The Care Quality Commission has delivered a grim report on the current state of safety in our NHS (Report, 15 October), describing some harrowing failures and expressing grave concerns, but the identification of the real source of the problems is, of course, outside its remit. What is clear to most of us is that the political establishment has decided, just as it has with the welfare system, that the “monolithic” NHS is unaffordable, a dinosaur leftover from a dark “socialist” past. Through continued “efficiency drives”, restructurings, funding cuts, persistent attacks on consultants, junior doctors, GPs and nurses, the entire system is being driven quite deliberately into an orchestrated crash.
There can surely be no doubt that the British people continue to be keenly supportive of the concept of a National Health Service. Nevertheless, the crash will certainly come. Perhaps the affluent among us have less to fear: the huge (mostly US) medical conglomerates are waiting in the wings, ready to step in and take over. After all, have not our political masters been both covertly and overtly inviting private medical providers to enter the British healthcare “market” for many years now, exactly so as to ready themselves for the moment when the system finally collapses and we shall all be grateful for any viable alternative. No doubt that will be the point when the market delivers to the British people the “customer choice” that they allegedly longed for, assuming that patients in future have big enough limits on their credit cards.
Milan Svanderlik
London
• Your leading article on financing the NHS (10 October) says rightly that the crisis is not a surprise – but it’s time to think the unthinkable. Instead of continuing to invoke the black box of “efficiency savings”, we need to question the assumption that efficient healthcare can only be achieved by means of a market – itself hugely wasteful of resources. By removing the distinction between purchaser and provider, and the unnecessary boundary between primary and secondary care, the expensive and time-consuming functions of commissioning and planning would become irrelevant. Patients, healthcare staff and taxpayers would all benefit. The only losers would be the shareholders of private healthcare companies. The budget for healthcare will always be finite. But it needs to be larger, and organised in such a way that choices can be transparent and honest.
Raymond Chadwick
Whitby, North Yorkshire
• A friend ascribed the NHS’s deficit to mismanagement and profligacy, likening them to a corporation failing to make profits, and this ignorant misperception may be what the government wishes to promote (Urgent demand for cash to fill £930m NHS deficit, 10 October). Unlike a business, income does not rise as “customer” numbers increase, nor can it raise its prices. It has a public service remit to provide healthcare for all – essential, among other aspects, in maintaining the work capabilities of our citizens – within a budget. But that budget must be sufficient and must take account of unfunded rising demand, equipment and pharmaceutical costs for efficient functioning. Equitably and intelligently the NHS is funded by all taxpayers as a form of collective insurance for when any of us needs care. It is ranked as the best health service in the world, yet we already get it on the cheap. As a proportion of GDP we spend not only half what the US does but also less even than the average across the EU. So the NHS is far from profligate and must not be destroyed by ideological penny-pinching. Moreover, despite what neoliberals and the rightwing media promulgate, the UK is not a heavily taxed country, and if an increase in tax is needed for this purpose it is unlikely there would be much objection.
Michael Miller
Sheffield
• On 13 October, Jeremy Hunt yet again told the Commons that his plans to cut junior doctors’ pay by up to 40% were necessary to implement a “seven-day NHS” (Seven-day NHS pledge doomed to fail, warns doctors’ chief, 14 October). He claimed this will tackle the “11,000 excess deaths” from emergency admissions at the weekend, caused by under-staffing. There are several glaring errors here.
First, seven-day emergency NHS care already exists. Every single patient is seen by a doctor within four hours, and a consultant within 24 hours. Second, no health service on the planet currently delivers seven-day non-urgent (elective) care. Third, increasing non-urgent weekend services will do absolutely nothing to reduce avoidable deaths from emergency admissions. Fourth, we spend less on health than almost every other western country. The NHS is facing the biggest funding and recruitment crisis for a generation. Making doctors provide non-urgent weekend care will push our overstretched weekday service to breaking point. Paying doctors less for antisocial rotas will worsen the recruitment crisis in exactly the areas we need them – emergency care and general practice. Finally, Mr Hunt’s “11,000 excess weekend deaths” figure was taken from a paper by Prof Bruce Keogh, in which he explicitly states “it is not possible to ascertain the extent to which these deaths are avoidable”. To assume so would be “misleading”.
Jeremy Hunt is deliberately misleading the public. Out of fear, patients have delayed going to A&E until after the weekend, with dire consequences. One person has already been left paralysed. Dr Andrew Wakefield was rightly struck off for disseminating equally misleading and dangerous public health messages. Mr Hunt needs to be held to the same professional standards.
Dr Danny McLernon-Billows
(Junior A&E doctor) Brighton
• I agree with Jane Dacre’s conclusion that the demand for more doctors to achieve a seven-day NHS will not be met. As a charge nurse on a paediatric intensive care unit, my concern is where will we find the nurses to deliver such a service. As we approach another winter, we can barely deliver our Monday-Friday service, the only respite at weekends being the two-day hold on elective surgery. As one part of a paediatric service (including all the other paediatric wards), we are expected to save another £40m before April, and yet my unit is currently asking all its staff to come and work overtime shifts just to meet our current demand.
I work with excellent colleagues giving their all to maintain this service. But it’s hard. On a recent shift a new member of staff was in tears as she was put in an exposed position so as to be able to admit an acutely ill child. The same shift saw a discussion between myself and the consultant regarding transferring a child out from our own A&E to another hospital so as to maintain the safety of the children currently on the unit.
We bend over backwards to get children who need our service on to the unit. What was once unusual, eg discharging children back to the wards earlier than in the past, is now the norm. The cost? Nurse morale is rock bottom. It is increasingly harder to recruit staff and those we get are mainly newly qualified nurses, who should really not be coming to a specialised unit like intensive care. Many leave, of course, adding more pressure on those that remain. Experienced staff are also exiting. It is a great shame.
As the consultant said to me, the demand for health services outweighs the number of people available in the NHS to deliver it, in all disciplines. I’ve been a supporter of the NHS (31 years on the frontline) but I do fear for my younger colleagues when I have retired. And I fear for myself as in the not too distant future I’ll need to call upon the NHS to meet my own health demands.
Andy McNulty
Leeds
• In the discussion of possible causes for the current NHS overspending crisis, why does no one mention, let alone analyse in detail, the bureaucratic, managerial and legal costs of competitive tendering for contracts? These costs are conservatively estimated to drain a huge £10bn every year away from patient care. Isn’t it time to stop taking them for granted and subject them to the same gimlet-eyed scrutiny as government and press seem to reserve for every other aspect of our NHS?
Jane Freeland
Southampton
