Thursday, 1 March 2012

The dilemma of the NHS

The NHS bill for England currently going through the House of Lords is in deep trouble. If you had any doubts about this, note that the Health Secretary Andrew Lansley has volunteered to give an interview to Jeremy Paxman (who was uncharacteristically civil last night, you can watch his interview with Lansley HERE ). 
Whatever you think of the politics of the NHS reforms, there are some aspects that hint at a deeper dimension of how we think about our public services. What do I mean? Consider briefly how different the approaches are to the NHS in England and Wales. It is no secret that the Welsh Government has little appetite for radical NHS reforms. While there is a lot of 'policy noise' from Cardiff about improving public services, integrating health and social care and more community care, the Welsh Government has consistently rejected to give front line professionals the means to change things for the better. 
We know that, in order to reform public services, you need to introduce the things that drive positive change; well meaning policy is not enough given the inertia of established practices and the attraction of 'things as they are'. We are all creatures that value constancy and stability whilst trying to reduce risks. 
In public services this may result in a false dichotomy as the most recent developments in Wales may demonstrate. Leaving the NHS the way it is means effectively to shrink it in its scope and resources. Wales, more so than England, has a rapidly aging population, with the attendant problems of increasingly expensive treatments and medication. And I have not yet mentioned the issues of personal choice and care quality for which there is a clear preference amongst patients.  
This all creates a perfect storm for the NHS in Wales which is facing reduced resources, spiraling costs of treatments, an aging population and current practices that privilege highly inefficient and costly approaches to health with poor care integration, and preference for hospitalisations over community care. 
Now, contrast that with what patients want and you realise that it takes courage and an enormous amount of risk to drive through changes in the NHS. As the latest demonstrations in front of the Welsh Assembly show, patients above all want one thing: the continuation of things as they are. 
Incidentally, that is exactly not what is likely to happen if things are left alone.  
So, in essence, there are no easy solutions, with politicians more than ever trying to muddle through complexities of care systems and exploding costs. Whether we like it or not, the NHS will increasingly adopt the role of an emergency care provider (free at the point of use) with patients being signposted to private providers where non-urgent clinical care is needed. Should we regret this? 
Whatever we think about free health care, it is only free at the point of use. The aim should be to ensure it remains largely free for those most in need. That would be an accomplishment we could celebrate even if, in future, many of those who can afford it may have to pay something towards their health care costs. 

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