1250 days to save the NHS: A new approach

First a little about myself. I am 53 years old and have worked in health care for over 22 years. I have voted Liberal, latterly Liberal Democrat, for nearly 40 years now. I, like others, have been frustrated by the ongoing swing politics that has affected the United Kingdom since the last war. Whilst like many others I am saddened by the outcome of the referendum I know as a party we are committed to be outward looking and pro-European. This will mean maintaining and fostering close links our European neighbours. However we need to plan now as to how we can win the next General Election in 2020, and in doing so protect to NHS as a public service.

The voting public must be made aware what is at stake and we must put forward a radical but costed vision for the health service. In 1997 New Labour came to power and pumped money into the NHS whilst establishing targets for waiting times. This was a sensible approach, but in recent years this has evolved into ever-increasing ‘fines’ for failing to meet those targets. Therefore, despite the Conservative government’s much lauded promise ‘to increase funding’ for the NHS, the reality is that year on year hospital trusts fall ever further into debt, leading to cuts in staff & frontline services in real terms. This is neither a responsible or sustainable approach to meeting the needs of the public or the NHS.

I propose that when elected the party would immediately freeze ‘fines’ on hospital trusts for a period of two years. This would enable trusts to channel funds into staff recruitment and retention and also to plan spending to meet the demands of a growing and ageing population, after that initial period. Instead of ‘fining’ trusts for failing to meet waiting times at A&E. or delayed discharges at the end of treatment trusts would be paid a premium for meeting those targets, thus incentivising innovation & service delivery.

During this initial two-year period trusts would look closely at how services are delivered, for instance an A&E department could reduce waiting times by setting up a GP service at weekends. This could be done in most towns and cities by requiring GP surgeries to provide cover on Saturdays and Sundays on a 4-weekly rota basis. This would reduce the burden on A&E departments at weekends and allow the public to see their own GPs rather than an expensive and often over-stretched out of hours service. Also rolling out in-reach services to treat residents already living in care homes, but requiring I.V. treatment for chest infections or other similar conditions. Provided by a ‘rapid response’ team run by experienced nurses with access to doctors and the necessary medicines, who could ‘crisis’ manage these patients in their homes without the need to take into hospital via A&E departments. These services would be accessed by nursing staff working in the homes who had been trained to recognise ‘the deteriorating patient’ by using the NEWS (National Early Warning Score) assessment tool.

These measures would then allow hospitals to concentrate on treating acutely ill patients following accidents, injury & sudden onset conditions alongside planned services such as routine surgery on a day case basis and outpatient services. Historically we have either prioritised treating people in hospital or in the community, but I believe that with a little forward planning we could deliver both and they would complement each other, delivering an NHS that can meet the needs of Great Britain in the 21st century. To meet those needs we would need to train more doctors, nurses and related therapists. A commitment to reintroduce bursaries for student nurses would recognise their contribution and the fact that they have never taken part in industrial action (to date). We will also need to address the funding and delivery of social care alongside this, but that merits a separate discussion.

* Jon Taylor is a member of the Liberal Democrats from Worcester.

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22 Comments

  • Jayne Mansfield 3rd Dec '16 - 10:32am

    Perhaps one should ask why Trusts have failed to meet their targets and investigate the accounting tricks that allowed the coalition and this Conservative government to make the claims made.

    The NHS is underfunded. Having just spent time with a sick relative who needed emergency admission, the staff drawn from so many countries were magnificent, despite being rushed off their feet, taking time to offer cups of tea to distraught relatives. This is the humanity that some want to squeeze out of the service.

    There are some people who do not want to save the NHS.

  • Simon Freeman 3rd Dec '16 - 12:02pm

    The NHS clearly requires more money pure and simple. The Lib Dem policy of putting in an extra £4 billion is a good one- I can’t see what Corbyn’s Labour have as an alternative-they just look muddled. Privatising the NHS and the internal market stuff like the Tories always want doesn’t work. As Jayne says (is that your real name?)The NHS does and always has drawn its staff from all over the world-and any soft brexit deal has to recognise that. I’ve had two spells working for the NHS and I think it needs to build on the skills of all of it’s staff-front line and support, medical and admin, manual and non-manual.

    There is also a specific need to put more resources into Mental Health Services which Norman Lamb has highlighted. As a lot of these are indirectly funded by local government through Section 75 Agreements the government cuts to local councils are actually hidden cuts to the NHS. As someone who was a beneficiary of such services-an excellent local GP and a sympathetic councellor and a course of CBT -I know at first hand how importatant these services are and how well people can recover if problems are nipped in the bud.

