem in the 1990s. The average waiting time in its emergency department was eight hours. Dr Craig Feied, now a professor of emergency medicine at the Georgetown University School of Medicine, was brought in to deal with the underlying mess. He found that doctors were spending 60 per cent of their time on information management - getting the patient's medical history, tracking down missing scans - and only 15 per cent on patient care.

“We often knew what information we needed, but it just wasn't available in time," Dr Feied told Steven Levitt and Stephen Dubner, the authors of Super­freakonomics. "In a busy emergency department, even two minutes away is too much." The hospital had more than 300 sources of information, he found, from handwritten notes to streaming video from cardiac angiograms, none of which could talk to the others.

Dr Feied designed a new computer ­system that brought all this information together on one terminal in the emergency room, allowing doctors to get at ­patient information quickly. The time they spent on information management fell by a quarter, while that spent on treatment doubled. In consequence, waiting times fell to two hours.

The NHS's troubled attempt to create an even more ambitious, over-centralised, nationwide computer system, the National Programme for IT (already more than 400 per cent over its original budget of £2.3bn), is at least nodding in the right direction. But it is likely to be chopped back in the next Budget in the interest of maintaining front-line services. Even if it is completed, it will still be behind cutting-edge developments in medicine. This is a pity, because information use is one of the most promising areas of innovation in medicine today.

The amount of data that can be generated about a patient is growing fast. A range of devices, from hand-held ultrasound kits to large MRI scanners, can provide insights into what is happening inside a patent. A one million per cent increase in the power of MRI scanners made it possible last year for doctors to see living, breathing lungs, in real time and in 3D, for the first time.

Future technologies will be even more impressive. Early screening will make it possible to spot diseases before they become difficult, or impossible, to treat. DNA tests will predict which treatment will work best on individual patients, ­allowing doctors to write tailor-made prescriptions, rather than trying one drug after another in an attempt to find one that works. Sophisticated scans will show not only the large-scale structures of organs, but the microscopic proteins and enzymes as they react with the agents of disease, drugs, and other treatments. Follow-up images will check that all is going according to plan.

If introduced and used properly, the new range of medical technologies could revolutionise the NHS, cutting costs and improving patient outcomes. Technology offers simpler improvements, too, such as reducing the number of missed appointments. For the forgetful or disorganised, a text message or automated reminder call made a day or two before a visit to the doctor is far more effective than a formal letter weeks in advance.

Adopting new technologies will not be enough. The NHS needs to find innovative solutions to delivering health care on a larger scale. As surgical techniques improve, for example, the number of nights a patient needs to spend in hospital falls, a trend that can only gain momentum with the spread of robot surgery, already used to assist with procedures as complicated as kidney transplants. But as fewer beds will be needed, it will make sense to concentrate resources in centres of excellence - or teaching hospitals as they used to be called. Polyclinics, particularly if they take walk-in patients, could fill the gap between a personal GP and a teaching hospital.

Change is never popular with everyone, and messing with the NHS is particularly risky. Managers don't want their empires to shrink. Doctors don't want to yield clinical power. Patients don't want to travel an extra mile. Critics can always claim that patient care is being put "at risk". Perhaps the toughest innovation will be to find a way to persuade people that the status quo is not satisfactory, and that the NHS, while not the worst system in the world, still has plenty of room for improvement.


Paul Rodgers is a freelance writer on science, medicine and technology


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Paul Rodgers is a freelance science, medicine and technology journalist. He was born in Derby, the son of a science teacher, and emigrated with his family to the Canadian prairies when he was nine. He began writing for a student newspaper in Winnipeg in 1982 and had staff positions on several Canadian dailies. Despite his return to these shores 15 years ago, he still talks with a funny accent.
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The Tories are the zombie party: with an ageing, falling membership, still they stagger on to victory

One Labour MP in Brighton spotted a baby in a red Babygro and said to me: “There’s our next [Labour] prime minister.”

All football clubs have “ultras” – and, increasingly, political parties do, too: although, in the case of political parties, their loudest and angriest supporters are mostly found on the internet. The SNP got there first: in the early days of email, journalists at the Scotsman used to receive bilious missives complaining about its coverage – or, on occasion, lack of coverage – of what the Scottish National Party was up to. The rest soon followed, with Ukip, the Labour Party and even the crushed Liberal Democrats now boasting a furious electronic horde.

