NHS Reform: Send in the Marines!

Barts Health Trust

James Evans sets out the challenges that face the NHS.

‘When someone makes a move//Of which we don’t approve//Who is it that always intervenes?’ asked satirical songwriter Tom Lehrer in his song ‘Send the Marines’. In terms of foreign war, the gung-ho political attitude which he set up could be argued to have repeated itself many times in recent Middle-Eastern conflicts! Successive UK Prime Ministers have engaged in interventionist politics whose wisdom, if judged by current outcomes, is greatly to be questioned. Frighteningly, however, my recollection of the words had no relationship to foreign affairs; it was the latest tales of woe from the NHS that brought this song to mind…

On 17th July, BBC News reported that Barts Health, the biggest NHS Trust, had called in the government’s ‘Financial Help Squad’ to help bring a spiralling deficit under control. Judging by the heated blame-game being played out in Parliament, Barts’ troubles are the tip of an Titanic-sinking iceberg. I know all too well of the challenges experienced by my own local trust, Heatherwood and Wexham…

In this situation, regardless of which politicians or administrators (or both) created the mess, clearly the government has to steady the ship. Sending the ‘marines’ to stabilise the regime is the inevitable consequence, much like a private company in trouble will send in the management consultants to bail their interests out! Not all ships can be salvaged, of course; the fall-out from the tragedy of the Costa Concordia still lingers on both in the courts and in the news.

Teams of ‘fixers’ are good at coming in and making the short-term decisions which the regular management are either afraid of or lack the vision to make. But, like the marines, they don’t stick around. History is littered with examples of short-term plans that fall apart once the shock troops return to their bases and the next phase of the challenge begins…

Successive Prime Ministers have been weaned at the teats of the sacred cow that is the NHS. Even David Cameron appears to believe that a National Health Service, free at the point of use, is the only choice for the UK. But even if we accept the convention of NHS infallibility, we should not be under the illusion that short-term fixes can solve long-term problems.

Successive Prime Ministers have been weaned at the teats of the sacred cow that is the NHS.

The fact is that Jeremy Hunt needs to get to grips with the structural problems which have led a generation of administrators to fail to keep the books balanced. At the same time, the government must win the war of public perception, so damaged by a string of stories about inadequate standards of care and treatment in hospitals, and overcrowded A&E departments.

Whilst I can’t tell the government how to unravel the Gordian knot at the heart of the NHS, bearing in mind that they have declined to cut it via an Alexandrine privatisation, some of the issues are very clear: first contact care is not working effectively, with too many people relying on A&E units, and thousands of patients each month are missing hospital appointments without cancelling them – costing NHS trusts a great deal of money and wasting resources.

Perhaps even more seriously, politicians need to be honest about the choices that we face. The general public are greatly attached to the concept of a local health service whereby hospital treatments are available within their community. But hospital-based healthcare is becoming too specialised for such a model to be financially sustainable. If we accept the evolving culture of referrals to highly specialised medical professionals, we must accept the death of the local hospital and of the general hospital practitioner, as such services can only be made available in medical metropolises or a string of smaller specialist hospitals jointly serving a very large area.

One thing is certain: the wrong choice for the NHS is simply to watch on whilst the Financial Health Squads do their work in the mistaken belief that they will save the day.

James has a practical background in politics, serving as a local councillor since 2007, and has studied both law and history at university. When he’s not trying to separate the reality from the rhetoric, James embraces culture in all its forms – especially performance arts.


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