Promises, promises

16th June 2015 by Judith Harvey

Promises, promises

It’s now a month since the general election, and it didn’t turn out as most people expected. But that doesn’t mean that the outcome for the NHS will be very different.

How many of the rash promises thrown like sweets at the electorate look likely to be realised? It didn’t seem worth reading the manifestos, or even the headline list of undertakings which the parties claimed they were ‘locked into’. They all had Houdini clauses to enable the parties to wriggle out of what look like cast-iron commitments. Even carving ‘An NHS with time to care’ in stone was never going to guarantee anything. A few – a very few – themes emerged from the war of words on the NHS.

  1. Labour promised us a world-class health service. Though beloved of managers, it’s a strange ambition, since the standard of health care world wide is nothing to aspire to. And, despite the NHS having fewer of everything (except patients), an independent assessment in 2014 of 11 western health services rated the NHS’s performance top in almost every respect.
  2. Jeremy Hunt promised that the Tories would “put GPs at the heart of a revolution in health care”. Turns out this means squeezing a seven-day week out of GPs who are already exhausted by five days of unachievable demands. Hunt spent the last parliament fomenting GPs’ demoralization, and the last month does not suggest he has realistic plans about rebuilding what he has done so much to damage.
  3. Everyone promised that patients will get an appointment today/at any time of day/night/every day of the year/NOW. It’s unrealistic. Oh, so it’s an aspiration? Just as well: it will take years to train the extra staff. Oh, and the promises are for patients who ‘need’ an appointment? Who will determine a patient’s ‘need’? In the consumer-oriented society that successive governments have fostered, that’s the consumer’s choice, isn’t it?
  4. Shorter waiting times for secondary care. We would all like that. But, again, where will the doctors come from, and does the budget, if one exists, include not just their salaries, but those of ancillary staff, equipment and additional buildings required?
  5. Money. There was a hot bidding war. It may have sounded like megabucks, but even the highest bid would barely meet the current shortfall. Eighty percent of acute trusts have overspent their budgets. Are they all inefficient and profligate? Or is it simply impossible to provide a decent standard of care with the money they have been allocated? Private providers like SERCO think so; they have opted out and left it to the public purse to take over.
  6. Three percent efficiency savings year on year – till the budget approaches zero? There will always be inefficiencies but the profits demanded by private providers may cost more. And some ‘inefficiencies’ provide essential flexibility. To an accountant, unoccupied beds in July is overprovision, but having too few beds in January is inefficient and costs lives.

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