We know there is a severe crisis when NHS England senior director Julia Simon resigns from her post, saying the STP process is “shameful”, “mad”, and “ridiculous” and the plans as 'full of lies'. NHS Providers chief executive Chris Hopson points out that just one in six NHS finance directors believe they can deliver on STP plans, and that there is "just not enough money in the pot".
Sustainability and Transformation is euphemistic jargon for new cuts. As the plans are unveiled, most of them include downgrading or closing Accident and Emergency units. reducing the number of hospital beds and concentrating services in a few big hospitals. What with the cutbacks in ambulance provision and also in rural buses, do remember to drive to the hospital BEFORE you have your accident, or you may find you have a long and difficult journey!
GPs will be expected to carry out more minor operations and treatments at their own surgeries rather than send patients to hospital. The trouble is that they are already terribly overloaded with appointments and patients.
This is a crisis, but it is not just a crisis in funding. It is a crisis in training nursing staff and a crisis in defining what the NHS is supposed to do. When it was set up in 1948 it provided only a very limited range of treatments, compared to what it is expected to do today. Medical advances, social changes and pharmaceutical research have created a situation where we could spend unlimited billions on "health care" and somebody has to decide what the priorities, and limits, are. So much has gone wrong, with the regrettable PFI system, over the past twenty years, where do we begin to steer ourselves back onto the right road?
Not everything that the present government has done is wrong. It has taken some steps to prevent pharmaceutical companies over charging the NHS for the drugs they supply. I would like to save our NHS for future generations and I would make the following modest suggestions:-
i) The government should refuse to pay the £420 million bill that the EU has just today presented us with for setting up an EU army, complete with lavish HQ that will doubtless resemble a palace as all their residences invariably do. And doubtless they will expect us to pay the same sum annually. REFUSE. Use that money to keep our Accident and Emergency units open.
ii) Stop sending £350 million per week to Brussels. The people have voted out of the EU. We must leave now, and spend that money on funding the community hospitals that are being so scandalously axed. Other funding priorities must be training new doctors and nurses. Scrap tuition fees for school leavers who train as doctors or nurses, on condition that they work here afterwards. Bring back the system of training nurses in hospitals, on the job.
iii) All patients should be required to prove eligibility for treatment, by showing an NHS number or passport. That is reasonable and fair. The system can only work if it is limited to those who paid, or the children of those who are still paying into the funds. End health tourism now - it is costing us billions, and may cost the NHS itself. We could also stop spending huge sums on translation for people who cannot be bothered to learn English. It was estimated two years ago that the cost to the public sector was £140 million per year and it is rising all the time. The NHS, police, courts, and local government are all funding this. It should stop. Anyone who lives here must learn English - or pay for the services of a translator themselves. The money could be used to save lives. The UK spends £30 million per year on legal aid for migrants trying to claim "asylum " status - not perhaps a large sum relative to the billions in the NHS budget, but enough to train and pay a lot more nurses.
iv) The NHS must make the right decisions about what to fund. We need to rationalise what is on offer. A senior doctor who retired recently after working for 30 years in Oxford University Hospitals told me that in his considered opinion, the NHS, while a wonderful idea, "has been abused". We need to listen to people like him. No money must be wasted on stomach stapling for the obese - a diet sheet and an exercise programme is what they need.
It is estimated that there are 137,000 victims of FGM in this country. If so, their own families, who carried out the harm, must be made to pay the costs of any medical treatment. It is unfair to make the tax-payer bear the burden of barbaric and illegal behaviour. At present we callously demand that old people should sell their homes to pay for nursing care. I would make the perpetrators of FGM sell theirs, and revoke their citizenship as well.
The NHS has many demands on its funding. Our priorities for spending should be new drugs for cystic fibrosis, cancer, Alzheimer's and Parkinson's disease, which are not self-inflicted conditions.
If these sensible, practical changes are carried out, there could be some hope of saving the NHS. Future generations will reproach us if we refuse to face reality and act now.