Government has rejected a proposal by a management consulting firm to cut 137,000 jobs in the NHS over the next 5 years in order to save GBP20 billion by 2014.
Both clinical and administrative positions were under threat, representing roughly 10% of the Health Service's workforce. This of course is only one chapter in the continuing saga over the future of the NHS and once again raises the question "are cuts really necessary to protect it?"
A discussion about the subject on BBC breakfast raised some interesting thought processes. The three reasons given by people opposed to cuts and used to justify additional spending on the NHS are:
- we're all living longer
- patient expectations are higher
- more drugs are coming onto the market
Keep in mind that NHS spending already accounts for about 20% of total government expenditure.
The discussion also pointed out that the cuts proposed were for doctors and nurses ... and should have been focused on better efficiencies. More clinical staff, less "pen pushing" middle-management administrators. This appeared to echo the sentiment of most of the people who e-mailed in to join the fray.
And of course, being that the NHS is a business, mention was also made of "productivity" ... essentially shorter lengths of stay with better outcomes. How slick!
I listened with interest and make the following observations.
Here goes:
1. We are not all living longer. That is a misleading statistic that is rolled out whenever people feel the need to justify continued investment in a system that quite clearly is against the ropes. The statistics show an apparent increase in average life span primarily because of less infant mortality (as hygiene standards have improved over the last 100 years).
The reality hidden in these numbers is that we are getting sicker sooner, then lingering on in a state of dependance. Hardly something to crow about ... but then there is always this moral imperative to measure "success" purely in terms of life extension. Surely quality of life is ultimately more meaningful?
And why pretend that things are better for us now when they actually are not?
Although people flinch from the truth, it is very profitable for the medical and pharmaceutical industries to sustain life at any cost. But we have no provision in our existing paradigm for an answer to that one any time soon.
2. Patient expectations are higher. That's interesting. Are we becoming more discerning, or simply more spoilt? Or are we believing the rhetoric that says that we should demand more from those in charge.
Personally, I feel it's totally unrealsitic to think that the system in its current state can even continue to tread water.
Again more lies. People should perhaps rethink ... and downgrade their expectations in line with reality. Or learn to live a healthier lifestyle.
3. More drugs are coming on the market. Finally, the truth! That is why we should be spending more folks. How else can we keep launching new drugs and keep this gravy train moving?
Onwards and upwards old chap ... let's increase government expenditure to 25% of total budget. Why show people how to get healthy and reduce a growing market? After all, it's what the market wants to hear.
My prediction ... sledgehammer cuts, many tears and people crying foul ... and more lies until the whole system becomes completely unsustainable. I wonder if my postcode will be fortuitous or detrimental?
How can we continue to miss that our focus should shift from picking up the pieces to prevention in the first place? We have an entire economy that depends on people getting sick and dependant.
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2 comments:
Don, as always right to the point. It's madness to cut the number of staff at the coal face while still maintaining high numbers in management. It's also madness to perpetuate the myth that there is a drug for everything, or at least an expensive procedure! A lot of people would like to die in the comfort of their homes with family, but are subjected to an unending attack of treatments. To what purpose? And for whose benefit? That's where palliative care is a blessing, allowing people dignity and choice. And at lower cost.
Thanks for your comment Jan
Sadly, this whole thing has become a political football. And as usual, the waters have been muddied.
The big debate is whether to cut or spend more.
But no-one looks at this situation and sees that a "growing market" effectively means more suffering, not less.
More people are getting sick, earlier in life. We are fighting a losing battle in disease management, without ever even acknowledging that the only way out of this mess is to focus on disease prevention.
This would shrink the "market" and more carefully targeted medical and pharmaceutical resources could then be applied where they are really effective and beneficial... in the arena of non-preventable illness.
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