The NHS is political football, whatever David Cameron says.
Healthcare policy is realised through relentless, tribal warfare of deep-seated
ideologies and the fierce factional loyalties of rival die-hard
supporters. Like Rangers v Celtic, Real Madrid v Barcelona, in the Healthcare
Championship, there is an historic struggle of ideas and identity going on, but
with vested financial and political interests manipulating the conflict in the
background. The players on the pitch, the NHS staff, want to put in a
shift, score goals and defend well, but the refereeing is inconsistent and
frankly a little suspect.
Over recent weeks, many grudge matches have been played out
over the UK A&E overcrowding crisis. Every lobby group jumps in to the
tackles with their own theory as to the cause. According to them, it is
variously the fault of the public for attending with trivial hang-nails, the
GPs for not liking being out in the dark or working weekends, the A&E staff
for being risk averse and admitting everybody, the closure of local hospitals
by cynical politicians, the global financial crisis, the Barnet formula in
Scotland, the elderly population, collapse of social care, insufficient
district nursing and so on. Every side sets out to secure maximum points and their
win bonuses, but no one gets shown a yellow card if the play was unsporting or
goals should have been clearly disallowed. Maybe the game could be massively
improved if referees looked to reliable data and reproducible evidence rather
than the shrill appeals for penalties from the partisan stands or players on
the pitch.
In Scotland (using Auditor General data), the numbers of emergency
attendances have been going up, but only gradually and slowly (15% in 10 years).
On the other hand, the number of elective (planned) admissions has risen
rapidly (36%) to meet crowd-pleasing treatment guarantees. The length of stay
has dropped in keeping with a degree of modernisation, but this has been way
offset by a substantial reduction in bed numbers (7%). The net effect of these
changes is increased occupancy, and progressively fewer beds to put emergency
patients in. Once a crucial hospital occupancy tipping point is reached, the
system collapses because patients are admitted here, there and everywhere, get
poorer care and stay longer thus compounding the bed problem exponentially. The
Emergency Department then becomes a holding warehouse for new admissions, the
staff get burnt out and irritable, and the occasional patient who wanders in
with a minor complaint (even though international evidence clearly shows that
this group do not ever cause overcrowding) gets the blame for the whole debacle.
Losing every week like this has been enough to cause some staff to quit their NHS
club and look for an overseas team.
The use of impartial evidence focusing on capacity and
occupancy could therefore be the match-winning strategy to resolve the issue of
A&E overcrowding. Globally though, the biggest healthcare game is between the
self-reliance, competition and market forces of the private sector versus the
equity, co-operation and cost-effectiveness of publicly provided services. Here
too, use of scores from fairly conducted matches rather than the opinion of pundits
may improve the sport for everyone. In a recent properly refereed international
play-off, for example, the Commonwealth Fund reported the UK NHS to have been
the most cost-effective and equitable healthcare system in the world. Some heavily
sponsored teams setting out to take on the NHS may indeed find a level playing
field difficult to manage. In fact one such team, Circle United in Cambridge, recently
suffered such a humiliating defeat that they voluntarily dropped out of the entire
league and are now restricting themselves to playing Rounders.
When Saturday comes, the NHS staff will boot-up and trot
onto the pitch. Their long-term performance in the league will crucially depend
on their manager, the board of the club but also critically, the backing of the
fans.
