December 2, 2021 - 10:18am
There’s been a lot of media panic about the Omicron variant this week, but there were two damning reports that have been completely overlooked. Both show the disturbing state of cancer and elective care in this country.
The first, by the Macmillan Charity, reported that there were an estimated 50,000 missing cancer diagnoses due to shortcomings in cancer care over the last 2 years. The second, by the National Audit Office, made for equally grim reading: between 7.6 million and 9.1 million fewer referrals for treatment were made during the pandemic. And yet, there is still a shocking 5.9 million, or around 1/10th of the UK population on an NHS waiting list, with the potential for this to increase to 12 million by March 2025.
The causes are likely complex and multifactorial: chronic staffing shortages, a fall in diagnosis (due to people staying at home to “protect the NHS”, and perhaps due to reduced in-person GP appointments), less hospital capacity for appointments, diagnostic and therapeutic procedures have all contributed to a perfect storm. It’s no wonder that this has been labelled the “biggest cancer catastrophe ever to hit the NHS”.
One crucial area that has often been overlooked is the impact of poor management in the NHS. A report recently released by the Centre for Health and the Public Interest has outlined some worrying decisions made during the pandemic. In March 2020, NHS England entered into what would become a series of contracts with the private sector. These contracts were designed to have specific goals: to provide some Covid care, uphold urgent elective care and operations, maintain NHS diagnostic capacity, and to undertake non-elective care.
The aim was to relieve pressure on NHS hospitals and to ensure that diagnosis and treatment of illnesses continued, even while the NHS suspended much of its non-Covid work. Estimates vary as to the cost of these contracts, but costs are believed to be in the region of £2 billion to £5 billion. For this money, the NHS paid for 100% of the capacity of private providers and received an additional 8,000 beds, 680 operating theatres, 10,000 nurses and over 700 doctors.
Permission was given to private providers to gain further revenue by treating private patients if the capacity purchased by the NHS was not used. These contracts acted to give private hospitals a guaranteed revenue stream for periods during the pandemic. The contracts were subsequently renegotiated for the second wave, but the NHS still purchased at least 75% of private hospital capacity, under similar terms.
The results were poor: very few Covid patients were treated in private hospitals and rather than the number of operations increasing, the amount of NHS funded elective care in private hospitals fell by 45%, resulting in 235,000 fewer procedures compared to pre-pandemic levels.
Between April and July 2020, there was a 73% decrease in the NHS-funded total activity of private providers compared to pre-pandemic levels, from 1.2 million operations, procedures and appointments to a mere 336,000. Far from relieving the burden on the NHS, it appears these contracts instead meant that the NHS paid for empty operating theatres and wards.
The NHS cannot continue to throw yet more money into poor management decisions and inadequate contracts. Management needs to work not just harder, but smarter.
Amy Jones is an anonymous medical doctor with a background in philosophy and bioethics. You can find her on Twitter at @skepticalzebra.
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SubscribeThe NHS cannot simply work smarter. If anyone knew how to do that then the USSR would have beaten the USA. The inability to appropriately handle change is the core problem of all centrally planned systems and why they always fail in the end. Healthcare in the UK has been able to live in denial of this fact for a long time because healthcare normally changes only quite slowly. The problems the NHS faced in 1995 were the same problems it faced in 2015, more or less, and because there is no price competition.
In a capitalist system these problems wouldn’t exist. You couldn’t have hospital providers falsely claiming no capacity existed to treat you because you/your insurer would have a contract in hand saying that it would treat you, with well specified terms stating what happens if the hospital cannot meet its contract. False claims relevant to the contract would land them in court.
In the NHS, they lie and claim there’s a capacity crisis whilst buying capacity they lack the managerial ability to use. And there are no consequences, no lawsuits, nothing. It is a communist system and should have been abolished a long time ago.
I agree that the NHS is inefficient and a capitalist system would not suffer as badly from management problems. I agree that management is incompetent. I would add that a huge number of the staff are involved in courses to teach them about race and gender issues – many surgeons are being chastised for not behaving respectfully to junior staff.
But having discussed the everyday issues the next question is what do we do about it? For me the biggest single problem is the aim of trying to prolong life indefinitely. I have no data but I would assume that about 65%+ of ‘customer resources’ are taken up by people of over-75 years of age. These people are living decades longer than they did when the NHS was established. I believe that any capitalist system would have to ignore most of the older people in order to maintain its efficiency and to be profitable. Who would pay the bill to prolong life in this way? Insurance payments for young people would be prohibitively high – or without insurance the government would pay and that brings us back in a circle.
The problem has to be resolved from everybody’s point of view. You have to take an approach looking down on the system, warts and all. You have to hammer young and old people into shape and force them to take responsibility for their actions.
(I don’t believe this is possible but for the sake of argument). We could prioritise those people with lower BMIs. We could refuse treatment to those who fill A&E on Friday and Saturday nights after going out to get drunk and fight. We could offer help and advice to those with diabetes but slowly withdraw support if they don’t try to help themselves.
Shock! Horror! It is almost unthinkable that we can do the things above but we can start the dialogue. Anything is better than doing nothing. NHS means National Health Service.
