Read Nye Bevan’s 60 years old NHS classic In Place Of Fear and you will find no mention of the role of the state in removing hair crimpers; just one of many Christmas ills that apparently clogged up A&E departments. Bevan’s discussion of a two-tier system, the role of prevention, and even ‘health tourism’, all stand the test of time. Less enduring is the paternalistic, illness-treating, hospital-based, one-size-fits-all system, even though that is what we still have today.
The current NHS crisis has been the stuff of my professional career, having worked for health authorities, a primary care trust and now for a clinical commissioning group. And, welcome as is the media’s realisation that A&E departments are failing the 95 per cent four-hour targets, I do wonder why it has taken so long for it to notice what the health press, Labour party, trade unions and others have been saying for months.
It is a truth universally acknowledged that simply to continue as it is the NHS needs more money than any party will commit. But a debate born of crisis is not the best way to consider what are our future expectations of the NHS.
Pressure on A&E is indicative of wider pressures on GPs, community services, the voluntary sector and social care. A&E should be just that – for accidents and emergencies. Such departments are staffed by highly skilled, experienced and therefore expensive staff. Despite this, numerous scholarly reports document an astonishing scale of ‘inappropriate’ attendances, that are neither accidents or clinical emergencies. Strategies to divert people to alternatives services include walk-in centres, NHS Direct, 111, urgent care centres, GPs or pharmacists.
Self-diagnosis, however, is not proving to be the public’s forte. Not only do we often fail to work out what is wrong with us, we also flounder when it comes to knowing where to find treatment. Often we end up trying more than one of these alternatives.
The middle-aged and younger generations, as well as parents and carers of children, are high users of A&E. These are the groups who need to be more involved in this election debate about the NHS. These are people who expect a high level of good-quality service, as opposed to being grateful for anything. For them, the current offering is counterintuitive. Popular support for increased NHS funding will be hard or impossible to achieve if we are simultaneously scolding people for using the parts of the service that they find most convenient.
The NHS is based on a simple principle. We pay as we are able to for a service that is free when required. Maintaining this pact requires the NHS to meet the needs of people as they are today and will be tomorrow. Accessibility and convenience are important. A quality service, 24 hours a day, and within four hours, meaning we can sort emails, work, tweet or do the shopping while we wait, is attractive.
If we continue to tell taxpayers that A&E is not for them, and a similarly convenient quality service is also unavailable, how will they view the NHS? Either they will balk at paying more for a service that they find inconvenient, or they will demand something different.
For the Tories the choice is easy. They are using the current crisis to introduce the idea the NHS is not affordable. That trajectory ends with reduced entitlement, top-up charges, private insurance, and private GPs. Labour must use the coming campaign to demand something different: NHS democratisation that allows people to take control of their own health choices. We must promote a better understanding of the relationship between cost, quality and level of service. This is an issue that impacts directly on all our lives and that has the capacity to really engage the electorate and ultimately save the NHS.
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Karin Smyth is parliamentary candidate for Bristol South. She tweets @karinsmyth
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