13 Feb 2023
Hard-hitting columnist Eris takes a look at the state of our NHS, and what solutions might exist to improve the current situation.
NHS problems are never out of the news. Dropping down the international league tables for healthcare service. Strikes for more pay. Long waits to get into hospital. Long waits to get back out again. People cleared to go home, but warehoused for months in hospital beds because there is no-one to care for them.
Conservative and Labour politicians are reluctantly beginning to realise there is a fundamental problem with how the NHS works.
Minor, populist political parties like the Liberal Democrats just want to throw money at it. They promise more staff, more beds, more money. Of course, they are always keen to spend other people’s money – look how they’ve gone £10 million over budget on the district council’s flagship project in St Albans city centre. Milton Friedman got it right – when you spend someone else’s money on someone else, you
don’t economise and you don’t seek best value.
If we had more NHS staff would that solve the issues?
A Nuffield Trust report last October stated that with around 1.5 million staff, the NHS is one of the world’s largest employers, only beaten by the US Department of Defence, the Chinese Red Army, Walmart and McDonald’s.
If NHS staff all moved to one city, it would be the second biggest in the UK after London.
1.2 million staff work in hospitals. The number of doctors has risen substantially, with a 64% increase since 2004, from 78,000 to over 128,000 in 2022. Hospital consultant numbers have shown an even bigger rise of 89% from 28,000 to 53,000. The number of nurses (full time equivalent) has fluctuated with less than 1% increase between 2009 and 2020, However it went up by over 21,100 from the start of
the Covid pandemic until March 2022.
Ambulance staff went up from 31,000 in 2010 to 43,100 in March 2022, mainly driven by a 61% increase in the number of paramedics. GP numbers are an issue, driven (anecdotally) by increased part-time working and early retirees.
Vacancies are an issue in hospital, but in most of the country (outside London) they are only running at 6- 8%. Agency or temporary staff often fill the gaps, costing more but reducing the operational impact.
If clinical staff numbers are increasing, is the underlying problem wages? Are medical staff on a permanent go-slow, angry they are not paid enough? The evidence doesn’t back that up.
Clinical staff work hard and excelled during Covid. So, why is growth in staff numbers and ever-increasing spending (£180.2B in 2022/3) not delivering a better service?
Could it be a sick NHS culture, with a huge, change resistant bureaucracy, spawning organisational complexity, endless committees, targets, jargon and paperwork, but offering limited personal autonomy, responsibility and accountability to staff? Working policies and processes mired in the last century and
focussed internally rather than towards patients? Inadequate use of information technology following the IT Programme multi-billion pound failure? Focussing on treating the already sick, rather than preventing the illness? If it is a failure of NHS leadership, any more money and clinical staff will just disappear down an organisational black hole. Perhaps the Tories and Labour, who seem to be agreeing the issues, need to work together to deliver a better approach?
