This week Britain’s top doctor, National Health Service (NHS) England medical director, Sir Bruce Keogh, called for the NHS to be run like high-street retailers PC World and Dixons. Keogh is currently investigating the crisis affecting NHS Accident and Emergency (A&E) departments, which was the subject of a Parliamentary Health Select Committee report last week.
The NHS must adopt its “more-for-less” working methods in place of the “inbuilt mindset that better quality costs more”, Keogh declared, adding, “If you go down to PC World or Dixons, each year you would expect to pay less for a PC and you would also expect the specifications to improve.”
Keogh also announced plans for NHS executives to undergo a mentoring scheme from entrepreneurs, based on the Dragon’s Den TV programme.
If Keogh gets his way, the future of the NHS will be even more disastrous than it is now. Keogh revealed more than he intended in choosing Dixons as a potential model. Last year, the last Dixons stores and web site were closed down after years of being run down. The parent company, Dixons Retail, which also own PC World and is one of Europe’s largest consumer electronics companies, has seen profits slump—from £295 million in 2007 to a loss of £115 million this year.
As for Dragon’s Den, it has been criticised by many contest winners for misleading them. Even entrepreneur and prospective Conservative MP Wilfred Emmanuel-Jones has been forced to complain, “How many deals in the Den have succeeded in the long run? Not many. And a lot of the deals the Dragons make will be based on loans or are equity-based, which is the worst kind of finance you can get for a start-up…. The Dragons are interested only in a good deal that benefits them, and their justification in being that ruthless is because a lot of the deals go wrong.”
Keogh recently completed a review into 14 hospitals that had above-average mortality rates. He ignored the policies of successive governments that are the real cause of the crisis and his own role as NHS England medical director since 2007. The rapid deterioration of the NHS has occurred under his watch.
The Parliamentary Health Select Committee found that the majority of A&E departments are failing to meet the standard for patients being seen and discharged within four hours. In the last quarter of 2011/2012, 47 out of 152 providers failed to meet the standard, and in the last quarter of 2012/2013, this figure had increased to 94 out of 148 providers, double the previous number. The College of Emergency Medicine told the committee that the emergency care system is “facing unsustainable workloads.”
A number of witnesses disputed the idea promoted by the government that the crisis was caused by increased numbers of people going to A&E for spurious reasons. Dr. Clare Gerada, chair of the Royal College of General Practitioners, said there had been an increase of about 1.7 percent per year over the last decade, more or less equal to the growth in population.
Gerada described how “I am getting e-mails from colleagues across the country to say that their surgeries are now fully booked by 8.30 in the morning, which is disgraceful. How can we run an NHS where, unless it is an emergency—and by that I mean a dire emergency—you cannot get an appointment with your GP on the day and appointments are fully booked by 8.30? This is not because GPs are going to play golf in the afternoon; it is because they are trying to respond by working 15-hour days.”
She explained that patients are making the rational choice to go “where the lights are on”, which invariably is the local A&E department.
The chief executive of the NHS Confederation, Mike Farrar, told the committee that the problems in A&E departments were the result of the fact “that demand has continued to increase but the resource available to increase supply has reduced.”
Dr. Patrick Cadigan, registrar of the Royal College of Physicians, said that fewer hospital beds had increased the pressures on A&E departments, explaining, “The more you reduce the number of beds the more difficult it is to cope with variations and fluctuations.”
The committee found that just 17 percent of hospitals had the recommended level of consultant cover, the out-of-hours call centre NHS 111 provided “a poor service in many areas when it was launched” and that there were “variations” in the quality of ambulance response times.
The committee reported concerns with the new Clinical Commissioning Groups (CCGs) and Urgent Care Boards (UCBs), set up by the government as part of its health reforms in April. This year, 211 CCGs run by GPs took control of £65 billion of health spending, two thirds of the NHS budget. It was an unprecedented step towards privatisation of the NHS, allowing CCGs to buy care either from the NHS or private sector. The government’s creation of UCBs was a short-term reflex response to the failures at A&Es.
Mike Farrar said, “I worry enormously that one of the things we have structurally built into the new system is different budget holders for different bits of the budget, social care, particularly primary care, separate from hospital and community budgets, and specialist services.”
The committee concluded, “It was unclear from the evidence presented by the Minister and NHS England how these structures represent a national response to the problems facing emergency care. The number of UCBs remains unclear (with approximately 150 established in England), they have no executive power but must develop local improvement plans and, despite their responsibilities, no formal structures are in place to ensure they are accountable…. There is little evidence that any form of national strategy exists beyond the creation of UCBs, and senior figures in NHS England could not tell us precisely how many UCBs have been established.”
Meanwhile the number of A&E departments facing closure continues to increase. On July 11, Health Secretary Jeremy Hunt approved plans to close the A&E at Trafford General Hospital—the hospital at which the NHS was founded in 1948.
This week, the permanent closure of A&E at Stafford Hospital, where 30,000 demonstrated in opposition to its closure earlier this year, will be announced. In Bedford, the hospital is suspending its accident and emergency service for children, who will be transferred to another hospital.