The exception is the Conservative Party. Britain’s table-topping team might have its first majority in 18 years and is widely expected in Westminster to remain in power for another decade. But it doesn’t have any fans. The party’s conference in Manchester, like Labour’s in Brighton, will be full to bursting. But where the Labour shindig is chock-full of members, trade unionists and hangers-on from the charitable sector, the Conservative gathering is a more corporate affair: at the fringes I attended last year, lobbyists outnumbered members by four to one. At one, the journalist Peter Oborne demanded to know how many people in the room were party members. It was standing room only – but just four people put their hands up.

During Grant Shapps’s stint at Conservative headquarters, serious attempts were made to revive membership. Shapps, a figure who is underrated because of his online blunders, and his co-chair Andrew Feldman were able to reverse some of the decline, but they were running just to stand still. Some of the biggest increases in membership came in urban centres where the Tories are not in contention to win a seat.

All this made the 2015 election win the triumph of a husk. A party with a membership in long-term and perhaps irreversible decline, which in many seats had no activists at all, delivered crushing defeats to its opponents across England and Wales.

Like José Mourinho’s sides, which, he once boasted, won “without the ball”, the Conservatives won without members. In Cumbria the party had no ground campaign and two paper candidates. But letters written by the Defence Secretary, Michael Fallon, were posted to every household where someone was employed making Trident submarines, warning that their jobs would be under threat under a Labour government. This helped the Tories come close to taking out both Labour MPs, John Woodcock in Barrow and Furness and Jamie Reed in Copeland. It was no small feat: Labour has held Barrow since 1992 and has won Copeland at every election it has fought.

The Tories have become the zombies of British politics: still moving though dead from the neck down. And not only moving, but thriving. One Labour MP in Brighton spotted a baby in a red Babygro and said to me: “There’s our next [Labour] prime minister.” His Conservative counterparts also believe that their rivals are out of power for at least a decade.

Yet there are more threats to the zombie Tories than commonly believed. The European referendum will cause endless trouble for their whips over the coming years. And for all there’s a spring in the Conservative step at the moment, the party has a majority of only 12 in the Commons. Parliamentary defeats could easily become commonplace. But now that Labour has elected Jeremy Corbyn – either a more consensual or a more chaotic leader than his predecessors, depending on your perspective – division within parties will become a feature, rather than a quirk, at Westminster. There will be “splits” aplenty on both sides of the House.

The bigger threat to Tory hegemony is the spending cuts to come, and the still vulnerable state of the British economy. In the last parliament, George Osborne’s cuts fell predominantly on the poorest and those working in the public sector. They were accompanied by an extravagant outlay to affluent retirees. As my colleague Helen Lewis wrote last week, over the next five years, cuts will fall on the sharp-elbowed middle classes, not just the vulnerable. Reductions in tax credits, so popular among voters in the abstract, may prove just as toxic as the poll tax and the abolition of the 10p bottom income-tax rate – both of which were popular until they were actually implemented.

Added to that, the British economy has what the economist Stephen King calls “the Titanic problem”: a surplus of icebergs, a deficit of lifeboats. Many of the levers used by Gordon Brown and Mervyn King in the last recession are not available to David Cameron and the chief of the Bank of England, Mark Carney: debt-funded fiscal stimulus is off the table because the public finances are already in the red. Interest rates are already at rock bottom.

Yet against that grim backdrop, the Conservatives retain the two trump cards that allowed them to win in May: questions about Labour’s economic competence, and the personal allure of David Cameron. The public is still convinced that the cuts are the result of “the mess” left by Labour, however unfair that charge may be. If a second crisis strikes, it could still be the Tories who feel the benefit, if they can convince voters that the poor state of the finances is still the result of New Labour excess rather than Cameroon failure.

As for Cameron, in 2015 it was his lead over Ed Miliband as Britons’ preferred prime minister that helped the Conservatives over the line. This time, it is his withdrawal from politics which could hand the Tories a victory even if the economy tanks or cuts become widely unpopular. He could absorb the hatred for the failures and the U-turns, and then hand over to a fresher face. Nicky Morgan or a Sajid Javid, say, could yet repeat John Major’s trick in 1992, breathing life into a seemingly doomed Conservative project. For Labour, the Tory zombie remains frustratingly lively. 

Stephen Bush is editor of the Staggers, the New Statesman’s political blog.

This article first appeared in the 01 October 2015 issue of the New Statesman, The Tory tide