The antidote

My first patient on Monday morning was an elderly man requesting stronger analgesia. We had referred him to the hospital for surgical treatment of his progressive hip problem 11 months before. In that time, this gentleman had become increasingly debilitated and increasingly housebound. He spent every day in agonising pain.

I was later struck by the normality of this conversation. I have hundreds of patients in my practice with a  similar story. Across the country there are at least 6  million people on NHS waiting lists – with 300,000 waiting over a year for treatment, many of whom will be in pain, conditions deteriorating.

The Tories are quick to blame this on Covid-19 but waiting lists were rising prior to the pandemic. A&E waiting times and cancer treatment targets – the very things the Tories claim to care about – were the worst on record. The lack of spare capacity pre-Covid-19 meant the NHS was in effect running in crisis mode – and so when coronavirus hit, mass cancellations and redeployment were necessary to prevent collapse.

But the inadequacies of the NHS run wider than capacity. A study of global health systems in advanced economies by the Commonwealth Fund put the NHS second from bottom on healthcare outcomes. Research from International Cancer Benchmarking Partnership puts UK cancer outcomes behind comparable health systems. And international studies on amenable mortality, infant and young person mortality also show the NHS performing below average with comparable health systems. The consequence of this is preventable death and suffering. To  put this into perspective, if we had the same infant mortality rate as Sweden 1,000 more babies would survive every year.

Our NHS has one of the smallest healthcare workforces in the world for our population size: For every 1,000 people, we have eight nurses and three doctors, both below the average in the OECD. When it comes to diagnostic technology, we have significantly fewer MRI and CT scanners than the OECD average. And when it comes to offering the best treatments to patients, again the UK falls short. In 2019, just 20 per cent of new medicines available elsewhere in Europe were available in the UK, despite having been formally approved for use. These statistics disguise the large variation in performance across the system, with luck of the draw on whether you encounter an excellent or underperforming part of the health service.

You get what you pay in. The Kings Fund still says that we are one of the best value for money healthcare systems in the world. But years of austerity and ‘efficiency savings’ have resulted in quality and compassion being squeezed out of care. The result of this has been scandal after scandal: thousands of preventable deaths that occurred at Mid Staffs, the deaths of mental health patients in Essex NHS trust, and the scores of babies and mothers that died or came to harm from maternity scandals at Morecambe Bay, East Kent, and Shrewsbury and Telford NHS trust. All reveal an underlying problem – those in charge put their fear of bad headlines ahead of patient care. A toxic top-down culture of neglect, cover-up and failure to learn.

Nye Bevan’s founding aim of world-class healthcare for all is being eroded by Tory ideology and incompetence. And as Covid-19 brutally exposed, those who are poorer and racialised minorities are getting sick and dying at a younger age.

The public remain grateful for the NHS, but they are not blind to its failings.

The elderly gentleman I spoke to that Monday was thankful for his NHS care but asked if I could advise him on getting the operation done privately, the pain was grinding him down. My patient afterwards was a mother of a young person with complex mental health needs. She broke down to me in tears of anger and exhaustion from constantly having to ‘battle the system’ to get the care her child needed.

This is not an isolated incident but in fact part of a  growing trend. Research by the IPPR showed one in three people found it hard to access the care they needed, and as a result, one in eight of them have chosen to pay for private healthcare. The UK is now the G7 nation with the fastest rise in healthcare expenditure from out-of-pocket or voluntary insurance sources. And after receiving billions of taxpayer funds during Covid-19, the private health sector is booming.

The consequences of this are manifold. It is manifestly unjust if you have a system where those with greater means are able to receive timely healthcare, whilst those without are left to suffer. This two-tier system will widen existing health inequalities. Our NHS exists on the principle of collective solidarity. As more people experience poor care, or ‘opt out’ of the NHS, that collective solidarity is undermined and fragmented.

So how should Labour respond? First, we must acknowledge people’s lived reality.

Simply declaring “we will protect the NHS” but maintaining the status quo is not good enough, when for many people their lived experience is an NHS failing to provide optimum care to themselves or their loved ones. We need to articulate the benefits of socialised healthcare and show how an extension of our principles leads to improvement in health.

Our plans cannot simply be reduced to more funding. We must show our vision for bold structural and cultural change to transform the health system, with patient care at the heart of everything we do. And finally, we must be loud with our ambition. The status quo is simply not good enough. We must show we have a comprehensive policy platform, to universalise the best, to ensure we have world-class healthcare for all.

Of course we must get the basics right. The government’s current funding settlement, against the background of 10 years of funding cuts, falls short of being able to deliver any realistic improvements in care. The NHS Confederation stated the service will need an extra £10bn of revenue funding within the next financial year. The lack of surge capacity, constantly running the system ‘hot’, means it lacks resilience to sustain shocks like outbreaks or pandemics. We must increase capacity, particularly in community and social care, recognising that the rising need comes disproportionately from the elderly with complex chronic morbidity.

The market structure within the NHS has fragmented the system, encouraging competition over collaboration. We need legislative change to allow integration and encourage the sharing of best practices and new innovations. To ensure we never again have scandals like Mid Staffs requires a shift away from a target-driven blame culture, towards openness, transparency, and shared learning with an emphasis on patient autonomy.

The pandemic showed how, under the right conditions, technology can be adapted and utilised swiftly. As the recent report from Policy Exchange shows, the Tories see greater use of technology as another form of cost-cutting, such as allowing virtual consultations with clinicians stationed overseas. Needless to say this is counterproductive to continuity of care. But if used thoughtfully, technology can enrich care. For example, virtual wards in care settings allow professionals from different disciplines to deliver holistic care to the patient in their own setting.

A nationalised health model has huge potential for innovation. It allows us, in theory, to collect real-world data, perform real-time and world-leading clinical trials, (as exemplified by the recovery trial, which allowed us to learn about Covid-19 treatments in real-time). Within the NHS we have an enormously rich source of health data. With the correct legislative safeguards in place, this data can be used for the shared benefit of us all, with exciting potential for innovation, and transforming healthcare delivery.

Reversing entrenched health inequalities will not be easy. It requires cross-government action and a radical rethink of our social and economic model. Societal good health must be valued as an asset. We should introduce metrics such as the ONS ‘health index’, reported on in fiscal statements as a measure of our prosperity alongside GDP. Health exploitation by profit-driven corporations needs to be countered. Learning from the environmental movement, the fiscal system can be used to reduce incentives to profit from ill-health. Tackling health disparities is not only just, but has societal and economic benefits. The IPPR estimates closing the health gap between the North of England and the rest of England would be worth over £20bn per year to the economy, from gained productivity.

Health is our asset. The status quo is not good  enough.  The Labour party must be bold with its ambition and offer a comprehensive policy platform to truly transform healthcare.

Image credit: Hush Naidoo Jade Photography on Unsplash