By any account, the NHS is in crisis, and a crisis more acute this winter than we have seen before. Some have described the challenges facing the service as a ‘perfect storm’ of pressures, and whilst there is a debate about whether it is a question of quantity of funding or how that funding is used, there are some alarming statistics that it is hard to get away from.
Dr Alex Gates, an NHS doctor from Bath, highlights some of the key issues. The first relates to community care, which has been drastically cut by the Conservative Government as part of George Osborne’s ‘austerity’ measures.
An ageing population brings with it more complex health needs. Many of these are best addressed in the community and not in an acute hospital bed. But most of our community beds have been closed, so as a GP there will be nowhere for me to send my frail 85 year old patient who has had a fall at home and can no longer cope.
This is compounded by a dramatic shortage of beds, compared both with the past and with other health services.
In 1987 there were over 297,000 beds available in England. By 2015, this number was just 130,000. This is a drop of about 56%. Even more worrying is the drop in mental health beds, down from 67,000 beds in 1987 to 19000 in 2015.
In 2014 the UK had 273 hospital beds per 100,000 population. Compare this to Germany (823 beds per 100,000 population) and even Greece (424 per 100,000)…
Overall, our spending on healthcare is at the low end of developed countries as a proportion of GDP—and that it has been significantly cut under the Conservatives in contrast to the previous growth under the Labour Government. (It is worth noting here that all European countries have halted the growth on health spending since 2008, but that Britain has slowed its progress in catching up with others, and several have quickly overtaken us.) Many people would like to see the discussion depoliticised—but I was not encouraged when my MP, Anna Soubry, complained that local Labour politicians were making political capital out of the call for depoliticisation!
But underlying the politics and the finance, there are much deeper issues which are crippling the system, and they are issues where theology might have something very significant to contribute. They centre on how we view health, and how we see the people involved in the system and how they work.
What is our theology of the patient? The NHS was established after the war as a ‘free at the point of delivery’ service on the assumption that, as existing medical conditions were resolved, people would become healthier and in less need of medical help over time, so that the demand on the system would be self-regulating. This failed to take into account the possibility of growth in the technologies of health care, meaning that more and more could be offered, but it would become more expensive. But it was also built on the assumption that most people had an inherent reluctance to make use of the system, based on a sense of moral responsibility for their own welfare. This was completely undermined by the move (here and in other systems of national provision) of a customer/producer relationship, where the patient is now a ‘customer’ or ‘consumer’ of health services offered by a ‘provider’, most notably in John Major’s ‘Patients’ Charter’. Such an approach is incompatible with a health service ‘free at the point of delivery‘.
This relates to our theology of health. It seems in most debates about the system that health is seen as an absolute standard which people might fall below, and the healthcare system is there to rectify the deficit. There seems little sense of health as a gift for which we are responsible stewards, which needs to be nurtured and even invested in, not just by individuals, but communally and in relationship and partnership with others. All the evidence shows that may aspects of health are seriously affected by quality of relationships, and that an ageing population needs to be thinking about long-term, personal and relational investment in health and well-being over a lifetime.
On the other side of the system, we need to consider a theology of vocation for those involved in the medical professions. The long history of antagonistic relations between doctors and Government reached a new low when Theresa May appeared to blame lazy GPs for the current crisis; even if this had a shred of truth in it, it would have been a profoundly unwise move to make in the current context.
The head of the Health Select Committee has said Theresa May must apologise for trying to “scapegoat” GPs over overwhelming pressure faced by the NHS. Former GP Sarah Wollaston told The Independent the Government was “failing to take responsibility for a system-wide issue which is not just about primary care”.
The idea that you can have the same number of doctors working for the same money but offer more appointments and work longer hours for the same pay is a basic error of maths. The NHS has for a long time depended on foreign-trained doctors; 27% in the service were not trained in the UK. The application of market forces on education is making that worse, and ever-increasing workloads, combined with the new cap on pension funds, means that something like half of all doctors in their 50s are considering early retirement. In the past, many went into medicine (both doctors and nurses) from a sense of vocation; if the shortages are to be addressed, then it will be essential to recapture this sense of being ‘amateur’, of being involved from a love for the job and a sense of calling.
This relates to a theology of decision-making. Almost all decisions in healthcare are now ‘protocol-led’, that is, a decision can only be agreed once a series of checks have been made and routines have been followed. It is rarely reported, but this takes time and so adds to costs and introduces delays. The aim is to ensure consistency and avoid litigation—now a substantial part of NHS costs—but it eliminates the need for professional judgements, and dehumanises the process of decision. It is an approach which both responds to and reinforces a lack of mutual trust, between healthcare professionals and between carers and patients.
Finally, we need theology of resources. The Private Finance Initiative was hailed as a way of pain-free investment in health infrastructure, but it has turned out to be a way of mortgaging the future for the sake of the present, and repayment of costs is another significant drain on finances. Healthcare infrastructure should be commodified as a source of profit.
It's not an aging population or patient demand that's created a crisis in our NHS.
Posted by EvolvePolitics on Saturday, 14 January 2017
If we do not tackle these fundamental assumptions, the crisis will only get worse—and these can only be tackled by some sort of national conversation. John Pike, a Bristol GP, posted this extract from a doctors-only website:
NHS will need 50% extra – government advisers
The NHS budget will have to increase by half in the next 50 years to keep track with growing numbers of elderly people, according to government forecasters. The prediction – equivalent to £88 billion worth of spending – emerged in documents published by the Office for Budget Responsibility. They are equivalent to a 2% increase in spending annually.
The OBR, which advises the government on its financial plans, warns that the rising costs of health care could make public finances “unsustainable.” It says governments will either have to raise taxes or cut other areas of spending. The estimates show the NHS budget would increase from £140 billion in 2020 to some £228 billion by 2066, a figure adjusted for inflation.
Richard Murray, of the King’s Fund, told The Guardian: “The OBR’s acceptance of the need for a larger long-term increase in the proportion of GDP we spend on health is a welcome dose of realism, but also highlights the current pressures on the NHS. Given that plans for the rest of this parliament will see health spending fall as a proportion of GDP, it is another reminder that it is unrealistic to expect the NHS to continue to operate within spending plans at the same time as continuing to offer the same level of service.”
The conversation needs to start now, and theology has something vital to contribute.
Much of my work is done on a freelance basis. If you have valued this post, would you consider donating £1.20 a month to support the production of this blog?