Not every problem has a market solution, in my opinion healthcare is one of them. Considering it’s meagre budget the NHS performs exceedingly well. Of course in an organisation that size you’ll have bad decisions, especially during a pandemic when everybody is in panic mode. However if the UK treasury spent the equivalent % of GDP on healthcare as its European neighbours or the US they wouldn’t have half the problems they do.
There is a market in everything whether you like it or not. In the NHS it manifests itself in waiting times.
Waiting times are caused by a lack of staff and capacity. It’s nothing to do with the market
The NHS is awash with staff and capacity. Allocation is the problem.
Except the European market is run by private health care
Only nominally. It’s completely funded by the taxpayer
It would be interesting to know how the referral to private hospitals worked. My experience is that entrenched NHSers would rather see you suffer than refer you to private care. I know of very ordinary people paying £15k plus to get private hip operations as they were facing 2 year waiting lists. In one particular case a otherwise fit and vibrant woman in her 60s would have been condemned to severe disability and other health issues if she did not get an operation. This can’t be right. In the past when I suggested to my NHS GP that I could access private diagnostics quicker than the NHS I felt I had suggested having carnal knowledge of their granny. We have a massive fallacy over the NHS – it’s not free and it’s not always accessible when you need it. It’s a lottery we pay our taxes into, often to subsidise a lot of people who don’t pay. The MSM is in awe of the NHS and the establishment protects it like the state religion. We cannot have a proper debate and solutions till this mentality changes and the NHS itself stops and owns up that it’s very overdue for radical change.
My father-in-law, a former ship-welder, chose to have both his hips done privately as he couldn’t bear the pain involved in waiting for an NHS operation. Fortunately it cost him a lot less than £15,000 at that time. He didn’t regard the NHS as the envy of the world as a result.
It does seem to be rather a lottery as to whether the NHS will refer an operation to be done privately or whether it is regarded as a disgraceful piece of queue jumping by an NHS worshipping apparatchik.
While the US system has severe drawbacks a number of continental health systems appear to produce more satisfactory outcomes for patients and ought to be considered. Some of the resentment generated by immigration and health tourism would be reduced if people did not feel that they were paying for health provision for people who had not contributed towards its cost.
We ought also to be training more doctors and nurses here in the UK rather than relying on overseas trained doctors and nurses.
The US system is unfairly disparaged. In many areas of treatment they have better average health outcomes than UK.
And , e.g, Australia has a mixed private/public system with far better cancer survival rates than UK. Somewhat like Germany.
I argued just yesterday that the UK didn’t use all the available beds. I don’t even live there and I knew that.
Yes. I live in the UK and I thought that everyone knew it. The idea here of ‘protecting the NHS’ was a government thing to make people feel guilty if they caught Covid. As if they didn’t have enough problems. My neighbours were all standing on their doorsteps applauding the air. Something to show on the TV in the future to get a few laughs.
I went out to applaud the NHS but largely to take advantage of a socially approved means of meeting neighbours and talking in a safe environment. I caught up with old friends and met neighbours I had never met before. Very enjoyable.
Even at the time While I was happy to clap those who continued to work on the front line in the NHS at some personal risk I was highly sceptical regarding the effectiveness of NHS as an organisation.
Yes, well said.
We also had the ridiculous spectacle of people who’d lost their livelihoods due to lockdowns being socially pressured to applaud the continuously employed NHS staff.
Yet another example of a socialistic, publicly owned organisation and its purchasing contracts, particularly when outsourcing to well run privately owned companies who laugh all the way to the bank. A further argument for demolishing the NHS and having everything done by private hospitals with access by insurance mainly state funded, as done in Germany.
Incompetent NHS managers? A couple of years ago the head of the huge Nottingham NHS trust had nothing more pressing to do than get rid of the well respected WRVS and other volunteer-run coffee shops and ‘outsource ‘ to a (foreign) ‘service provider’ who, it seems, cant make it pay so want to pull out. Entirely predictable but entirely unnecessary
How much expensive managers’ time was spent in making the change? And did the outsource company entertain the managers concerned at any point?
The money wasn’t wasted at all. It went directly into the pockets of the Government’s private sector friends, which was the whole point.
Usually when you have a shortage of ICUs, the problem isn’t that you don’t have enough machines or buildings. It’s the staff you don’t have. How did the builders of the Nightingale Hospitals plan to staff them? Did something go wrong with that?
The reduction in private beds availability, due to their resources being commandeered (in effect) by the NHS, meant that those prepared to pay, or who had private health insurance, couldn’t get seen to either.
I accidentally came across it one night (Wednesday it was here) while walking the dog.
Some people on their balconies pointed their phones at me as if they were filming the non-clapping heretic (with his hands full of dog lead and full poobags) for posting to their local Neighbourhood Facebook site.
It’s appalling. Far from privatising the NHS, this “conservative” government has been nationalising private medicine over the last two years. In addition to the private hospital bed scandal you discuss, it’s been illegal to get a private vaccination.
Shocking! And then the “Nightingale Hospitals” built to relieve the overflow of Covid patients that never was…