Taxpayers expect the government to spend their money wisely. It is not surprising that politicians feel the need to prove that this is happening.
The government learned through focus groups that waiting times in the NHS were a big public concern. Rightly it chose to tackle this issue.
Announcements were made that by a certain date waiting lists would fall to a certain length. The DoH was directed to make this happen. SHA chief executives were given an ultimatum to make sure waiting time targets in England were met, or there would be ‘consequences’.
With such pressure to succeed, each SHA chief executive spoke to each PCT chief executive. They were told to meet waiting time targets.
It soon became clear that the task would not be easy. Doctors were recruited to work at disproportionately higher costs to clear waiting lists. Patients went to distant hospitals to have operations at higher cost. Centres were set up quickly despite disquiet from local clinicians about standards to clear the backlog.
Money was diverted from other medical fields to those which had targets. Toenails were removed rather than major operations performed because they were quicker to do and reduced waiting lists more effectively.
Despite all the efforts some targets were too ambitious. Managers, rather than face the wrath of their superiors, resorted to a variety of tactics, which were later revealed in the national press as effectively ‘fiddling’ the figures. The result of this was that many PCTs could tick the box marked ‘Target achieved’.
This pleased the SHAs who could then tick their boxes, which in turn pleased the DoH because it could tell ministers that the targets had been achieved. They could announce in parliament to a grateful public that waiting lists had fallen. Of course, doctors and patients saw the evidence that things were not as they appeared.
Limited resources
Some patients have benefited, but has this been the most effective way of managing scarce NHS resources? Despite record resources being poured into the NHS, PCTs are heading for large deficits. We are already seeing the effects of this. It is going to get worse. After 2008 there will be a drastic percentage-term reduction in new money for public services including the NHS.
The taxpayer has been encouraged by political spin to believe that our healthcare system is the best in the world. Yet mortality figures for many major diseases rank us with countries such as Turkey rather than the USA and France.
Despite this we seem wedded to our system. Any politician mentioning private enterprise or limitation of NHS treatment has been shot down. Yet we badly need to debate issues around the extent of a public-funded NHS.
Competition
Politicians have woken up to the idea that competition among providers will bring savings. The public does not care where it is treated as long as it is good and fairly local. Yet all main political parties cling to the idea of a public NHS because to argue against it would be political suicide.
David Cameron, the Conservative party leader, proposed only this week that while the NHS would remain public under his leadership an independent body would be set up to run the NHS.
Gordon Brown has also spoken of an independent NHS body and the prime minister has long been a champion of private enterprise working within the public sector. It is clear that politicians realise that they cannot go on trying to manage the NHS from Whitehall.
The hope is that with better clinical engagement, less central management and reduction in waste the figures will add up. There is a strong possibility that sooner or later there will not be enough in the pot. The question then is whether to raise taxes even further, reduce the scope of the NHS by narrowing its provision or seek additional funding from individuals as they use the service. This might require the introduction of medical insurance on a large scale.
All of these options will be politically unpopular and only a radical shift in public opinion is likely to save a government that introduces them.
It will take a clever prime minister to shift public opinion faster than it will go naturally. It is the public who have tied the hands of politicians.
Perhaps the question should be ‘Is the NHS safe in the public’s hands?’
Dr Charlson is a GP in Brough, East Yorkshire, and a member of Doctors For Reform
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