Q: How many patients would be harmed if every single NHS diversity tsar were given their marching orders? A:
By ISABEL OAKESHOTT TALK TV PRESENTER AND CO-AUTHOR OF LIFE SUPPORT Isabel Oakeshott is international editor at Talk TV, and co-author of Life Support: The State Of The NHS In An Age Of Pandemics with Lord Ashcroft.
dmg media (UK)
AS ANYONE who has been unlucky in love knows, it can take years to recover from a broken heart. A heart that is physically breaking can be a much quicker fix – as long as medical help arrives fast. However, these days, patients who suffer a life-threatening heart attack or stroke in this country can no longer be sure of being treated before it’s too late. Why? Because the NHS is not ‘on the verge of collapse’ or ‘at breaking point’, it is already in bits. As frontline services disintegrate, the standard of care, including for those suffering life-or-death cardiac arrests and strokes, is fast becoming a national disgrace. Even at the best of times – and that means weekdays – services are hit-and-miss. Happily, many patients still have a positive experience. Off-peak, it’s another story. Dr Andrew Stein, a kidney consultant, recounted recently in a breathtakingly candid interview on Radio 4’s Today programme how chronic under-use at weekends of the NHS’s vast network of expensive medical equipment is adding 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,’ Dr Stein 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.’ This mass exodus of doctors and nurses is leading to a terrifying spike in mortality rates. As reports in today’s The Mail on Sunday show, the ugly truth is that patients admitted to certain hospitals on a Saturday or Sunday have a much higher chance than others of leaving in a coffin. Almost every part of the NHS is now engulfed in this crisis, from A&E units to diagnostic centres, cancer clinics and geriatric wards. Quite simply, there are nowhere near enough healthcare professionals; nowhere near enough beds; and the system for discharging elderly patients who no longer need to be in hospital is a mess. The minute the clock strikes 5pm on a Friday, diagnostic equipment is switched off; multi-million-pound operating theatres are deserted; and all but those in the most dire need are forced to wait until Monday morning. Chancellor Jeremy Hunt knows all this better than most. After all, the man who last week gave the NHS an extra £3billion spent the best part of six years as Health Secretary trying to force it to become a seven-day service. There is no denying the damning facts and figures. There’s overwhelming evidence that health services in other wealthy nations perform better. I have looked at all the relevant international studies and I am sorry to report that when it comes to cancer survival rates and so-called ‘amenable mortality’ – meaning deaths that can be avoided with effective and timely healthcare – the UK is typically near the bottom of league tables. It’s no surprise that Ministers say they will axe the ‘Stalinist’ targets and armies of bureaucrats which are crippling the NHS. As for our hospital buildings, having toured a few of the worst – including flagship teaching Trusts such as St Mary’s in Paddington – I can honestly say that I’ve seen better in the Third World. Many older premises are in a shameful, dangerous state, with collapsing ceilings, dirty floors and patients cared for cheek-by-jowl on overcrowded wards, with only a cursory nod to their privacy. ‘Our’ NHS the envy of the world? Hardly! How has it come to this? Certainly it’s not for want of money – at least not in terms of the overall amount spent. Between 2020 and 2021 the Department of Health and Social Care burned through £192billion, about £50billion more than usual, due to the pandemic. Unfortunately, all that extra cash for Covid (more than the UK’s entire defence budget) did not leave the health service in a better place. On the contrary, the obsessive focus on the virus at the expense of almost everything else crippled the NHS, creating a disastrous backlog as millions of appointments and operations deemed non-urgent were deferred. Chronic conditions went untreated and cancer diagnoses were missed. Some 7.1million patients are now in a long queue for treatment, a far worse state of affairs than prepandemic. Tragically, many of those affected will pay with their lives. It is true that we spend a bit less on healthcare per head of population than many comparable countries. All the more reason, then, to use what is still an extraordinarily generous budget more wisely. But the entire system is riddled with waste – from the scandalous sums squandered on locum doctors and agency nurses, to the casual duplication of expensive tests, the loss of patient records, the inflated amount spent on drugs, and the failure to take advantage of the extraordinary bargaining power of what is still a centralised system. Meanwhile, drunk on the notion that what’s left of this once-great institution is ‘free’, many patients fail to play their part. They are allowed to miss appointments with impunity, are encouraged to celebrate being fat in the name of ‘body positivity’, and continue to smoke and drink to excess despite overwhelming evidence that it’s very bad for them. Perhaps worst of all, the structure of the NHS is hopelessly top-heavy. The whole system groans under the weight of hundreds of thousands of expensive pen-pushers and middle managers who gobble up resources that would otherwise be available for frontline staff. The growing army of well-meaning diversity and inclusion officers – who busy themselves ordering doctors to remember Black History Month, and telling people to stop using the word ‘woman’ for fear of offending trans patients – could easily be given their marching orders without leaving a single patient worse off. Sadly, they are the lowest-hanging fruit. There are tens – perhaps hundreds – of thousands of other unnecessary hangers-on, getting in the way of those trying to make sick people better. None of this is to denigrate staff who work extremely hard in an ever-more desperate and pressurised environment. It is a vicious circle: the smaller the workforce, the faster those that remain must keep running on the hamster wheel. As more doctors and nurses walk away, unable or unwilling to hack the pace, the gap between what they trained to do – provide excellent care – and the dismal reality of what they are able to deliver grows ever wider. While some may say it’s all hopeless, and the NHS should be broken up, there is no point making this argument right now. A new funding system, which retains Nye Bevan’s original founding principle of care that is free at the point of need, might be desirable in principle, but is never going to happen under this Government. Battle-weary Tories have neither the appetite nor the political capital. So the onus must be on the art of the possible. There is no time to lose. For the remainder of their stint in power, Ministers must focus on extracting maximum value for every pound spent, ordering every NHS Trust in the country to ruthlessly cut waste. Bosses that fail to transform bloated organisations into much leaner machines should be fired. The resulting savings should be ploughed into recruiting and training more frontline staff – and paying them properly. Meanwhile, every resource available – especially private capacity, of which there is plenty – should be used to drive down waiting lists. Make no mistake, the NHS is on life support. With a sickening feeling, voters are beginning to realise that Britain’s best-loved institution is sinking into the abyss. We are fast approaching the evolution of a two-tier healthcare system, in which the rich routinely pay for quicker and better care, while the poor are condemned to a failing public service. This is exactly what the creation of the NHS was designed to avoid. It will lead to many more broken hearts.