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As we approach the General Election on the 4 July 2024, the two main political parties have fiercely debated over healthcare policies, particularly the current poor state of the NHS patients and its demoralised staff.
The NHS has always been a major issue between political parties, especially around election time, but this time, the state of the NHS is critical. Its performance has clearly deteriorated over the last few years and virtually every sector of its empire has suffered. Many other public sectors have been crumbling whilst paradoxically taxes have been rising.
Few would argue against the idea that the NHS is on its knees, and both staff and patients are deeply unhappy about its current state. Watching the first television debate between Prime Minister Rishi Sunak and the Leader of the Opposition Sir Keir Starmer clearly shows that the NHS is at the forefront of their minds, yet throughout the debate I was no clearer on how either of them were going to solve the problems facing the NHS, and I suspect I am not alone. It is easy for party leaders to say they will throw more money at the NHS if they are elected, but there is little spare cash around given the fact that healthcare spending comes in at just under 20% of total government expenditure.
A closer look at the problems facing primary and secondary care
In primary care, it has become significantly harder to obtain a GP appointment, while in secondary care, waiting lists have become far too long. Ambulance delays, problems with staff rosters, a demoralised workforce, crises in emergency departments and staff shortages are also in the mix.
In the past, many politicians have claimed to have the answers but have not delivered. Now, with the NHS in a grave crisis, it feels as if the situation is spiraling out of control. I am equally pessimistic that currently no politicians have a proper and feasible plan to return the NHS to full function.
Part of the reason why politicians are frightened to meddle with the NHS is that it is such an important and critical institution, and the vast majority of the population expects free healthcare to be delivered efficiently.
Nigel Lawson, a famous politician working under Margaret Thatcher, famously and rather cleverly stated that “the NHS is the closest thing the English people have to a religion”. I would argue ‘British’ would have been more appropriate than ‘English’ but the sentiment is very useful and pertinent. Most changes to the NHS to date have been minor, with most politicians fearful of a public backlash if there is a dramatic change to the way that the NHS is set up.
What does the future hold?
As a former GP with 34 years of experience, I am very fearful about what will happen to primary care in the next few years. Like many clinical areas of the NHS, primary care is very much on a downward spiral, losing many medical staff to retirement and not enough replacements feeding in to replace them. Despite the shortage of GPs to meet the public demand, incredibly there could be newly qualified GPs out of work this summer. This is reportedly due to the Additional Roles Reimbursement Scheme (ARRS) which does not allow funds to be used to employ additional qualified GPs. But when jobs do come up for GPs, there is a substantial number of candidates.
Just like in secondary care, the clinical workforce is demoralised, overworked and stressed. GPs did provide continuity of care, but that important role is slowly being eroded. While pharmacists, nurse practitioners, and physician associates can help in certain circumstances (as GPs roles evolve), their introduction requires specialised training (which requires money) and significant supervision, often by GPs (which requires time). Significant amounts of time and money are currently in short supply in primary care. There is fragmentation of care both within primary and secondary care as well as between primary care and secondary care. As well as being inefficient and unproductive, this adversely affects patient care.
A big issue within secondary care is the pressure on inpatient services and the difficulty in discharging patients to appropriate social care settings. Sadly, so called corridor care is quickly becoming a national emergency. Clinical staff are demoralised and we are losing experienced staff who are changing jobs, moving abroad or retiring early. With demoralised staff and no proper planning for workforce requirements, no wonder there is medical staff unrest across all sectors.
While the Conservative Party has announced they will be building 100 new GP surgeries and expanding the role of pharmacies, we must question whether pharmacies can cope with additional demand and whether there is capacity to staff new GP surgeries. Many patients complain they cannot get an appointment to see a GP, and worryingly with the current contract uplift offered to General Practice, there is a risk that some practices may fold.
Meanwhile, in their manifesto, Labour says it will create 40,000 more appointments a week within the NHS whilst bringing back the family doctor. We have had promises from politicians of all parties before and they don’t always deliver. If polling is correct and Labour do gain power, we will have to wait and see if they deliver on these commitments.
How can we fix our NHS?
The current set up of the NHS is not fit for purpose. The service had its genesis in the years following World War 2 and, of course, we are now in a completely different era. The NHS has not evolved at the same rate as society, the economy and the way we live and work, so the disconnect between the state and function of the NHS and the society it has to serve has become a huge chasm. Politicians fearful of being criticised and dumped out of power are too timid to make the necessary changes; they are simply moving the deckchairs around rather than performing radical surgery. This lack of leadership and vision lies at the core of many of the current problems the NHS faces.
We are all proud of the NHS and the fact it is free at the point of delivery, but this very important feature is also its Achilles heel. It keeps devouring cash as our society becomes older and iller with complex multi morbidity. It is now a huge employer (one of the largest in the world) and it certainly has its inefficiencies. Critics have pointed out that the set up and funding of the NHS makes it a unique institution globally, and because no one else has copied this concept of health delivery, this means that it is not the correct solution. I am not saying that is a correct assumption, but it is food for thought.
Since the NHS is such a significant pillar in our society, any radical surgery has to be carefully thought through so that all the stakeholders are on board. However, before we do anything, we must solve the medical workforce crisis, although this only marks solving the beginning of the problem. My personal view is to propose five potential solutions and put them to a national referendum: the winning solution is the one that politicians have to work with. You may agree or disagree with this radical idea and I would be interested to hear your thoughts on this topic.
Whatever happens next, we cannot keep kicking the can down the road as we have doing until now. A radical solution needs a radical plan, but these plans must involve the public who rely on this vital service. So, will the next administration be up to it? Currently, I don’t think any political party has a clear answer to this question.
Dr Harry Brown is a retired GP, Leeds