    Unlike Jon I can’t claim 40 years unbroken support. 4 years voting Liberal, 14 years as SDP/Liberal Democrat member. 21 years voting Labour(with 1 local govt and 1 Euro Election to the Greens) I paid £3 to vote for Andy Burnham as leader then got cast into the political void by Corbyn. I did vote Lib Dem for the first time in years at our recent parliamentart by-election – but it would have been good to see a clear line on the NHS on the leaflets rather than just maps and slogans.

    The party needs to develop a simple clear message on around 5 or 6 themes and the NHS has to be one of them. I am more and more encouraged by the line the party is taking and the win in Richmond Park is the best political story of the year. More to come next year I hope.

  • Martin Land 3rd Dec '16 - 12:29pm

    It’s a bit of a mantra, isn’t it? The NHS needs more money. I’m sure it could use it, but does it need it? As Lib Dems we need to take a more measured approach.
    As a frequent patient I see considerable waste and duplication of services and there are many issues which could be addressed by a half decent IT system.
    Medical care and treatment must always be free, but free food? Why? Surely I should pay for my meals. Then I could insist on better quality too!
    I don’t pay for my prescriptions. Why? Because I’m diabetic – which is my own stupid fault. I can afford to pay and I think I should.
    In other words I think we need a two-pronged approach. More funding for treatment from a more efficient and effective National Health Service.

  • Lorenzo Cherin 3rd Dec '16 - 1:57pm

    Jon

    You make sensible points.

    As a user of the NHS , who , as a result of ongoing issues, including a car accident that has, particularly for my wife , meant years of disability issues in fact, I have , as someone very political , analysed the subject and spoken and written about it a lot.

    Rather like with the EU and the BBC , or in my own field , the Arts Council, I think there are various approaches.

    The right ward one seems to be utterly suspicious to the point where the further you go on that road the more suspicious !

    The left ward one seems to say yes no matter what , and more money is all they ever want , and the further you go in that direction the less criticism of the organisations , the more it seems of wicked governments who do not like them !

    The Liberal , and therefore our Liberal Democrat perspective should strike a balance between the two, but often seems to be too complacent in my view.We would not have Brexit if , instead of EUrophilia , we had all these years changed and improved a failing organisation !

    The NHS, in the experience of me , and my wife , is at some considerable level, an appallingly second rate service compared to some . We have experienced it , many have, but say it less.

    It also does great good.

    We need to be very aware of the need to change it .

    There is a new grouping in the party , and a commision. I can find no details . Why ?!

  • Sue Sutherland 3rd Dec '16 - 2:45pm

    Interesting post Jon. I think A&E departments started to feel much more stretched with the closure of walk-in centres, but I don’t know if this opinion is correct. Has there been any research on this?
    I agree so much with Martin Land about free hospital food because the only people who have to pay for their food are people on benefits because they are deemed to have received money for food already. This may have worked when the NHS was first set up but much has changed since then. Many operations are carried out at regional centres which entails travelling costs for people’s families and probably accommodation costs too if the hospital’s own accommodation is full. My husband had an operation at a national centre of excellence a few years ago and he was in hospital for four weeks. He needed me to visit every day to keep up his morale and help his recovery. We were lucky that we could afford this but I don’t know how someone on a low income or on benefits could pay for a B&B for that length of time as well as having to pay for the patient’s food by a reduction in their benefits.
    I do hope the party can look at this with a view to reform.

  • Could someone please explain the theory and practice of fining “nationally owned”/significantly subsidized organisation, such as the NHS?
    Does money taken from a public purse in the form of fines then go back to the same or another public purse, possibly less admin. costs etc.?
    To which purses do the fines go, what are the admin. costs and who gets them?
    Is an OK metaphor for such “fines procedures” that of someone trying to make a blanket cover well by cutting an end off and then either sewing it on to the same blanket or even another blanket?

