The NHS is a British institution we’re proud of right? We even played tribute to it in the opening ceremony of the 2012 Olympic Games.
In 1948 the NHS was set up to provide free healthcare at a point of requirement for everyone no matter who or how wealthy the person was, removing the previous inequalities in health that existed. This is something that as a nurse I am incredibly proud of. I have worked in systems where this is not the case and where many people die instead of getting help. I worked at one hospital in Africa which asked for a contribution of the equivalent of 20 pence to be seen in the hospital. The hospital didn’t turn anyone away if they were really poorly but by that time it was usually too late.
The NHS has many issues at the moment, and to be honest it is making me question whether I want to be working in the system.
NHS funding comes from the taxpayer. It is recognised within research that the total amount of GDP used for funding the NHS has gone down in recent years from 6.3% in 2000 to a projected 5.2% by 2020. This is significantly below the EU average of 10.1% and despite there being a privatised system in the USA their funding in GDP terms is around 17.8%. That sounds incredible doesn’t it.
A well funded system is able to support the future of healthcare, money can then be put into education and research as well as front line services.
The real terms effect of this reduction in funding is services being squeezed, beds being closed across hospitals, staff put under more pressure to deliver services, with fewer resources. There would appear to have always been some difficulties in delivering services within the budget, when three years after the start of the NHS it was decided to start to charge fees for prescriptions, dental treatments and eye care.
Now there is increasing demand for all services and less funding, some treatments don’t get the same amount of attention. For example some places in the UK will have guidelines for non urgent care like IVF, or even guidelines for specific expensive drug treatments like oncology treatments or mental health treatments. Both of which have a significant impact on the patients overall wellbeing.
So as funding has decreased, the cost of new treatments, new drugs and innovations has increased. As has patient life expectancy, among with the reduction of childhood mortality. Have we got to a point that the NHS can’t actually do everything? Are we expecting too much.
This can be seen with the recent NHS Cyber attacks, the computer system was vulnerable because the cost of upgrading it and looking after it just wasn’t as important as other funding priorities. Only on becoming a national crisis was something done about it, and sadly I know that some patients had negative outcomes as a result.
It would be interesting to know where money is going. For example when I trained we were told each nurse cost the NHS £45000 to train. Now students are having to fund themselves to train …. where is that money going?
Sometimes i do think that the NHS have significant money wastage. I never can understand why I can buy a decent chair at Ikea for £50 but almost the same one through NHS procurement is £400. Why does each trust need to go on recruitment trips overseas each year to plug the latest staffing crisis, when they could grow their own and look after the ones that they have. A lot of recruitment trips prior to Brexit brought workers to the UK and polls after Brexit suggest that 60% of European workers were considering going back due to the uncertainty around employment. We need to look after these workers, they are the ones propping up our creaking system.
So at the minute we are in a position with less financial resources even though on the front line there is a constant pressure to maintain good patient care and deliver performance targets.
On a personal level more and more I realise that I pay for services that I would have previously expected the NHS to provide. For example I was injured in an accident 4 years ago in the course of my treatment I needed an MRI, Physiotherapy and Psychotherapy input, when I realised this would be difficult to fit around my full time job without requiring sick time and that the waits were a long time along with the anxieties of not knowing what the problem required. I paid for everything privately at my own convenience. I’m really lucky in that I could afford that at the time, but it has made me appreciate that other people have significant challenges in obtaining the care that would improve their overall health and wellbeing. We are so focussed on individual problems, instead of overall well being. To be honest I write a prescription every single day that I know will not be picked up due to the cost of it. So much so if someone gives me a really good story about why they won’t get their prescription I’m also quite liable to give them a tenner with it.
Staffing issues are increasingly prevalent within the system, use of agency has been under scrutiny, mainly because of the cost and IR35. I work with the most amazing agency workers who come from all over the world, there is some resentment from the staff on the shop floor, how an agency member of staff is paid significantly more than the sister in charge of the department with very little responsibility. But these workers are absolutely required until establishments are recruited to and retention of staff is improved.
My opinion is that although the NHS was set up to address inequalities in healthcare, more and more it is creating inequalities every day. We can help it by using services appropriately, buying medications over the counter, consider financial wastage, improve funding but that can first be done by looking at where the funding goes and the effectiveness of it. Most of all we need to encourage staff to stay, it’s all too tempting for young nurses to go to Australia or New Zealand, where they can have better wages and an improved work / life balance. Why can’t we adopt some of those strategies here.