Returning to Westminster this week, politicians face a choice. Do we support the NHS reforms, or stick with the status quo? There is one principle that everyone can agree upon: that we must do what is best for the patient, delivering the best possible equitable care and treatment, free at the point of delivery, regardless of ability to pay. The problem is that in a health service run through a labyrinthine layer of middle management divorced from the reality of frontline care this does not always happen. Without the patient at the centre of their own treatment, money that should be spent on patient care is instead being spent elsewhere.
Examples of wasteful spending are not difficult to find. Since 2007, primary care trusts and strategic health authorities have employed 491 media professionals- at a cost to the taxpayer of £182 million- spending money on spin, not patients. Or there is the now notorious example of NHS Hull spending nearly £500,000 on a yacht as part of a local youth scheme. Managerial costs have risen to £6.2billion in the past five years, with 42,500 senior managers in post compared with 23,400 in 1997. Yet despite this, inefficient procurement across health authorities is estimated to cost around £1 billion per year, a symptom of out-of-control purchasing by management.
This kind of spending can hardly be justified, yet it has previously been excused since the NHS assumed it will receive a more generous cheque from the Treasury each year. The result of his assumption was that there was no need to focus upon productivity, with productivity falling in the NHS by 4.3% since 1997. This isn't just a statistic. It is wasted money that could potentially have gone towards addressing the continued wide variations in care and treatment. Productivity matters. If the average hospital was as efficient as the top 25%, then the NHS could provide 27% more treatments for the same cost. Instead, examples of inequalities are scattered across the service: average length of a stay in hospital for a broken hip still ranges from 11 days in the best hospitals to 45 days in the worst while, as the OECD has remarked on NHS performance, 'the quantity and quality of health care services remain lower than the OECD average'.
The need for greater productivity in order to achieve better care is gradually dawning. Health Service is currently in the process of making 15-20% efficiency savings, agreed under the previous government, amounting to £20 billion to be reinvested in frontline services. That in itself is the greatest challenge the NHS has had to meet in its history. In the past year, £4.3 billion of efficiency savings have been made, all of which has been invested in frontline care. But this will be needed just to stand still, to meet current demand by 2015. It does not take into account the demographic crisis we face of an ageing population, the scale of which will cripple our health service unless we reform now. Between 2011 and 2016, 1.4 million people will turn 65, and by 2030 the number of people over 85 will have doubled. Each will need the best possible care to meet dignity in old age, which will mean a renewed focus upon getting money to where it matters-- at the frontline.
This the status quo will not, nor cannot, achieve. In light of the challenge we face, there can be no denying the status quo is unsustainable. Reform is the only possible option if we are to ensure that the NHS does not run out of money. By placing responsibility for commissioning with GPs and their patients, the NHS will save £5 billion during this Parliament in management and administrative costs, with a reduction in management levels of 45%. By allowing greater choice over which services patients can choose, including voluntary groups and charities, driven above all by competition on quality not price, the best possible services can be delivered leading to the best healthcare outcomes. By ensuring that public health is placed at the core of health policy, we can begin to tackle the need for prevention of chronic illness caused by lifestyle choice. Above all, by ensuring that the NHS is returned to professionals who hold the key to unlocking the best possible practices and innovation, we will be able to discover new ways of how to deliver the best and most effective treatments and care for patients. Reform is not something to be feared, but welcomed.