  • Martin; I agree with much of your last post.
    The NHS needs more money? How much will ever be enough and how is it going to be raised? At least Tim suggests a 2% tax increase, but what happens when due to expectation, population growth and an increasingly elderly population, we get to the next
    point at which the NHS needs more money.
    I too see a lot of waste, and duplication in the NHS, given the budget one might expect access to the best treatments, equipment and drugs available in the world. The reality is very different, with patients often (though not always) experiencing very good care, but second or even third rate treatment.
    I’m not a big fan of bursaries for nurses, there are more than sufficient number of people willing to take a loan and it reduces the number of training places available, if they are brought back then I think individuals should commit 5 years to the NHS before they go elsewhere or if they do leave within that period, should pay back the amount the received.
    He was often shouted down for raising the issue, but I agree with what Forage repeatedly said during the referendum, the funding process for the NHS is not sustainable in its current form we need to have a grown up conversation about what we want the NHS to do and how it should be funded, no that doesn’t mean anyone is advocating the American system.

  • I really like this piece because Jon Taylor’s solution is not to put more money into the NHS and his ideas need careful consideration. They seem very workable to me and should improve things in the NHS.

    If the comments above are correct we are promising £4 billion during this Parliament and an Income Tax rise of 1p for the NHS and 1p for Social Care and these are good things.

    The quality of management in the NHS is an issue, from the experience of my sister it seems extremely poor and seems to do things to reduce moral and motivation of those working in the NHS.

    I don’t know if my experience of my GP practice is a general compliant across the whole of the NHS but I feel it is run for their convenience and is not flexible to the needs of patients, especially those who need to be treated in a non-standard way.

    How we can get “patient care” to be the same standard of the best commercial company’s “customer care” is a problem we do not seem to have any answers for. We rightly reject the idea that privatisation will automatically provide it, but my experience is that a private provider gives better “customer care” than I receive from my GP practice or NHS Trust.

  • On a trip to Cuba, around 2001, I remember being amazed that the barman in the hotel, was a fully qualified physician, and the waiter was a school teacher. But looking beyond the poor pay structures, that made it more lucrative for highly qualified Cubans to seek work in the tourist industry, there is surely, a valuable resource within the Cuban health system, that needs further consideration,.. one which could be useful for our NHS.?

    In ‘bang for buck’ terms, the Cuban health system is second to none. At the very least, it must be worth sending a delegation of health professionals to Cuba to study their systems, to see if we can slim down some of our over-bloated NHS bureaucracy, yet maintain optimum health care.?

    Further than that,.. as Cuba will inevitably ‘open up’, in the coming years,…post Castro(s),… is it not worth initiating the groundwork for some form of UK trade deal with Cuba,.. sort of,.. you send us your spare physicians and health care techniques, in return for our discount cars, aviation technology, or IT communications infrastructure.?

    Just an idea.?

  • Katharine Pindar 3rd Dec '16 - 6:57pm

    @ Lorenzo Cherin – hi, Lorenzo! I have no expertise and less experience than you and others in this thread, which I am reading with interest to learn from you all, but it does happen that I enquired of HQ about Norman Lamb’s New Beveridge Group after it was mentioned at Brighton. I was told that it consists of a range of experts in health care which is to consider the case for a dedicated NHS care tax and how to build a modern, efficient and dynamic NHS and care system treating mental and physical health equally. (I am quoting what I was told.) The group was to work for six months before making recommendations to the party. Norman had said it was time for a new Beveridge plan for the twenty-first century and a new long-term settlement for the NHS and care, though it would have to be honest about cost, maybe requiring an extra penny in the pound income tax.
    This information was kindly provided for me by our excellent Policy Department, and I was told that the point of contact for the Commission is the party adviser on health: [email protected]. Having received it, I think in October, I felt content to wait for information as six months had been mentioned, so this is not entirely up-to-date, but I hope it helps.

  • Jayne Mansfield 3rd Dec '16 - 10:17pm

    @ John Dunn,
    It is interesting in light of discussions about Cuba and the quality of its healthcare provision, that it was two Conservative Ministers in their 1988 paper, Britain’s Biggest Enterprise: Ideas for radical reform of the NHS, who compared the NHS to the soviet union with rationing by queue, and to maximum security prisons.

    In their pamphlet they set out their ideas for privatising the NHS, of their five recommendations for reform, two have taken place as a consequence of the NHS and Social Care Act which created the legal framework for privatisation. The re-organisation of the NHS into an independent Trust and an increase in joint ventures by the NHS and private providers. We have seen this in the case of PFI, Hinchingbrook hospital and the attempt at privatisation of health provisions in Lewisham.

    The third principle was that of charging with some subsidies for the poor for some but not all services once provided under the NHS.

    The fourth was a system of ‘health credits’ and the fifth a national health insurance scheme with all the expensive bureaucratic waste that would entail. Health insurance is the final goal of all those who want privatisation, it generates huge profits.

