Take politics out of the NHS – and start fixing its problems
By Michael Powell and Brendan Carlin
dmg media (UK)
DOCTORS have rejected calls to work weekends to resolve the NHS crisis, saying it would harm their ‘work-life balance’. NHS bosses have come under pressure to switch to a seven-day working rota to help clear a record backlog of seven million people waiting for vital tests and treatment. Former Health Secretary Lord Lansley told The Mail on Sunday: ‘We owe it to patients to provide the best possible care at weekends.’ His intervention follows a recent interview with kidney consultant Dr Andrew Stein on Radio 4’s Today programme in which he said chronic under-use of NHS equipment at weekends adds to the misery of millions awaiting tests and treatment. ‘In most hospitals in the UK, it’s like the Mary Celeste on a Friday afternoon,’ he said. ‘People start heading to the car parks at 12, and by 2pm it’s all quiet, and the hospital is not used to full capacity through the weekend.’ Last week Health Secretary Steve Barclay suggested doctors’ failure to work at weekends is fuelling the crisis because there are fewer decision-makers to discharge patients. But Dr Vishal Sharma from doctors’ union the British Medical Association hit back last night, saying a shortage of staff made the seven-day plan unworkable. He said: ‘It would not increase the number of patients that get treatment but would simply reduce the number of staff available during the week. ‘It would also result in staff working even more weekends than they currently do, with further detriment to their work-life balance without delivering any additional capacity.’ Previous analysis has found 86 consultants work in a typical hospital on an average Wednesday, but only 12 on a Sunday. Death rates for those admitted into hospital at the weekend are 14 per cent higher than those who go in during the week. Patients wait months to be seen but one in ten hospital beds – 13,200 – are occupied by patients who no longer need one. Meanwhile, state-of-the-art medical kit worth millions of pounds – including lifesaving radiotherapy machines – is left idle every weekend. The seven-day NHS plan was a key pledge made by David Cameron’s government. But it hit the buffers during a row with junior doctors, who threatened to strike over their pay deal. Lord Lansley said: ‘Ten years after David Cameron and I raised this problem, we have made nowhere enough progress in NHS hospitals providing seven-day services. We owe it to patients to provide the best possible care at weekends. ‘We owe it to them because we know those admitted on weekends tend to be sicker than those admitted during the rest of the week – so it is vital they are seen by experienced consultants. ‘We owe it to those now waiting for appointments and treatments, so that we can tackle the postpandemic backlog as quickly as possible. However, we also owe it to the taxpayer – as seven-day working would be a much more efficient use of public resources.’ NHS sources said there are a record 100,000 job vacancies. Lord Lansley said: ‘Of course, providing seven-day working across the NHS as a whole is entirely dependent on having the necessary staff – not only doctors and nurses but others like pharmacists as well. No one, certainly not me, minimises the scale of the health service’s staff problems. But at the moment, patients who should be discharged at weekends, which would free up much-needed beds, are left in hospital simply because the necessary staff are not available on Saturdays and Sundays.’ On the average weekday last month, hospitals across England discharged 10,211 patients. But that slumped by a third to 6,828 on the average Saturday or Sunday. Respected consultant oncologist Prof Karol Sikora said it was ‘criminal’ radiotherapy equipment worth millions was lying idle at weekends. He said: ‘Airport and rail staff work seven-day rotas, as do retail. Everybody else does it. Why should healthcare be different?’ Poor weekend staffing meant Rachel Mendez was treated with the wrong antibiotic for a serious infection, leaving her in ‘excruciating pain’ overnight. Ms Mendez, 54, from Bedfordshire, who is prone to urinary tract infections, said: ‘I always pray that it doesn’t happen at the weekend. I know I will have to wait so long to be seen and then even longer to be seen by the right consultant.’ Jonathan Pearce, CEO of Antibiotic Research UK, said: ‘Patients can deteriorate quickly if they don’t receive the right antibiotic treatment at the earliest opportunity.’ WHAT is the point of targets, if nobody ever hits them? And yet the National Health Service, striving to pretend to itself that it is the envy of the world, is still beset by targets which it repeatedly fails to meet and cannot hope to meet in its current state. Governments have imposed these goals in the hope that they might at least improve things. But anyone who has waited in any big hospital Accident and Emergency department is painfully aware that it has not done so. The prescribed maximum waiting time of four hours is as fictional as anything in the adventures of Harry Potter. Indeed, it would probably take a magician to achieve such a thing, given the multiple pressures on the NHS, of worsening GP services and the Covid aftermath. Average waits for stroke and heart attack patients are likewise far too long, but given the current difficulty of getting patients out of ambulances and into hospitals, it is hard to see why new targets will make much difference. Such things, because they are generally driven by politics, eventually take on a purpose of their own, which – in the case of the NHS – has little to do with improving actual health care. The outcomes can be perverse. For example, the original idea behind cutting thousands of hospital beds was noble and wellintentioned, aimed at getting elderly patients, who were not actually ill, back into the community. But many of those elderly patients have nowhere suitable to go, and so they now occupy beds which are badly needed for emergency cases and epidemics. And so ambulances queue for hours outside major hospitals, unable to discharge their patients and prevented from attending new urgent cases. So it is not unreasonable to call the current regime of targets ‘Stalinist’, since officials become so preoccupied with meeting them that they forget why they were imposed in the first place, and they do no actual good. The classic example of this futile target obsession was the Soviet nail industry, which was allocated a target of millions of tons of nails, which it realised it would struggle to produce in time. But because the goal was set by weight rather than by quantity, managers ordered production lines to stop making small nails, and instead to make them several feet long. The enormous nails were quite useless, and had to be melted down again later, but the tonnage target was fulfilled. So a bonfire of timewasting top-down targets is an entirely reasonable aim. It is more likely to bring about a solution of the NHS’s problems than yet more attempts to force that lumbering organisation to undertake tasks it is not capable of doing. And the appointment of the Blairite veteran, Patricia Hewitt, to investigate the innovative use of technology to cut costs, may also turn out to be a cleverer move than it at first appeared. Ms Hewitt is certainly no friend of Conservatism or of the Government. She comes from the heart of the Labour movement. But that is exactly why her role in the planned reforms is useful. It will shield the Government from opportunistic Left-wing attacks on their plans, of the kind which tend to intensify as elections approach. And as she is a former Health Secretary, it cannot be denied that she has deep experience of how the NHS actually works. In truth, the NHS should be taken out of politics, and all the major parties should agree that it is more important to fix it than to use it as a source of political propaganda. But, as this seems unlikely to happen just now, the Sunak Government’s approach has the virtue of intelligence and thought. Modest unspectacular improvements that work are better than a hundred noisily-trumpeted targets which are never met.