Kailash Chand: How can we resource a 24/7 NHS?

Kailash ChandThe secretary of state for health in England Jeremy Hunt, has on numerous occasions expressed that he would like to see a seven day a week NHS, where patients get the same quality of treatment at weekends as on any working day. This is laudable. All efforts should be made to improve services at weekends, in the evenings, and out of hours, but we should not ignore those who are already working throughout the night and on Saturdays and Sundays in order to provide life saving care for their patients. People forget about the majority of consultants who provide on-call urgent and emergency care, or the 40% of GPs who do work out-of-hours. This is quite contrary to the impression being perpetuated that at 5pm everyone packs up and goes home.

The government has spent two years pushing through changes to the NHS on reluctant doctors and unexpecting patients, yet these changes have done nothing to meet the real challenges we face.  The launch of NHS 111 was meant to be a miracle cure to the building pressures of out-of-hours care, and yet its botched introduction has only made the situation worse. Jeremy Hunt’s proposals over the weekend to provide routine NHS procedures seven days a week and handing over out of hours care back to GPs are too crude and pander to a political agenda of wanting to look strong on the NHS and stand tough on patient safety. And yet the question remains—how do the politicians who call for a fully functioning 24/7 NHS expect to resource it when the government can hardly afford its current model, and when demands are being made to take out a further £20bn from the NHS budget by 2015 as part of the Nicholson challenge? These measures will only fuel the demand culture, and fail to take into account the available resources, investment required, and flexibility that will be needed to achieve this.

Nobody disagrees with Jeremy Hunt that a continuous evolution of the NHS is needed to resolve its challenges and massive problems, but so far no tangible gains have been achieved. From Alan Milburn’s term as health secretary to Jeremy Hunt’s current stint, the usual response to problems has not been to try to solve them, but to apportion blame on others, while projecting the image of safeguarding the NHS.

The NHS cannot continue to match its impressive historical performance if it is thrown to the mercies of private corporations and insurance companies. The economist Mark Britnell, formerly NHS director general for commissioning and system management, now KPMG partner in charge of “global health,” and one of the front runners for the NHS chief executive role, said to US private equity investors that “the NHS will be shown no mercy and the best time to take advantage of this will be in the next couple of years.” Is this the road map for Jeremy Hunt towards a sustainable 24/7 NHS care? Providing patient care seven days a week and patient safety above all other aims isn’t possible alongside the government’s escalating privatisation of the NHS which puts profits before patients.

In 2010 the public’s overall satisfaction in the NHS was 70%. If he wants to find a way to stabilise the future of the NHS, Jeremy Hunt should examine why this level of satisfaction plummeted to 58% as the coalition government’s reforms started to bite. Or why A&E waiting times have gone up. So far the response from politicians has been to look to the past and put all of the blame for the crisis in urgent and emergency care squarely onto the 2004 GP contract. This is to oversimplify the complexities of the problems facing A&Es and ignores the systemic failures that the reforms have created within the NHS. And what is clear is that these are problems which have snowballed on Jeremy Hunt’s watch. To blame a contract created under the last government is an attempt to do nothing more than take political potshots while creating a smoke screen to hide the government’s own mishandling of the NHS.  We have witnessed a relentless drive to cut down on the number of nurses, district general hospitals, and A&Es, and a simultaneous push for an expansion of community services, as well as secondary care from within the existing resources. Pouring more money in may not be the solution, but ministers’ own duty of candour must surely require them to engage with professionals, be transparent with the public, and above all stop politicising the NHS.

The NHS faces huge challenges. However, a high quality and efficient NHS working seven days a week will never be achieved using the market forces of “creative destruction.” We all want a patient focused NHS, but this comes at a cost. Unlike supermarkets and banks, which can increase their income streams by making their service more attractive to customers, the NHS cannot attract more revenue by changing its availability to the public as the NHS works within a fixed budget. Longer routine work will mean more costs—there is only so much than can be achieved by efficiency savings and these are being already squeezed out to unprecedented levels at present. The coalition government needs to work with doctors, and likewise we want to work with them. A divide and rule policy will not solve these problems but the coalition needs to be frank with the public and professionals about the resources that are available, and what is required to improve the performance and functioning of the NHS. An injection of realism is necessary to stop the destruction of the NHS, rather than forcing reform after reform or chasing spurious projects that can only undermine the objectives of this publicly funded body and the morale of its workforce.

Kailash Chand has been a GP for last 30 years. He is deputy chair of the BMA council and he was on the general practitioner’s committee. He was awarded an OBE in 2010 for services to the NHS. The views he expresses in his blog posts are entirely his own.