    The coalition put together the final pieces in the plan that Margaret Thatcher’s government first started when it introduced the NHS and Social Care Act 2012.

    Letwin and Redwood called the NHS ‘a bureaucratic monster that cannot be tamed’, (scapegoating health service managers and referring to them as a bureaucracy has a long history in the incremental privatisation of our NHS, starting the expensive incremental privatisation of the NHS by the creation of an internal market.

    @ Jon Taylor
    I don’t think that the NHS can be saved, too many powerful people are wanting to change the Beverage style system into the privatised American type system favoured by Redwood and Letwin. UKIP is presumably still in favour of this (except when it is not). The NHS is being privatised incrementally in plain sight.

    @ Martin Land,
    I would argue that the provision of nutritious food for hospital patients is an important part of their treatment and care. Charging some patients and not others would I believe, simply increase what others already dismiss as a bloated bureaucracy.

  • Cuba does indeed have the best health service in the third world, but is critically short of many drugs (lack of foreign currency to buy them), and it provides free education for doctors and other staff. But they are then paid the standard rate of about 30 dollars a month, as are teachers, which is why many have gone to work as barmen, waiters and guides in the tourist industry where they can earn that much in tips on a good day.

  • Some food for thought and I admire that it’s not restricted to the predictable ‘bung it more money’ or ‘too much waste’.

    There are definitely areas where efficiency could be improved, but the NHS consistently scores very highly on efficiency when compared against other systems in the Western World. We spend far less on our health-care in this country than comparable nations, so any proposal for ‘saving the NHS’ that doesn’t acknowledge this is not credible.

    There remain many areas where improved efficiency is possible, and the most obvious areas are those where IT can support substantially superior data management systems. The problem is that they don’t come cheap, and trying to bring them in on the cheap leads to disaster. I’ve heard some horror stories about public IT projects, and have insight from a relative who has worked on these for a private company. The private companies come out worse, but the lack of respect for IT skills is a factor.

    It is something to consider when people talk about having too many ‘backroom staff’, and not enough nurses. Don’t get me wrong, we need more nurses, but I prefer the nurses to be nursing. I prefer surgeons to be in the operating theatre, and not ordering dressings. Efficiency is something that requires investment of at least some time and money, and once successful, that may translate into money savings, or a better service, or a bit of both. Expecting efficiencies without proper investment is like trying to lose weight and thinking that chopping off a foot is a success.

    I’m horrified by the idea that we should start to charge people for their meals. That really would be unnecessary bureaucracy, and do we want nurses to be checking if people are up to date with their lunch money before they are given their thin soup and bread that costs 40p to produce? The food in hospitals does need to be overhauled, but it needs to be made better. There was a BBC programme following James Martin doing work on this that has some great ideas that should be followed up more widely.
    http://www.bbc.co.uk/programmes/profiles/1BX7n1LgGS9tf1337FxL1M5/hospital-blueprint

  • On the question of what we do when the nation keeps on aging? Well, we could just bring in a scheme of euthanasia for people over a certain age, or if that’s not palatable, we must plan for it, which means investment. I’m afraid, the ‘have cake and eat it’ ideology remains just that. If we want it, we have to fund it.

    Successive governments dithered about increasing the pension age, and we are now all paying the price. We all need to put more aside to look after us as we get older, and that probably means a modest tax increase and a sensible policy on retirement age that acknowledges that while most of us would like early retirement, we’d also like to have a decent NHS to rely on during that retirement.

    On the subject of elderly care, the integration of health and social care is a positive move, so long at it is done right. One area for investment should be a sort of ‘half-way house’ for patients who are well enough to leave the ward, but not yet well enough to go home. These could have different levels of dependency and operate along the lines of being temporary sheltered accommodation, which could have space for a spouse. This would be cheaper to run, and much more pleasant for the individuals. There could be a team of carers and physios ensure that patients get used to the return to independent living in a safe environment. When old people are in hospital for any length of time, they often lose the skills that allowed them to live independently, so rehabilitation will reduce the return visits.
    I’ll add to that, town planning should ensure sufficient suitable housing for our aging population too.

  • David Wright

    Like you I’m fully aware of the political structure of Cuba, and the why’s and wherefores of how extremely qualified people would rather live on lucrative tips as barmen and waiters, as opposed to $30 per month.

