Saving the NHS – and ‘bright ideas’ that might wreck it

By Savi Hensman

July 2, 2018

The UK’s National Health Service is severely underfunded and overstretched. The Labour Party leader, Jeremy Corbyn, was among the speakers at a London rally and march on 30 June 2018, celebrating 70 years of the NHS and calling for better funding and an end to privatisation.

Meanwhile various suggestions on how to make better use of existing resources have had wide publicity. However some of these are likely to do more harm than good to patients and the NHS (and maybe cost more than they save).

One of these is that everyone who goes to A&E is wasting resources unless they definitely need treatment. “More than 9 million people were sent home from A&E in 2016/17 with just advice which they could have got from a pharmacist or by calling 111”, NHS England tweeted

But it is not sensible, if having a heart attack, to wait until absolutely sure it is not just muscle pain or some other ailment, by when the chance of survival may be slim. Skilled health professionals and scientists, with advanced equipment, can find out what patients and carers cannot and act swiftly if required.

Emergency doctors, among others were quick to respond. “Well, thank you for insulting every EM clinician. Have you considered that much of that advice required expert assessment and judgment? …the assumption that advice only = no expertise required is beneath you”, one tweeted.

Another explained, “They might not have received the same advice from 111 as from an Emergency Physician after full assessment. Lots of these patients have already seen a pharmacist, a nurse, a GP or called 111.” One person also raised the question, “But how many should have gone to A&E but didn’t want to burden the NHS and ended up more ill as a result? Please present stats for that...”

Over-reliance on electronic devices rather than personal contact is another risk. Technological advances sometimes have major health benefits and the internet offers valuable possibilities – for instance many people make use of websites such as NHS Choices and Patient Info. But caution is needed about ‘high-tech’ solutions.

At present there are numerous apps available but apparently often little reliable evidence that these are effective. There is currently much controversy over the use of artificial intelligence to make crucial decisions about treatment, with varying views on how well these perform compared to experienced professionals. While these might be very useful in assisting staff, relying solely on them carries greater risks.

There is also a possibility that healthcare might become increasingly impersonal, deepening the isolation of some people, which might affect their health. In an understaffed NHS, especially in such fields as mental health, computerised devices cannot always take the place of human relationships.

In June, the British Medical Association rejected a motion which would have called for financial charges, for instance for use of GP services , which undermines the very principle of a free NHS.

However the notion of charging for some care is reportedly backed by many GPs. Yet ‘small’ sums of money may be relied on by poorer families for food and heating; and it can be expensive if people delay getting medical treatment until very ill, quite apart from the human cost.

But when funding is tight, desperate measures may have a certain appeal. Also many of the public also seem to favour charging patients who miss appointments or “have diseases and illnesses which are caused in some way by their lifestyle". So the idea of charges may return.

At first it might seem reasonable to expect people to pay if they do not cancel appointments they do not attend; but getting through on the phone can be difficult. And some patients who are physically very sick or have mental health issues may lose track of the time or find it near-impossible to communicate, let alone get to a clinic or hospital. Also ‘unhealthy lifestyles’ may result from such factors as struggling to cope with childhood abuse or major bereavement, in which case further punishing patients would be cruel in the extreme. Eventually too, if the principle of a free NHS were eroded, numerous patients would suffer.

Another risk is of privatisation in guise of ‘integrated care’. Better coordination is indeed important but expensive and disruptive system change is often not needed – and the possibility of handing over whole chunks of health services to contractors needs to be ruled out. Giving firms driven by profit the power to decide who lives and dies is far removed from a just and accountable NHS. And, as evident in the wake of the collapse of Carillion and other private sector failings, it could deepen instability.

A different way forward

A better way forward involves embracing values such as compassion and justice, widely shared among people of various faiths and none. Far from being unrealistic, this may involve asking tough questions about policies which seem to be driven by neoliberal ideology, which can become a kind of idol to which humans are sacrificed.

Humility too may be a useful virtue. Top managers should not assume they fully understand the complex processes which lead to good health. Instead they should listen attentively to frontline staff, patients, carers and communities before introducing ‘solutions’ or ‘innovations’ which might potentially make problems worse. And rationing mechanisms or attempts to cut humans out of decision-making processes may all too easily be not only unjust but also expensive.

To rebuild an NHS and social care system badly damaged by cuts and privatisation, as well as tackling social conditions which increase ill health, will not be easy. Yet many people care passionately about its future. If community (including faith-based) organisations can join forces with staff, trade unions, service user and carer groups, the NHS might be renewed 70 years after its creation.

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© Savitri Hensman is an Ekklesia associate and respected commentator on welfare and other issues. She is author of the book Sexuality, struggle and saintliness: same-sex love and the church (Ekklesia, 2016): http://www.ekklesia.co.uk/node/22613 and has been involved in seeking greater inclusion. She wrote on ‘Health or Wealth?’ in Feast or Famine? (http://dltbooks.com/titles/2195-9780232532616-feast-or-famine)