Profit before patients? Why the future of the NHS remains uncertain

Three NHS ambulances parked at a hospital A&E entrance

Right now, the NHS is standing at a crossroads.

It has been on the receiving end of dramatic government funding cuts along with a complicated reorganisation from the top down. Simultaneously, as it struggles with the demand of hitting higher targets with fewer resources, hugely negative press has rained in from many news outlets, be they in print, online, or on TV and radio.

And just yesterday (11th March 2014), parliament voted in the controversial Clause 119, a measure that gives England’s Health Secretary Jeremy Hunt unlimited powers to close or downgrade local hospitals at just 40 days’ notice and without consultation – regardless of its level of performance.

There is currently concern being raised not only by government opposition, but also from within the coalition itself (and throughout large swathes of society) that the decision on when to use these powers will be based upon the performance of a trust’s finances rather than the quality of its medical care.

For example, one hospital could be performing well on both fronts but could be closed or downgraded if there are failings at nearby cash-strapped trusts. This (in)famously almost happened to Lewisham Hospital but following landmark legal action, the Court of Appeal ruled that Jeremy Hunt did not have the powers to downgrade it.

Following the passing of Clause 119, now he does.

On the other hand, the Health Secretary believes that Clause 119 is a step in the right direction for an ailing NHS, and will only be used as a “last resort” to help to reduce the bureaucracy of lengthy consultations required when making such decisions, along with cutting the costs required to support failing institutions.

That said, the controversy of this vote shouldn’t mask the fact that change is required for the NHS, yet at the moment it certainly seems some way off for both wings of the House of Commons to come to an agreement about the best ways in which to proceed.

Support

Despite the cloud of negativity lingering overhead there is still strong public support for the NHS, best illustrated by the 50,000 people who took to the Manchester streets in September 2013 to protest against governmental NHS austerity measures, as well as the formation of the National Health Action Party.

For every negative NHS story that is drip-fed into the nation’s consciousness, there are thousands of success stories that go unreported. Yes there are problems to be addressed, and the failure of institutions such as Stafford Hospital resulted in drastic but necessary action, but spare a thought for the people who undergo successful pioneering brain surgery whilst awake – for free – at such lauded neuroscience institutions as the Walton Centre in Liverpool.

The NHS is, at heart, a good thing, but improvements are vital for its future as a going concern. So what can be done? At the Health and Care Innovation Expo in Manchester earlier this month, Jeremy Hunt revealed his ideas.

The MP stated that the NHS must bring itself in line with the information age and suggested that modernisation will help the service be able to cope with demand.

Tellingly, Hunt compared it to the online revolution of the banking sector and the way that millions of us now only bank online and stated that by comparison, “little has changed” in the NHS and that it has “barely scratched the surface” of the banks’ technological achievements.

Technology

Taken at face value, this appears to be a promising and truly exciting solution to some of the NHS’s woes. To stand still in this current climate is to stagnate, so investment in modernisation should make it easier for people to get the help that they need.

GP waiting lists could be a thing of the past through the introduction of Skype-led appointments and it is hoped that it will also reduce the strain felt by A&E departments. It is anticipated that apps will be rolled out to help patients self-manage their long-term conditions, and even more basic processes could be introduced such as booking appointments over the internet.

Hunt believes that with these changes, the NHS is on the “cusp of one of the most exciting changes in delivery of health care that will ever happen in our lifetimes”, and that it will help personalise the medical care we receive.

But then there are the estimated 11 million people in the UK population who have little to no digital skills, a proportion of whom will of course experience illness and disabilities – in fact, half of all people ‘offline’ are understood to have a disability, so must still be accommodated in the traditional avenues offered by the NHS.

However, to implement such wholesale changes costs money, and since the government’s austerity measures have been introduced, the NHS doesn’t have much of it. How will the NHS be able to catch up to the banking sector? Despite the devastating global impact of the banking sector’s mismanagement, it still benefits from billion pound bailouts; eye-watering figures with which the NHS is simply unable to compete with.

Future

The NHS can be considered as one of Britain’s greatest achievements. For over 65 years it has provided universal healthcare and invaluable medical assistance for anything from the mildest of wrist sprains to the severest of brain injuries whilst making incredible scientific advancements.

But there are widespread suspicions of the dismantlement of a free NHS in the UK; it began during the prior government’s incumbency and appears to draw increasingly ever-closer. If that turns out to be the case then investment from private contractors will surely be the likeliest method employed to bring the UK health service into the 21st century – but at what cost?

Should competition between pharmaceutical giants and rivalries between trusts – the driving forces for “growth” – ever be encouraged over the sanctity of human life?

Will it be fair that only the people who may be able to afford insurance get access to healthcare? Generally, the poorest in society have lower standards of health and therefore need help the most – are the poor undeserving of having access to a better quality of life simply because they have less money in the bank?

A revolution of the NHS would be welcome, but if only those who can afford to pay for it can have access to it, then it will be unable to do its duty. The NHS helps anyone who is sick, needy or dying in the best way it possibly can and for free.

If this is taken away from us then what does it say about our society?

The NHS is standing at a crossroads, and the answers to these questions depend on the direction it takes next.