Labour’s warning at the last General Election that voters had ‘24 hours to save the NHS’ was probably the final blow which knocked out the already teetering Major Government. It played on both the public’s fear that another five years of the Conservatives would fatally wound the NHS, and a strong association in the nation’s psyche between Labour and the welfare state’s most popular element.
This summer, Labour unveiled its ten year National Plan to revive the ailing service after eighteen years of Tory neglect. Just as they did in 1997, voters have responded well. The combination of a massive injection of cash, combined with a long-term plan to shake up the way the NHS works, taps well the widely held perception that while the NHS is chronically under-resourced, money alone is not the answer to its problems.
Although most of the public have their individual tales of the NHS’ failures – and successes – it is the service’s staff who are perhaps best placed to judge Labour’s record so far and its goals for the future.
Kate Clayton, a senior staff nurse at the Charing Cross hospital, is brutally honest in her assessment, Since Labour came to power, she argues, ‘the standard of care being dished out has not actually changed significantly, and I know my working conditions have not improved.’
The NHS and its staff, she believes, still face huge problems. And it’s not all a question of money: ‘The NHS’ key weakness is the lack of access to healthcare.’ Most patients simply want advice or a referral, and, often unable to see a nurse or told they must wait to see their GP, they turn up at casualty. This has ‘a knock-on effect on the emergency services. We cannot cope with emergency patients because we’re trying to cope with primary healthcare patients.’
The morale of nurses, Clayton argues, is also being sapped by the fact that, while the expectations on the profession are being upped, ‘we are not given the pay or credit to reflect that.’ Nurses don’t only want to be better paid and respected, they also want to be safe at work. ‘We’re actually more likely to be assaulted at work than a police officer,’ she says.
Clayton’s assessment is, in part, shared by Wandsworth GP, Dr Nicola Jones. The NHS, she suggests, is ‘under-staffed and under-resourced.’ Primary care funding incentivises high patient lists, at a time that there is, ‘increasing consumerism amongst patients, appalling IT development and an inappropriate skill mix.’
At the same time, though, Dr Jones believes the NHS has seen improvements over the last three years. Revalidation of GPs, she says, is ‘what every good doctor has been waiting for: the opportunity to show proficiency, and what every patient has a right to know: that his clinician is competent.’ Dr Jones praises the new National Institute for Clinical Excellence, clinical governance which addresses both ‘quality and continuous improvement’ and personal medical service pilots which are providing, ‘forward-thinking practices with the opportunity to experiment with different models of care and employment.’
For Claire Perry, until recently a health authority chief executive and now on secondment, the NHS doesn’t ‘feel any different on the ground yet, especially in financial terms.’ Nonetheless, Labour’s election has seen improvements, including ‘an immeasurable difference in terms of raising the profile of healthcare quality.’ This has been brought about because the performance of chief executives is no longer measured simply in financial terms – quality matters too, now. The Government has also brought in with it, ‘a huge improvement in the culture of cooperation and partnership. We’re no longer competing against everyone else, both within the health service and externally.’ Perhaps most importantly, NHS staff are now able to ‘talk about inequalities in health and acknowledge that the service is supposed to tackle them.’
But what of the road ahead? Clayton believes the new investment the Government has pledged is just ‘what the NHS has been crying out for, for a long time.’ Perry finds the amount of money, ‘unbelieveable. One-third more money after five years has to deliver real change.’ It may not be sufficient to enact everything in the NHS National Plan, she believes, but it should create an environment of ‘doing things differently, not just doing more.’
Doing things differently, of course, is at the heart of the Government’s vision for a renewed NHS. As Perry suggests: ‘There are a lot of highly trained staff in the NHS with components of training all the same or very similar. Yet there is massive inflexibility about the way these people work in practice.’
Clayton agrees. ‘Increasing the responsibility of nurses,’ she says, ‘is central to easing the strain on the NHS. We don’t have enough doctors and realistically we are not going to. But does it take a doctor to explain to someone how to manage a sore throat?’ The new NHS walk-in centres are crucial to making the delivery of healthcare far more patient-centred. ‘The public absolutely rave about them,’ she says.
GPs, of course, have traditionally guarded their position jealously. But Dr Jones argues that they should adopt a more balanced approach. An extended role for nurses should be ‘welcomed, not feared,’ she argues. At the same time, though, the concerns of doctors – that they may be held responsible for errors made by nurses – need to recognised and addressed.
Another aspect of the Government’s drive to increase public access to healthcare is NHS Direct, which is broadly welcomed by staff. For Perry it is ‘a culture-breaker, changing the idea that you have to go first to the GP, who might then refer you to a consultant.’
‘I think NHS Direct is a brilliant idea and I can’t believe we didn’t have it before,’ says Clayton. However, she also believes it is a mistake that not all of the staff are nurses: ‘I don’t think a computer programme, however well developed, can respond to the individual. I think a nurse operating the Direct system can respond very well.’
While warning that ‘vulnerable patients may be disadvantaged as they may not take the responsibility which is required of them,’ Dr Jones believes that the concerns of GPs that they may no longer be at the ‘hub of patient care’ should not worry the Government unduly. ‘Really this is about GPs and their feeling of vulnerability rather than anything to do with what patients need.’
In its drive to improve the NHS, however, the Government cannot run rough-shod over the service’s staff who, at the end of the day, share the same goal. Perry believes that Labour’s pledges to improve staff pay and conditions are ‘excellent.’ But, she notes, ‘feeling is believing. Staff must feel it, too.’