After Covid 19 – A new start for the NHS?

Fit for purpose

It has surprised me that none of the many commentators on the present crisis seem to have noticed that behind the fact that all the current contingency arrangements clearly recognise that the NHS is woefully unprepared for the onslaught of COVID 19 infections is the tacit admission that the NHS is not fit for purpose, in other words that it is inappropriately organised, incompetently managed and inadequately funded.

Those of us with any knowledge of the NHS – I worked in it for 40 years as a clinician, public health practitioner and chief executive and am still a user and interested observer – have known ever since the 1974 NHS reorganisation that the organisation of the Service is dysfunctional and that it has become ever more so with each reorganisation since; that the standard of management like that in most public services in this country is generally low; and that it is grossly underfunded – one look at how much our European neighbours spend on healthcare demonstrates just how gross this underfunding is and has always been.

For me it dawned some years ago that many of the problems with the Service are attributable to a large extent to the fact that it is a political football kicked hither and thither with no idea of where the goal is by a succession of governments without any real understanding of what health is or how to run a large uniquely complex organisation.

So the way forward is to take the NHS out of the political arena and secure a cross party consensus on how it should be organised and managed and then left alone; and then to fund it properly. The funding issue is a simple one to solve – the public as consumers should be asked to pay more for it through an appropriate hypothecated tax. All the evidence suggests that they would willingly do this.

It is likely that even if the NHS were much better funded it would still struggle in the current circumstances but that struggle would be less arduous and the number of preventable premature deaths would be significantly fewer .

Looking to the future when COVID 19 is just history, I hope that the general recognition how much we depend on the NHS and how much we value it will act as the stimulus for demanding a new dispensation that is faithful to the founding principles of the Service as envisaged by Beverage, Atlee and Bevan that is taken out of the political arena and which will include a new health and social care framework fit for the survivors of the pandemic as well as being a fitting tribute to all those, professionals and members of the public, whose heroic dedication will have enabled us all to survive.

Paul Walker

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