Empty hospital beds

‘Happy’ Birthday, NHS?

Nicola Biggerstaff

This week saw the 75th anniversary of the founding of the National Health Service. Launched on the 5th of July 1948, by then Health Secretary Aneurin Bevan, its early incarnation is remembered as a revolutionary success for social welfare, shaping our future attitudes for generations.

However, the challenges we face now are drastically different to those that the NHS was established to tackle. Rates of harm from infections such as tuberculosis and polio have reduced to almost zero thanks to advances in disinfection and vaccination, but new modern issues such as our aging population, obesity, poverty, and complications from rising alcohol and recreational drug harm require an adapted health service which remains free at the point of need for all. Combined with the unprecedented pressures placed on services during the coronavirus pandemic and the resulting fallout in the years since, it is clear that something needs to change, but this change has to be done right.

As an idea which was conceptualised and implemented by the early Labour party, it is jarring to hear both current and former party leaders and prominent figures discuss the need for the NHS to adapt through the lens of increasing privatisation. Just this week, Tony Blair was heard advocating for increasing use of private contracts which, during a celebration of the service, feels quite jarring to watch. With the current Labour leadership also publicly supporting increased privatisation, the dismantling of services in the UK feels inevitable. Here in Scotland, we are headed down a similar path thanks to chronic public mismanagement.

A lack of faith in our public services from the very top will only serve to reinforce this in public opinion, and we cannot allow this fear to win. We have the potential in this country to provide world-leading nationalised healthcare, and our politicians must be the ones to lead this faith in our services, rather than use it for their own political agenda.

We cannot allow private interests to overtake public need for good health. This is the underpinning of our healthcare policy here at Common Weal. All provisions, treatments, and contracts should remain in the hands of a public NHS body which is fully accountable to the public.

A fully resourced and fully functioning NHS will only work at its most efficient in tandem with a fully resourced and fully functioning National Care Service. These would provide local, co-ordinated services within communities which can cope with the vast majority of health and care demand. This would include the expansion of the local hospital network, including the reintroduction of colloquially known ‘cottage hospitals’, and the introduction of local health and care ‘hubs’ as a primary point of contact to lessen the burden on GP surgeries, as well as a reinvigorated employment structure which places the deserved value on health and care staff at the lower end of the pay scale to decrease turnover.

These new local services would serve as a place to allow patients the time to heal, placing less pressure on the ever decreasing number of current hospital beds, as well as provide some minor services, such as X-rays and post-op recovery/rehabilitation services such as physiotherapy. By giving patients the time they need for an adequate recovery, in an environment which doesn’t simply see them as a body taking up a bed space, they can expect to adjust back to their lives more quickly and be less likely to need further treatment for complications in the future.

These would be staffed by a new generation of health workers who would previously have been prevented from pursuing clinical or medical careers. The employment of Healthcare Assistants and Community Health Support Workers in the new healthcare landscape will help to expand staff capacity, relieving pressure on the parts of the service which are suffering the brunt of increasing cuts through the years, such as Accident and Emergency departments and the availability of beds.

Management in hospitals should be clinically led, by those with the knowledge and experience required to understand the inner workings and dynamics required in their professional settings. This is why we propose that management is taken over by a Medical Superintendent and/or a Chief Nurse, who would be answerable only to their fellow staff. We also propose an overhaul of the Health Board network, instead replacing them with a network of locally elected Health Councils, comprised of clinical and non-clinical staff and some patients’ groups. These local councils would elect representatives to also attend a National Health Council, which would become the primary point of contact between government and the health service, reducing their bureaucratic interference and target-setting culture.

A mutually owned National Health Company would take charge of procurement to take vested interests out of our health service. It would seek to take advantage of Scotland’s world-leading life sciences research bases to acquire patents, produce generic medicines, and secure supply chains for resources that cannot or are not yet being produced here in Scotland, such as PPE.

Litigation costs are one of the largest drains on the NHS budget after procurement and treatment costs. Restrictive insurance practices prevent trained staff from performing minor routine procedures, like suturing or administering injections, despite being more than qualified to do so. A new Statement of Subsidiarity would put trust back into the hands of healthcare staff and allow them to perform their roles with the full support of their employers. The statement would set out guidance on the full extent to which certain members of staff can perform certain duties, expanded to include these otherwise minor procedures and encourage collective responsibility. This legal protection would also reduce litigation costs, supported by the creation of an Independent Health Service Reviewer, set up to investigate cases of malpractice and issue rulings, deciding based on evidence whether there is precedent for patients to pursue complaints.

