The NHS needs radical reform – this is how I'd start

The NHS needs radical reform – this is how I'd start

by Jonathan Stanley
article from Thursday 28, June, 2018

FOR TOO LONG the NHS has been treated as an institution instead of a service. The reason politicians do this is because by definition institutions are owned by the establishment not the people.

Marcuse wrote that the Left should take a long march through the institutions so that the establishment could be captured first and then the people later. Hardly an egalitarian sense of liberation.

As Brexit comes to fruition, one way or another, it is time the Right takes a stroll through lunacy asylums that have been made of our institutions, to rebuild them in our image, the image of real people.

This can only start from the ground up. This is what I mean when I have previously mentioned social unionism as a concept, to rebuild the keystones of the union in the image of its people and not its masters. It is time Scotland took back control of the NHS from the political establishment.

Reforms in England can be studied, so too the make of healthcare in Holland and Switzerland where the health services are constituted from regional or cantonal bodies that only hand power to federal systems when it is necessary.

We have three major challenges moving forward in healthcare.

How do we manage social care and medical care together for the elderly?

How do we ensure as many innovations as possible are tried to keep healthcare at the cutting edge so patients benefit?

How do we maintain a service that delivers the needs of patients and not the dreams of politicians?

I would start with a TOTAL devolution of all primary and secondary healthcare to local authorities and to be combined with the same budget. No legislation can match the power of a joint budget. Local authorities would combine to cover electoral regions for secondary care. Holyrood would authorise specialist services where no one region could afford or provide for.

This would mean that beyond specialist treatments and communicable diseases there would be NO health policy. None. We do not need it beyond the regional level. 

All unplanned care, from ambulances, out of hours GPs and A&Es would come under a single directorate that would be the regional branches of the Scottish Ambulance Health Care. That way the best policies and the most appropriate treatment is provided and waiting times could lead to a preference for treating those in rural areas. The current universal four-hour wait that ignores time taken to arrive at the point of care is a sop to the urban majority and has no clinical legitimacy.

I would introduce Dilnot-type reforms to the way we pay for the social care component, keeping free personal and nursing care for those who cannot pay but eliminate the problem of the Govan Widowwhere poor people needing residential care pay more than a wealthy couple cared for at home – which makes Scotland's care system the most regressive in the union.

For those above retirement age national insurance contributions must be made. If this is not possible the single person allowance for council tax should be eliminated for council bands E and above. There isn't any excuse I can find for reduced rates being applied to the wealthy elderly. 

I would legislate so that 10 per cent of the health budget was spent on services provided by GPs and I would let anyone book an appointment at any practice online, which is where the record would be kept! The share has fallen since the SNP rose to power and it must be indexed to total spending rather than constantly playing catch-up to rising secondary care needs.

Training of doctors and nurses would be forecast by an independent body for workforce planning, independent of the pork cycle of single term governments at Holyrood.

A public campaign would be raised for the three Ps essential to urgent and community care: the Pharmacist, the Physiotherapist and the Paramedic. I would encourage local authorities to develop their own walk-in centres in each major city that would work as polyclinics using these three professions alongside a nurse practitioner. 

Each is essential in avoiding admissions to hospital, all too often we overmedicalise and overmedicate. I have just treated someone back home better than their local GP who booked scans for a sore heel and gave out a load of pills. I simply directed my friend to some basic orthotic care at the chemist's and their pain has gone!

Such treatment for patients known to have lung or heart disease can be as important as magic pills and can provide long lasting benefits. We underuse these talents at incredible cost.

Lots of healthcare services means lots of ideas and innovation. They would allow the reintroduction of healthy diet and exercise as part of the service as was provided during the Peckham experiment in London before the last war. Healthy diet and physical graft lead to a happier mind too. 

Top down civil service-led healthcare is a poor show compared to what Europe achieves. Let's catch up!

Dr Jonathan Stanley is a locum in Scotland.

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