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August 15, 2006

The Future of the NHS - (Ed.) Michelle Tempest

Posted by Harry Phibbs

The Future of the NHS
edited by Michelle Tempest
St Albans: XPL Publishing, 2006
Paperback, 14.99

This is an impressive publishing venture, not least because its editor Michelle Tempest is a practising psychiatrist, whose has edited this volume with proceeds going to Mind. (I think the rival mental health charity Sane would have been a more worthy recipient but enough of that.) She has made a genuine effort to include a range of views in this collection (including from health spokesmen from the three main parties.) Unusually she has started a website,, to allow the debate started in the book to continue. She says:

It is an ideal time to start planning for the future of the service and to ensure 60th birthday celebrations are not a sign of retirement.

But then she also says:

In psychiatric language it could be said that the NHS is stuck in a cycle of addiction, needing quick fixes fast, and spending almost any sum of money to get them. Perhaps it is time that this is reviewed and that the NHS is sent for its own form of specialised rehabilitation.
So she is a friend of the NHS, but a critical friend.

In an endorsement, the grandly titled World Affairs Editor of the BBC, John Simpson, writes:

Whatever the criticisms that are levelled against it at home, I find when I travel abroad that the NHS is greatly respected right around the world, both for the standard of its care and for the ideals it embodies.
Hmmm. Simpson doesn't offer an example of a country that respects it enough to copy it.

Among the contributions is one from the Tory Euro MP Dan Hannan and the lawyer Tim Kevan concerning the lack of local accountability in the NHS. They point to the extreme example of its failure with the objections to the closure of Kidderminster Hospital actually leading to the formation of a local political party taking control of the local council and winning the local constituency of Wyre Forest in the General Election. But it was no use. Among their proposals are for the Primary Care Trusts' boundaries to correspond with those for local authorities to allow directly elected representatives.

In their contribution Andrew Haldenby and Nick Bosanquet call for "supply pluralism". They rebut the charge that choice wouldn't work by claiming that it already is where the Government has tried out pilots - for instance in the case of heart disease patients waiting over six months. Under the scheme patients were able to choose another NHS provider or an independent provider after that time. 3,034 were offered choice and 1,550 opted for treatment elsewhere.

Offering another example they add:

The Independent Sector Treatment Providers are already showing a great improvement in productivity compared to other NHS providers. In 2002-03, the NHS in England carried out more than 270,000 cataract operations in 141 different providers. This equates to about five cataract removals per provider per day. The mobile Independent Sector Treatment Centres have achieved 39 cataract removals per day, an increase in output of 700 per cent.
In his essay Dr Eamonn Butler, Director of the Adam Smith Institute, takes us galloping through the "alternative funding models". Butler says that the fairness argument:
has merit [but that] it suggests no more than that the state should fund those who can not fund themselves.
Butler suspects however that funding reform would be harder to achieve politically than reform of providers. The Government should pay private contractors to do more of the work currently delivered by the NHS workforce, providing:
transparency, patient-focus and value for money awareness.
Derek Draper (yes, the outspoken former lobbyist whose boasts about cash for access to New Labour seemed shocking at the time) contributes an essay on "The Future of Mental Health Provision". Draper has reinvented himself as a psychotherapist. He still keeps in touch with the political process, however. For example he spotted a comment from Geoff Mulgan, the former head of the Downing Street Policy Unit, lamenting the "quiet crisis of unhappiness" in the country. Draper says that 10 million people in Britain are suffering from "a clinically diagnosable mental health disorder". Draper suggests that because of cost constraints a much greater role should be placed on volunteers. He gives the Samaritans as an example of good practice. He also points to his experience in America. He says:
While undertaking my psychotherapy training in the US, I worked in a community counselling centre. It is the inspiration for my idea of a nationwide force of 'para-counsellors'. The centre depended on charitable contributions, but was also paid fees by the local state health insurance body to carry out certain work.
It sounds sensible but I think the idea of expanding charitable giving to US levels, and removing hostility to volunteering from the public sector bureaucracy would be easier said than done.

Certainly across the political spectrum the NHS has ceased to be a sacred cow. Claire Rayner, an agony aunt and enthusiast for the NHS ideal is increasingly dismayed by the practical reality. Reflecting on hospital visits in he past she writes:

What patients never feared was the risk of catching a dangerous infection. Hospitals were famous for being exceedingly clean as well as exuding a very familiar hospital smell made up of such cleansers as carbolic, Jeyes' Fluid, soap, beeswax polish and Brasso. The ghosts of Semmelweiss and Lister walked every corner of every ward and department of every hospital, and staff at all levels washed their hands so often that many needed to use large amounts of cold cream under cotton gloves when they went to bed.

Now, as any fool knows, hospitals are a byword for dirt and disorder and above all extremely unpleasant at best and fatal at worst hospital acquired infections (HAIs).

Perhaps the most timid contributions to this book are from the politicians. No surprise perhaps. But sooner or later they will have to catch up with a public opinion increasingly aware of the failings of the NHS we have today.

Harry Phibbs is a journalist.

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A very balanced and perceptive review of this book. As one of the co-authors, I may be somewhat biased in my opinion but it is still worth commententing on the sheer scope of the contributors in this book. They range, as Harry says, from politicians through to think tanks but also importantly there are a number of chapters on the future of the various medical specialties from some of the most eminent practitioners in medicine. Overall, it's a much needed kick start to a debate which has hitherto been characterised by fear of upsetting the status quo. As the review says, hopefully the politicians will take note.

Posted by: Tim Kevan at August 17, 2006 05:02 PM

Claire Rayner's comments are very foolish indeed. the smell of brasso presumably tells MRSA, which a third of the healthy population carry, to go away, right now. Cleaning is obviously important, but the best way to control MRSA is to nostril swab for this bacterium on admission. If the heart Hospital (NHS) London can do this---other hospitals could follow. And as for her rosy view of a glorious infection free past, has she never heard of the C19 menace 'hospital gangrene'? Harry Phibbs asks with heavy sarcasm why other countries have not imitated the NHS. Well which health systems have you tried, Harry?

Posted by: Deirdre at September 28, 2007 10:57 AM
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