Of course, these measures would be best implemented when Scotland has full control of its monetary and fiscal policy. That does not mean there are no measures that can be implemented now to improve conditions in the NHS for staff and patients. Measures like the latest accepted pay offer will always be welcomed, but the new administration must ask what else can be done to improve conditions, and bring us back to the world-leading standards in nationalised healthcare that the founders of our NHS had in mind.

If a lot of this week’s article from me feels vaguely familiar to our regular readers, or as if I am repeating myself over and over, it’s because I am. Over my last year at Common Weal, I have written about the dubious state of our health service, and the solutions we have here to fix it, more times than I can count. The problems and solutions I have presented this week can also be read about here, here, and here, the only difference being the topical twist I opened with.

Our government is not listening, and it is time for us to act.

The Scottish Government must, with urgency, commit to making the NHS a priority. Here at Common Weal, our health policy is shaping up to be a comprehensive overhaul of clinical management and processes which will save our NHS from the managed downward spiral we are currently witnessing. Read all about it in our latest publication, Sorted: a handbook for a better Scotland, before the release of our most extensive health policy yet later this year.

3 thoughts on “‘Happy’ Birthday, NHS?”

  1. Alasdair Macdonald

    “…. we propose that management is taken over by a Medical Superintendent and/or a Chief Nurse, who would be answerable only to their fellow staff.”

    Your article is well thought out and addresses the separation amongst different aspects of health and care which has developed and seeks to facilitate greater integration because all these aspects have to be integrated within each single patient.

    However, I take issue with the sentiment of the sentence at the head of this post.

    I think public services ought to be led by professional staff who have actually done the jobs which the service provides and that includes cleaning, catering and transport staff, because they do, indeed know from the inside how the system works.

    However, there is the well-documented phenomenon of ‘goal displacement’, which is known by other expressions, such as ‘producer capture’. Goal displacement is when the people who run in an organisation start to move its operation in a direction which favours their professional interests rather than the interests of those for whom the organisation was established. Thus, hospitals give greater emphasis to the demands of staff rather than patients, schools favour the interests of teachers over those of students, banks give staff bonuses rather than investing in small businesses, etc. No service – public, private or third sector is immune from this, and, without checks and balances it can distort significantly the functioning of the organisation.

    Therefore the management of the organisation has to be publicly transparent and also has to be accountable to a body which has on it a majority of people who are NOT professionals. These people should be drawn, not from ‘the great and the good’ as is currently the case, but from a wide section of society. In the case of a major body like the NHS, perhaps there ought to be elections for different categories, such as patients.

  2. Excellent reflection from Nicola. Nicola’s stark diagnosis of the critical situation of NHS is a concern to be reckoned with by all and sundry. It is a dire call for concern with immediate effect. Yes, the NHS must remain an institution of publicity utility. Privatising the NHS will entering the wrong side of history and betrayal of the vision of its founders. Heath can not commodified. The American Model teaches us that good health services are the privilege or appanage of the rich. I think what makes the UK’s health services and Scotland in particular enviable is her ability to provide health services for every person, poor or rich. The human person is in the Centre. The current situation of the NHS should not push policy makers to seek easier ways out, like privatisation. The IMF pushed many countries in the developing world to privatise their National Services but today there are lots of regrets, because private companies care mostly about Profit not the necessarily the lives of their fellow human beings. Neo-liberalism should not blindfold our policy makers. I think that through the agency of Common Weal, Nicola should be invited to Holyrood to address the MPs and health policy brokers. There is urgency in overhauling the current functioning of the NHS. Many people are disgruntled. This goes same for Transport and Climate policies. If the Government of Humza is able to do this, then it will be a palpable gage of their capability to function as an independent state, if one day this dream dear to them becomes a reality. Yes, Nicola is absolutely right;”The Scottish Government must, with urgency, commit to making the NHS a priority.” This is what must people think !

  3. To be clear, two National Health Services were launched on 5th July 1948. The NHS for England and Wales began life on 5th July 1948 as a result of the National Health Service Act 1946, and the NHS for Scotland also began life on 5th July 1948 as a result of the National Health Service (Scotland) Act 1947.

    While much of the credit for the idea is often given to the Labour Government that was elected in 1945, it is worth noting that, prior to 1948, half of the area of Scotland had benefitted from a state-funded health system for 35 years due to the work of the Highlands and Islands Medical Service.

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