Party Conference: Margot speaks on “Can we afford tomorrow’s NHS?”

I spoke at this fringe meeting organised by the Smith Institute with Asthma UK (a patient organisation) and Novartis Pharmaceuticals. My answer is straightforward: Yes, but not if we keep managing it like we are at the moment.

1. The NHS is over managed with perverse incentives both of which drive up costs for no patient benefit. In Stourbridge a patient or carer with say a mental health problem or learning disability would find themselves dealing with four statutory bodies in addition to their GP:

• The Dudley Hospitals Trust
• The Dudley Primary Care Trust
• The Walsall & Dudley Mental Health Trust
• Dudley Council

There is also what is known as a GP Commissioning group. Too much management. We need to reduce the number of bodies managing the professionals, and free up resources for nurses and doctors.

2. Our PCT is losing money. Our GP practises have good ideas to keep patients out of hospital that reduce costs and improve care. But the losses continue and the GPs find roadblocks all the time as they try and implement their ideas. Why? Because of the system of payment by results now operational in hospitals. In order to balance its books, the Dudley Hospitals Trust has an interest in maximising the number patients who come in to hospital either as out patient consultees or as in patients. Sometimes patients are shunted around the hospital for several appointments as each consultation is a ‘result’ and therefore carries a payment to the Trust. One financial accounting process to cover an entire patient population please, that way all managers whichever part of the process they are accountable for would have an interest in best possible care at lowest possible cost. A million miles away from where we are at the moment.

3. Qualification inflation. Professional groups are constantly raising the barriers of entry to their profession. Such self interest has gone on since the year dot among all professionals, the greater the barriers to entry the more everyone can earn. A simple equation and it applies to lawyers, accountants, everyone really not just healthcare professionals. Nurses now have to be graduates for example. Perhaps this is why there are complaints about lack of care on the wards? There is far more of a role for footcare assistants, healthcare assistants, and maternity support staff than is currently fulfilled. Healthcare can be delivered more cheaply by deploying staff who are not over qualified for what they do and there are is a lot of routine delivery and basic care and support that could be delivered far more cost effectively than is done at the moment.