News from Nowhere September 2015

Being British

The NHS is on the brink of collapse, says the Observer (September 20th), quoting former secretary of state Norman Lamb. The catastrophists are back in business, having failed so dramatically to save the NHS with a Labour victory in May. Or was it the other way round, the catastrophists failed to save Labour with horror stories about the NHS’s imminent demise.

The actual precipice is two years away, says Lamb, which is a very, very long time in politics, so we need not bail out and pull the ripcord just yet. Given the streams of money being found to salvage over-spent hospitals, the collapse may be pushed even further back. Or it may change direction and do some serious damage to general practice, which is now seeing the funding it needs to run a 7 day a week operation tipped into the bottomless pit of hospital spending. This diversion of resources is nothing new, of course, but the demand for greater productivity is. We shall see. Keep your eye on that brink, Norman, the one on the distant horizon.

On the subject of catastrophists, let’s think about the Northern Trust running two fully functioning District General hospitals six miles apart. We say fully functioning, but they are struggling to run two adequate A&E services, partly because of budget constraints and partly because getting A&E staff to join and stay is hard. The situation was justified historically but now is barmy. Merger of the two hospitals is inevitable, and one will be down-graded to community or elective hospital status whilst the other becomes the treatment centre for emergencies. That should set off a wave of Save the NHS protests.

There would be less room for placard wavers on the margins of NHS politics had Labour and the trades unions been willing or able to work out how to influence policy in a nationalised industry with a gargantuan democratic deficit. Labour has been too busy with its elected local government councillors to work out a strategy for an election-free zone like the NHS, and the trades unions have been too busy with workforce problems to make an impact on NHS strategy – much to the delight of managers (who want to hog the policy role), professionals (whose organisations have a good grasp of how the NHS works) and politicians (who like to be in charge). Any dewy eyed Marxists buoyed up by the working class’s historic destiny as the ruling class of the future need only look at the NHS for evidence of the opposite.

News from Nowhere’ s moles became very jolly when screening expert Walter Holland declared that the NHS is wasting £450m a year on health checks or “mid-life MOTs” for 40-74-year-olds. They are a waste of time, widely ignored by patients and not based on sound evidence, he and his co-authors declared in the Journal of Public Health. This is not exactly news, but such an authoritative critique adds to the widespread discontent with health checks. The Department of Health continues to rebuff all criticism, as it must, but watch out for a quiet exit for this silly policy. It is only a matter of time.

Cambridge University Hospitals Foundation Trust has been put in ‘special measures’ after the Care Quality Commission rated it “inadequate”. (Health Services Journal 22nd September 2015) Inspectors found a “disconnect” between senior managers and frontline staff and said the Trust had “serious problems” which jeopardised patient safety. Cambridge University Hospitals FT is part of the elite Shelford Group of “leading academic healthcare organisations”. This is the first time a Shelford Group Trust has been rated “inadequate”. Some NfN informants have enjoyed the Trust’s discomfort, and the group’s too, on the grounds that there is a “disconnect” between leading academic healthcare organisations and the needs of the public. Words like ‘smug’ and ‘self-satisfied’ were heard, but contrary comments posted on the HSJ were enlightening. For example “If you require staffing levels at local level which you know there are insufficient staff nationally to meet, how is failing local organisations fair, ethical or helpful to patients? If you require financial balance when you know there are insufficient resources nationally how is failing local organisations fair, ethical or helpful to patients?”

Alzheimer’s Research UK has been doing a splendid job. First it planted stories in the media about a third of the population developing dementia, then its begging letter for donations for research to fight dementia landed on door mats. News from Nowhere asks the ‘so what’ question academics fear so much. All of us will die, and according to one source 40% of our deaths will be attributable to “progressive dwindling”, which wraps up dementia and physical frailty. It is all because we are living so long, for dementia is mostly a disorder of very old people. It is a short affliction, about three and a half years long on average, and other things – heart attacks, stroke, pneumonia – often carry us off before it can do so. Research efforts have failed to find a cure for the last two decades, and the pharmaceutical industry is giving up on unprofitable dementia research. Not that we want to spoil ARUK’s drama, because a cure may be just around the corner.

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