The new UK
government isn’t the first to talk about wanting to change the NHS from a
sickness service into a health service, with more emphasis on prevention rather
than cure. And it won’t be the last. Nor will it be the first to talk the talk but
fail to deliver – and yesterday’s announcement by Starmer has impending failure
written all over it, for at least three reasons.
The first is that many
of his proposals – worthy and sensible though they might be – are necessarily
long term. For sure, tackling obesity and reducing the consumption of sugar and
junk food will reduce the demand for health care, but even if assorted
campaigns and new legislation to do those things are both implemented
consistently over many years and succeed in achieving their aims (and neither
of those things are guaranteed), the impact will be negligible at first, only
building up to a significant level over a decade or two. They do nothing to
address the crisis facing the NHS now, which doesn’t have the resources to
tackle that crisis.
Secondly, whilst
they are entirely correct to be placing more emphasis on primary care in the
community, there is a little problem of chickens and eggs. In previous attempts
at health reform, we’ve seen health boards cutting the numbers of hospital beds
on the basis that care would be better provided in the community. But what we’ve
not always seen is a corresponding increase in the provision of that care in the
community. Any approach which depends on cutting first in order to free up the
funds for the required investment in community care is inevitably going to make
the problem worse in the short term – even if they do eventually get around to
improving the community care element, rather than just banking the savings. The
investment needs to come first, but the statement that there will be no new
money until after the reforms have been implemented is setting the whole approach up to fail from the outset.
Thirdly, it looks a
lot like silo thinking, as if the NHS can reform itself in the desired ways in
isolation from all other policy decisions. What they say they want to achieve
needs a ‘whole-of-government’ approach, and it won’t work if other departments
(and especially the Treasury) are pulling in a different direction. The most
obvious and immediate example concerns the effect of poverty on health care. We
know, from study after study, that poor health and poverty go hand in hand. It
isn’t just a case of poverty ‘causing’ poor health; it isn’t quite as simple as
that. But a lack of money can limit lifestyle choices – giving people a choice
between heating and eating, for example, can lead to people choosing the
cheapest rather than the healthiest options. Educational level is another
factor in such choices as well, of course – and we know that the level of
education is also closely associated with levels of income.
Taking a deliberate
decision to withdraw funding from some of the most vulnerable pensioners without
assessing the impact, and taking a deliberate decision to leave
hundreds of thousands of children in poverty are not decisions taken by the
health secretary. But they are decisions which will directly impact the demand
for health services in the very short term. By a margin which it is impossible
to calculate accurately, they will make things worse. It is, or should be, the
job of the PM to ensure that his ministers are working to a joined-up agenda,
but allowing one minister to take decisions which will increase the demand on health
services whilst instructing another not to increase the supply of those
services underlines that it’s not a job which he is currently performing.
There is a lot for
which he can justifiably blame his predecessors, but none of that excuses
deliberately making things worse.
Posts
No comments:
Post a Comment