Medical Politics

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    We don't have a politics forum so I thought I might post this to give another view of the NHS political football game.  It was posted as an open letter on the BMJ website and, I believe, deserves a wider audience:

    Open letter to Ed Miliband and Westminster

    Dear Mr Miliband (and every other politician for that matter),

    Do you honestly believe that 2.7 billion pounds (which is not even guaranteed given the sources you have proposed) has the ability to “rescue” the NHS? What you’ve done is given the general public a figure that sounds very impressive (a billion sounds a huge amount to a most voters, many of whom are currently finding it difficult to scrape together enough cash to feed their family at the end of the month). You are all unwilling to face the facts and every one of you, regardless of party, should be ashamed.

    Let’s have a look at the facts shall we?

    The NHS treats 1 million patients every 36 hours.

    Compared to 10 years ago, in 2012/13 there were –
    55% more attendances at Accident & Emergency departments (14.0 million to 21.7 million).
    4 million more hospital admissions (even though trusts have been forced to cut more than 8,000 beds since 1997).
    60% more operations performed by the NHS (6.6 million to 10.6 million).
    75 million patients seen in outpatient departments (an increase of 1 million on the previous year alone!)

    How about some financial statistics?

    As you will be aware the NHS has a budget of 110 billion pounds per year and spends 77 billion on patients with chronic illnesses. Taking diabetes as an example, we spend £25,000 every minute, £1,500,000 every hour, £13,000,000,000 every year (12% of the total NHS budget) on managing this condition. So why, do I ask, are we going to tax cigarette companies and people with big houses? After all, smoking-related illness only costs about 5 billion pounds per year. It wouldn’t be so easy to put a tax on junk food now would it? I believe it is because they are easy targets and you think it will win you some easy votes. Surely it’s not because you actually believe it will work?

    Let us look at the utter scandal that is PFI, introduced by the Conservatives and abused by Labour –
    The NHS will end up spending 80 billion pounds on hospitals that cost 11 billion to build (I believe one PFI hospital for example, will end up paying 4 billion pounds for their 380 million pound hospital).
    Most trusts that reside in a PFI building end up spending over 6% of their annual budget on PFI repayments and this can include extortionate maintenance costs.
    The largest single player in the UK PFI market currently owns or co-owns 19 UK hospitals (and remarkably it only has 25 employees in stark contrast to the 1.7 million employed by the NHS). Their profit margin was 53 per cent in 2010 (apparently most successful FTSE 100 companies make margins of around 6 per cent). The founder and chief executive of this company, in 2010, owned almost three-quarters of the company (or 14 UK hospitals) and collected pay and dividends of £8.6 million, a significant proportion of which is essentially tax-payers money (I suppose that’s not very much when you consider it would only pay for the treatment of diabetes for just over five and a half hours, but still, it’s all relative).

    Compared to other healthcare systems and despite coming 10th in the category of “Healthy Living”, in 2012 –
    Health expenditure in the UK was 9% of GDP (USA 17%, Netherlands 12%, France 12%, Germany, Denmark and Canada 11%).
    The UK had 2.8 physicians per 1000 population (4.0 in Germany, 3.9 in Italy, 3.8 in Spain, 3.3 in France, 3.3 in Australia).
    The UK had 2.8 hospital beds per 1000 population (8.3 in Germany, 6.3 in France, 3.4 in Italy, 3.0 in Spain).
    Average length of stay in the UK was 7 days (9.2 in Germany, 8.2 in New Zealand, 7.7 in Italy, 7.4 in Canada).
    In comparison with the healthcare systems of ten other countries (USA, Canada, Australia, France, Germany, Netherlands, New Zealand, Norway, Sweden, and Switzerland) this year the NHS was found to be the most impressive overall by the Commonwealth Fund. It was rated as the best healthcare system in terms of efficiency, effective care, safe care, coordinated care, patient-centered care and cost-related problems.

    And do you know why Members of Parliament?

    It is because of the remarkable individuals who work for the NHS. The wonderful nurses, the healthcare assistants (who now do the old nursing job thanks to government bureaucracy), the midwives, the cleaners, the porters, the allied health professionals, the secretaries, the researchers and the incredible doctors who are keeping the NHS the best it can possibly be. The public needs to know the facts and appreciate the pressure they are working under. It has been them, not you that have made it the best healthcare system in the world. It is the best in spite of what you have done, not because of what you have done.

    But sadly it can’t continue like this. The number of doctors leaving the NHS to work abroad has increased by 20% since 2009. Morale amongst nursing staff is at an all time low. We’re getting better at keeping people alive for longer, which puts pressure on community and social care. You’re going to make us work longer and so we’re going to have to keep people healthy for as long as possible. Thankfully we’re curing more and more cancers, however it isn’t cheap to cure (5 billion pounds per year). As a nation we’re getting more obese and we’re either having to make people’s stomachs smaller or manage the complications of their poor health (9 billion pounds per year). You want more patients to be managed at home but the community services can’t cope as it is (9 billion pounds of cuts to Primary Care services since 2004). Pharmaceutical companies keep inventing excellent groundbreaking treatments but they’re extremely expensive because like the oil industry, the companies put profits “into research” as well as into the pockets of shareholders. The UK population is set to increase by another 7 million (more than 10%) in the next 15 years. And yet, every Wednesday at midday, on the green leather benches, all I hear are the same old arguments and excuses.

    So Westminster…….given all of this, can we have an proper plan of action?

    Yours faithfully,

    Mr Richard Laing
    General Surgical Registrar


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