I’m at a loss to understand how the NHS is going to meet rising demand.
Despite all the talk of efficiency and productivity, it’s going to be a tall order - and practically impossible if we want it to stick to its founding principles.
Several recent stories convince me of this. Hard evidence on demand comes in the form of a recent study by the Nuffield Trust which points to a “unsustainable” rise in emergency hospital admissions. There’s been an almost 12% rise in admissions over the last five years, costing the NHS an additional £330 million per year.
The government’s announcement that it’s disbanding NHS Direct, the 24-hour advice line, isn’t going to help. I’m no expert on primary care, but it appeared a useful service that helped take the heat off A&E and GPs.
If you believe the Save NHS Direct Campaign (with it being led by John Prescott, maybe you won’t) then the phone line fields 27,000 calls a day, or 9.5m a year. It’s staffed by 1,400 nurses, provides evidence-based information on its website and scores well on customer satisfaction.
Replacing it with a cheaper service, with fewer health professionals involved, is unlikely to help with demand.
Department of Health figures released this week suggest that GP referrals to secondary care are accelerating once more. Data on outpatient referrals and attendances show the number of GP referrals made from April to June this year increased by 169,000 to 3 million.
Referrals can be clamped down upon temporarily during times of financial crisis, but not when facing inexorable pressure.
It strikes me that there are parallels with global warming (largely because I’ve just ploughed through a weighty tome on the subject to assuage my guilt over reading Stieg Larsson on holiday).
There are loads of things we could do to help with the long-term sustainability of our health system. We should improve our approach to public health, deliver more preventative services, and so on. But, much like reducing our carbon emissions, it’s going to take too long. The NHS is going to be bankrupt long before then.
We have to do something now to deter the ‘time wasters’ from entering the system, and the only way to do this is to put a value on an NHS appointment. We need a simple system of charging for appointments. The usual groups would be exempted from charges and treatment would still be free (I’d even scrap the anomalous prescription charges system).
Jumping back to my rather spurious comparison with global warming, it’s the equivalent of investing in a quick technological fix rather than obsessing about the long game. My personal favourite is to mimic a volcano and pump some sulphur dioxide into the stratosphere to enact some global cooling.
It’s not something you want to do - and there’s always a risk of unintended consequences - but a dramatic approach like this is increasingly necessary, even if it compromises a few principles.