The NHS Needs More Money, but it Also Needs a Community Revolution
In 2017, Britain’s National Health Service was beset by a “humanitarian crisis” that saw Red Cross volunteers stepping in at overcrowded accident and emergency units. At the beginning of 2018, we have witnessed a system not just at breaking point but practically snapping at the seams.
Labour blames the Conservative government’s underfunding. The Tories retort that NHS spending has been ring-fenced. Since 2010, the annual spending increase has been one percent on average. Britain still lags behind health spending in other major European economies. This is a Conservative crisis.
General practitioners leaving the NHS outstrip the number being trained as morale is so low. Difficulty accessing GPs makes more patients resort to A&E.
Since the Brexit referendum over 10,000 EU nationals have quit the NHS and recruitment from the EU has collapsed. In an absurd irony, work visas are being denied to medically skilled migrants from outside the EU who could fill vacancies, as the salaries on offer are too low under Home Office regulations.
The NHS has a staffing crisis just as critical as its economic crisis - it has nearly 90,000 staff vacancies, 35,000 of these being nursing posts. Changes to junior doctors’ working rotas led to strikes over safety concerns and frontline staff have suffered years of pay freezes.
So how can we resuscitate an NHS on life support?
an ageing and expanding population means that politicians need to be more ambitious
A general tax increase - or even a dedicated NHS tax - might be controversial, but the outcome would be an NHS capable of providing a high quality service. Labour have pledged to increase NHS spending by £30 billion over five years.
A more ambitious target would be to match the average healthcare spend of the wealthiest EU economies, which would require an extra £40 billion per year - a tall order but achievable if we tackle long-term dilemmas.
The public pay cap is a false economy, costing billions in agency staff costs. Raising pay is vital to ending the staffing crisis.
But an ageing and expanding population means that politicians need to be more ambitious.
The pharmaceutical industry has persistently increased its prices despite taxpayers funding the research developing drugs. The government should be more proactive in reducing costs. Shortening the time of drug patents would allow rivals to develop drugs more cheaply. Transparency laws revealing where companies invest profits would put them under public pressure. Savings could be invested in frontline care.
While addiction should be approached with compassion, “drunk tanks” would discourage revellers burdening A&E at weekends.
Nor can we seriously address public health problems without confronting social injustice and vested interests.
The drop in life expectancy in some areas of Britain has been directly attributed to cuts in public services and social security. Poverty and poor quality housing inevitably contribute to mental and physical health issues.
But to effectively improve public health we must also improve the provision of care in general.
Hospitals should be the last resort, not a first resort
Cuts to social care budgets have put an unnecessary strain on hospitals. Elderly patients who cannot be safely discharged, or for whom there is no space in the care system, are quite insensitively known as “bed-blockers”. In many cases, they could be discharged if they had assistance in their own homes.
It is time for radical reform to make the NHS fit for the 21st century. The organisation can regain its former prestige by merging with social care as part of a community revolution in healthcare.
Hospitals should be the last resort, not a first resort. By integrating social care and the NHS, a community service could not only work with patients to prevent health problems but also provide long-term care.
With medicine extending lifespans, more people are suffering from chronic diseases such as dementia and heart conditions. These could be dealt with by community clinics, or even at home, rather than at hospitals.
Patients can manage their illnesses without attending hospital month after month. That does not mean less care. It means better, more personalised care.
Meanwhile, hospitals can focus on acute conditions, intensive care and emergencies. Fewer cancelled operations. Shorter waiting times at A&E. Patients not spending sixteen hours waiting for an ambulance.
After years of failure to provide parity of NHS funding, a community NHS could provide better mental health facilities. At present, A&E is the only recourse for tens of thousands in mental health crisis. Localised treatment has the benefit of being more appropriate for mental health patients, who could use quiet drop-in centres equipped with counsellors and inpatient beds.
Community healthcare would allow the NHS to invest as much in prevention as it does with cures.
The Equality Act obliges public bodies to make equality central to their decision-making. An equivalent Better Health Act could require local authorities and schools - in fact, all public bodies - to promote healthier and active lifestyles, and counteract damaging consumer advertising - such as aggressive alcohol marketing and an emphasis on body image harmful to young people.
In 1948, Labour founded the NHS in a post-war spirit of compassion. But it also took Aneurin Bevan’s political determination for it to become a reality. The policies to save the NHS from decline, and preserve it for future generations, may have to be as revolutionary as its foundation.
About the author
Jacob Richardson began his career with Disclaimer and writes on culture, politics and society. Politically he is a democratic socialist and Labour Party supporter. His other interests include cinema, psychoanalysis and professional wrestling.
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