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NHS: Can this patient survive?

Published 15 January 2007

Reform of the health service is slowing just as it needs to intensify. If we don't accelerate now, billions of pounds will have been wasted, warns the top cancer consultant

This month saw a blast of more bad news about our beloved health service. Too few nurses, too many doctors, no money, operations cancelled, another radiotherapy scandal, staff threatened with redundancy and entire hospitals going bust or being bailed out.

Many people must be wondering where all the taxpayers' money poured into the service has gone. After all, if you increased the budget of any commercial organisation from £34bn to £84bn a year you would expect to see dramatic improvements. But car parking is impossible, the loos are still dirty and patients sit around clutching pieces of paper in an age where you can travel the world with an invisible electronic ticket.

I have worked in the NHS for 34 years, so it comes as no surprise to me. It's a large monopoly provider employing 1.4 million people that sometimes seems more responsive to staff needs than to those of its customers. Buffeted by the winds of political and social change, assaulted by a barrage of new expensive technologies, faced with consumers who are far more demanding than their parents, it is now struggling for survival.

And in 2008, current increases in NHS funding of 7 per cent a year dry up. So what is the solution?

It has to be reform. Not tinkering at the edges but pushing quickly forward with the bold plans already in place. Increased pluralism with new players providing innovative services will lead to real competition and a market-driven approach.

Novel ways of working will result in greater efficiency, better motivation and allow staff to work together to drive innovation rather than whinge about the lack of it. The key is to get the multiplicity of professionals working together in the best way for patients. This will need close but not intrusive management.

We have nothing to fear from the further implementation of payment by results (PBR) - which simply means paying hospitals and GPs for what they actually do. It is exactly what happens in any other service industry. Imagine a supermarket getting paid the same wad of money each week regardless of how much it sold. PBR turns patients from service users into welcome customers.

Consider high-street opticians. The old lady with her shopping trolley living on a state pension is as welcome as the girl about town in Prada and pearls who wants Gucci frames. Both come out seeing better. Can we not apply the same model to cancer care and hearing aids?

The trouble is, as the think-tank Reform recently pointed out, the whole process of change is slowing down just as it needs to accelerate. Waiting times in some areas have actually risen and novel rationing systems have emerged.

There was an outcry from both left and right when a Department of Health report on workforce numbers was leaked. But these were probably only the back of an envelope doodles by civil servants, rather than a serious assessment of demand, technology improvement, patient preference and skill mix.

The real issue is that by 2008 we have to have moved from central to devolved planning. Local, not central, management should by then be deciding what staff to hire, what they should be doing, how many of what grade are needed and how much to pay them, just as in high-street shops. Real incentives for productivity, completely omitted in the recent, very costly, doctors' pay award, are vital in a pluralistic marketplace.

Stripping away bureaucracy to reduce costs is an essential component of therapy for the NHS. One report suggests that we are heading for a £7bn deficit in the NHS by 2010 and that is not allowing for changes in technology. That represents a 2p in the pound increase in income tax for everybody unless we can make things more efficient.

Major new investment capital is available from City institutions subject to robust business plans. The usual emotional statements of need or woolly wish-lists simply won't do. Doctors hold the key.

They can carry the other health professionals by providing decisive leadership. Achieving good rapport between local medical leaders and managers is vital, as is delivering services to patients in convenient settings rather than city-centre teaching hospitals, while retaining access to technological advances.

The NHS staff that I have known over many decades have the talent, skills and education to make this transition. Whether it is dealing with a child with leukaemia, a coach crash on the M25, or managing an elderly man with cardiac failure, NHS people can do it as well as the best in the world.

But only by intensifying the current reform programme will the NHS ever be got out of intensive care and sufficiently revived to make the long transition to a consumer-driven marketplace of health. Whatever our political persuasions, we must all surely agree that a speedy recovery is in everyone's interests.

Karol Sikora is a former director of cancer services at Hammersmith Hospital. He is now medical director of CancerPartnersUK, an independent sector provider which is working with the NHS to create the largest integrated cancer treatment system in Britain. He is on the advisory board of the independent think-tank Reform

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3 comments from readers

david prentis
15 January 2007 at 09:31

Contrary to Karol Sikora’s contention that changes in the NHS should be speeded up, it is the sheer pace and weight of change that is damaging the service. Instead of keeping the NHS in a state of permanent revolution, changes should be carefully trialled and evaluated. No business would push ahead with massive change before making sure they will work.

It is marketisation that is fuelling the current financial deficits, and undermining the very ethos, fabric and stability of our NHS. Instead of co-operation and collaboration we have competition and the obscene spectre of hospitals driven to spend precious NHS resources on advertising for patients.

We know that millions of pounds of public money has been siphoned off into the pockets of private sector billionaires through the Government’s misguided policy of driving through untested market-driven reforms. Most people do not want more competition in the NHS, they want local hospitals and health services that run efficiently and deliver good patient care.

The introduction of Independent Sector Treatment Centres is a prime example of new policy gone wrong. These private companies are given 5 year contracts and are paid for a set number of operations whether or not they carry them out. So called choice goes out the window as patients are pushed towards ISTC’s. Trusts face financial meltdown because money follows the patient and they are forced into using private providers instead of NHS facilities.

Patients should not have to wait in pain for their operations, but we now have the obscene situation where NHS operating theatres, scanners and even wards are being left idle or underused because multi-million pound contracts have been given to these private companies.

The Government should hit the pause button on reform; take stock of where we are, what we are doing and where we want to go. It should listen to the experts – the staff who deliver the service and the patients who use it.

David Prentis, General Secretary, UNISON

scarthin
17 January 2007 at 20:05

I do not really understand why people take any notice of Karol Sikoa. His verbals have always run a very, very long way ahed of his abilities and achievements, yet somehow he has talked himself into important jobs and positions of influence with th media. Just ignore him.

WP Colquhoun
30 March 2009 at 13:20

I agree with the David Prentis’s remarks about Karol Sikora’s article. My experience of the NHS is as both patient & a person who has been responsible for over 200 NHS staff visiting Romania to advise & assist change in Romania’s health care (see full page MSR advertorial - New Statesman 16 March). The motivation of NHS staff is generally high. But it is undermined by the targets culture, and an accountability system that ignores the factor of trust. Baroness Onora O’Neill’s 2002 Reith Lectures, “A Question of Trust,” hit the nail on the head where accountability & trust are concerned. Blackmailed by the false alternatives of the targets culture, managers too frequently choose to hit targets at the expense of medically directed action. This destroys morale and compromises patient care.

More private healthcare provision will not help. It costs more, as these companies are in it for profit. And if as happens now, the simpler operations are done by the private sector, the more expensive difficult operations are left to the NHS, which are then deprived of much needed revenue from these operations. Staff development in terms of training & experience also suffers.

Also, Multi Disciplinary Team Meetings (MDTMs ) so successful in the NHS for improving diagnosis & treatment decisions, will not happen in private sector.

Change is needed, but as Prentis writes, the sheer pace of change is part of the problem as well as their nature.

In the 18 years of NHS staff coming to Romania with Medical Support in Romania (MSR) I have never known morale so low. These targets introduce practices in the NHS which we are trying to stop in Romania, namely a punishment mentality & corruption. Targets, with their financial penalties lead to both. Staff are tempted to cut corners in order to hit targets.

The real change that is needed is to effectively harness the incredible good will & motivation in the vast majority of NHS staff.

Patrick Colquhoun, Director, Medical Support in Romania