    By stripping the politics out of this, my point was more pragmatic in light of such a waste of much needed talent.?

    a) They [Cuba], have a surplus of trained health professionals, and we [UK] need trained health professionals. ( Cuba ~ 6.7 per 1000 population. UK ~ 2.7 per 1000 population ).

    b) We have drugs, car manufacturers, communications and IT technology, and they need,.. drugs, cars, communication and IT technology.

    Putting a) and b) in the same box and jiggling them about, it is surely not beyond our ability to design a functioning,.. mutually beneficial,.. trade deal.?

    I’m also emphasising [as a Red kipper], that immigration frankly, is not the issue,.. it is about the UK controlling immigration to promote [indeed encourage !], access for people with needed skills,.. such as Cuban health professionals.?

  • One extra point which I’ve mentioned before is the use of AI, (artificial intelligence).

    Health care,.. can broadly be sub-divided into Prevention [of ill health], Diagnosis, and Treatment. Diagnosis surely,..is ripe for major advances in the field of AI.? We should maybe put much more money into this field of A.I. diagnostics, in a better managed balance from just throwing ever more money into personnel.

  • Andrew McCaig 4th Dec '16 - 3:44pm

    Fiona,

    We used to have that half-way house. It was called convalescence. 30 years ago there was a convalescent hospital in Leeds but they closed it, and as a result my father in law spent the last 6 months of his life on an acute ward (our house not being suitable at all for an amputee..). Before that he had spent a couple of weeks at a convalescent home run by a religious order, but that has also closed now…

  • Jayne Mansfield 4th Dec '16 - 5:18pm

    It is not a case of just bung the BHS more money. It is a case of finding the correct solutions to the question of funding care. For 30 years the solution has been the introduction of privatisation rather than ensuring value for money.

    The Liberal Democrats claim to made evidence based policy. Where was the evidence to justify the claims made for marketisation which had started decades ago with Thatcher’s introduction of the internal market and subsequent further introductions of markets and privatisation in the NHS?

    Why did no-one baulk at the cost of the market itself? There is enough evidence to demonstrate the waste generated by the market itself. Creating and maintaining the ‘market has incurred huge costs. Professor Calum Paton , Professor of Public policy at Keele university wrote many books and researched reforms to the NHS since the 1980s . In 1994 he argued that a conservative estimate of the recurrent annual cost of the market to be 4.5 billion.

    I would recommend that anyone not tied to the right wing ideology and dogma that persists in creating a market in health care read at least the summary of a paper:-
    ‘ At what cost, paying the price of the market in the English NHS’.

    In 2014 there were voices of sanity. One such voice was Dr Charles West. ‘ Liberal Democrats Health policy, who is the rebel’

  • Jayne Mansfield 4th Dec '16 - 5:22pm

    Professor Paton’s paper was written in 2014 not as I mistakenly typed 1994, .

  • I’m glad that we’re talking about the NHS & there seems to be a inate realisation that the governments agenda is privitisation. I was writing as a nurse first & foremost & not as a ‘politician’. I do believe that we as a party can bring forward some viable ideas that can be part of the solution. My main points were that we need to utilise the existing resources better. The closure of walk/in centres certainly had an impact on A & E departments. The fact that without PFI many new hospitals would not have been built. But not one was built with more beds than the hospitals they replaced. Admitally key hole surgeries have become much more widely used.Reducing admission times post surgery, however this has been substainly offset by a ageing & rising population. The media has feed the idea that immigration has been a prime cause of queues at hospital doors. Which along with Brexit has stoked racist attacks. However there are those ordinary people that fear the perceived pace of change. This is something we must acknowledge in taking policies forward.
    I also did not want Brexit to provide a convient smoke screen for the governments privitisation agenda. I believe that the NHS, protecting workers rights & further tax reform can give the party the platform to engage the voting public.

  • Lorenzo Cherin 4th Dec '16 - 10:46pm

    Katharine

    Thanks , there is also a new Health and social care association in our party . Any details ?

    It does trouble me a little that those who start up things do not write on here letting us know !

  • Jayne Mansfield 5th Dec '16 - 4:08pm

    @ Jon Taylor,
    First and foremost, may I thank you for the work that you and your colleagues do under increasingly difficult circumstances.

    You might find the King’s fund summary of their report . ‘ Better value in the NHS- report summary interesting reading, particularly the example of the Plymouth hospital Trust.

    Sadly, because ‘reform’ has just become a euphemism and smokescreen for privatisation, I see a future with further downgrading of A and E departments, further threats to District General Hospitals and more pressure for patients to pay for services.

    There are too many people in power with a vested interest in expanding the lucrative field of private medicine.

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