After decades of seemingly perpetual crisis, can the NHS survive?

    20 October 2016

    How many times have you read a headline suggesting the NHS is in crisis, or that it’s about to break down due to excessive demand? What is the real state of affairs beyond the headlines?

    Recently, Chris Hopson, chief executive of NHS Providers, warned that without more money there will have to be reductions in care levels or longer waiting lists. NHS Providers is the membership organisation for acute, ambulance, community and mental health services, and it works alongside NHS trusts. In September he provoked controversy with a blog stating: ‘It is surely now time for our national health and political leaders to publicly acknowledge that the NHS can no longer deliver what is being asked of it for the funding available. The evidence that there is now an unbridgeable gap between what the NHS is required to deliver and the money to pay for it is both widespread and compelling.’

    He cited the fact that waiting lists were at their highest since December 2007 and that in the first nine months of 2016, only four of 138 large accident and emergency departments in the country met government targets and saw 95 per cent of their patients within four hours.

    Meanwhile, the Society of Acute Medicine is prophesying ‘pockets of meltdown’ in emergency care this winter. Other reports highlight reductions in facilities and increases in managerial salaries at the expense of training more doctors. And the doctors we do manage to train (enforced contracts, long hours and strikes not withstanding) leave the NHS in droves. At the end of 2015, according to the BMA, 48 per cent of junior doctors left the NHS after just two years of on-the-job training, leaving the NHS understaffed and out of pocket to the tune of approximately £250,000 per doctor trained.

    And yet, if news reports are to be believed, the health service seems to have been in crisis for decades. When the move from clinical direction to professional management was introduced, lots of people said it would be the end of the NHS, and 25 years later politicians are still concerned about its management. Last year Ukip MEP Louise Bours suggested clinical staff were outnumbered by ‘bureaucrats’ using up funds that would ‘be better spent on frontline services’. On closer examination, however, her alleged ‘bureaucrats’ included hundreds of thousands of cleaners, porters and healthcare assistants.

    According to the Health and Social Care Information Centre, pure management roles in the NHS account for only 4 per cent of employees. As a body, it has problems recruiting enough quality managers to senior roles, as these are high-pressure jobs where actions and results are closely scrutinised. As a result, the NHS does spend a significant sum buying in outside consultants. Since 2010, the bill for management consultants has more than doubled. The popular image of NHS managers as overpaid suits tying up the doctors in red tape ignores the fact that around 30 per cent of clinical staff in the NHS have some sort of managerial role.

    The closure of wards and the decreasing number of hospital beds is another cause for concern for many people. Over the last 26 years, the number of hospital beds has reduced by 51 per cent. However, in part, this reflects the change in how conditions are treated. Beds for people with learning disabilities have been cut by 95 per cent and for older people with long-term conditions they have been cut by 64 per cent but this does not mean such patients are not getting treatment; it simply reflects a change in how and where they are looked after.

    Shutting wards saves money, but it can go too far. It appears that most hospitals do not have quite enough beds to go round. In 2014/15, hospital beds were occupied, on average, 89.5 per cent of the time, 4.5 per cent over the level at which the National Audit Office suggests regular shortages of beds and increases in healthcare-acquired infections occur.

    As the NHS undertakes a widespread consultation on how to ration its resources, do mutuals such as Benenden have a role to play in service provision? We ask a range of people what the NHS can do to provide better healthcare – and where it should focus its precious funds.