- Email: [email protected]
Response to Offline: Is the NHS in crisis?
Correspondence
The accusation by Richard Horton in The Lancet (May 6, 2017, p 1783)1 that it is “intellectual delusion” to suggest the National Health Service (NHS) is in crisis is surprising considering that this conclusion has been reached by many commentators. Unlike Horton, we are front-line clinicians and see first-hand the human cost of a struggling service, which has been termed a “humanitarian crisis” by the Red Cross,2 and a “burning platform” by Sir Michael Richards of the Care Quality Commission.3 We make no apology for drawing attention to the adverse effects of the erosion of the founding principles of the NHS. Introducing market values into health care distorts clinical decision making, widens health inequalities, and wastes money, all of which we are witnessing in the UK today. Department of Health figures show that last year, £6·6 billion was taken from the public purse to pay private health providers, and NHS Private Finance Initiative repayments cost about £2 billion each year. Services are fragmented across the four nations of the UK, and in England, 853 independent-sector organisations now contribute to a growing patch work of care. Health disparities in the UK are widening and the State of Child Health report4 by the Royal College of Paediatrics and Child Health shows the stark relationship between socioeconomic disadvantage and poor health. Since the 2012 Health and Social Care Act diminished the responsibilities of the Secretary of State for Health, it is unclear who is in charge. We work in the NHS; we know that it is not perfect and is slipping in its provision of effective care. Regardless, the NHS has been shown to be the most cost-efficient and equitable health-care system in the world.5 It is legitimate to ask why available solutions are not being implemented. There is no longer any doubt that UK health care is under-resourced, yet politicians continue to revert back and forth with www.thelancet.com Vol 390 July 15, 2017
funding decisions. UK health services are affordable through public taxation, and pegging the UK health budget to average EU health expenditure is as good an approach as any to raising funding incrementally and enabling stable forward planning. The National Institute for Health and Care Excellence was established to identify treatments that should be provided by the NHS on the basis of evidence of effectiveness and predefined cost– benefit boundaries. A prime example of undermining this innovative approach to managing demand equitably and affordably is the now discredited Cancer Drugs Fund, which poured more than a billion pounds into the pockets of the pharmaceutical industry. Private Finance Initiative repayments could be renegotiated centrally follow ing the lead of Northumbria Trust, which saved £66·5 million on a single hospital (Hexham General Hospital, Hexham, UK). The ideology of the supremacy of market forces in health care has been successfully challenged by the NHS since its inception. In large part this has been because of a stable workforce who are proud to work in the public sector. Yet a generation of NHS doctors was alienated in a damaging dispute predicated upon a misleading use of mortality statistics, and no Brexit reassurances have been given to the 55 000 staff who are EU citizens. Paediatrics is contending with rising demand and an average of 14% of junior doctor positions and 5·4% of consultant and other non-training positions in this specialty are vacant, despite it being foremost in adopting new models of working, interfacing with general practitioner colleagues, and offering other ways forward.4 Our approach is not one of “mental laziness”1 but a well considered analysis that concludes that the principles of the NHS model are sound, but investment, ability, integrity, and vision are needed to take UK health care into the 21st century, rather than fines, fragmentation, and marketisation.
In pointing out the stark discrepancy between what is being said (the NHS is safe in our hands) and what is being done, we advocate for all patients. Horton says “Any voter listening to this debate would have been disturbed by what they heard”. We agree. JW is Chair of the BMA Junior Doctors Committee. BW declares no competing interests. NM reports grants from the Medical Research Council (UK), National Institute for Health Research (UK), British Heart Foundation, Westminster Medical School Research Trust, HCA International, Bliss, and the Healthcare Quality Improvement Partnership; an institutional research donation from Nestlé Research; commissioned work from NHS London, NHS Improvement, NHS Litigation Authority, and the UK Department of Health; conference travel and accommodation fees from Prolacta; personal fees from Alexion; and has a patent pending for Infant Body Composition. NM is President of the Royal College of Paediatrics and Child Health.
Reuters - LM1E767173X01
Response to Offline: Is the NHS in crisis?
See Editorial page 203
Jeeves Wijesuriya, Ben White, *Neena Modi [email protected] Hackney Vocational Training Scheme, Homerton Hospital, London, UK (JW); Department of Medicine, Royal Hampshire County Hospital, Winchester, UK (BW); and Royal College of Paediatrics and Child Health, London WC1X 8SH, UK (NM) 1 2
3 4
5
Horton R. Offline: Is the NHS in crisis? Lancet 2017; 389: 1783. Campbell D, Morris S, Marsh S. NHS faces ‘humanitarian crisis’ as demand rises, British Red Cross warns. The Guardian (London), Jan 6, 2017. Donnelly L. NHS standing on ‘burning platform’ as current model is not fit for future. The Telegraph (London), March 2, 2017. Davis K, Stremikis K, Squires D, Schoen C. Mirror, mirror on the wall: how the performance of the US health care system compares internationally. New York: Commonwealth Fund, June, 2014. http://www.commonwealthfund.org/~/media/ files/publications/fund-report/2014/jun/1755_ davis_mirror_mirror_2014.pdf (accessed May 10, 2017). Royal College of Paediatrics and Child Health. State of Child Health. Short report series: the paediatric workforce. London: RCPCH, 2017. http://www.rcpch.ac.uk/system/files/protected/ page/State%20of%20CH%20series-The%20 Paediatric%20Workforce.pdf (accessed May 10, 2017).
Crisis in the National Health Service: a call to action The Lancet’s Editor-in-Chief, Richard Horton, criticised National Health Service (NHS) front-liners in his
Submissions should be made via our electronic submission system at http://ees.elsevier.com/ thelancet/
225
The accusation by Richard Horton in The Lancet (May 6, 2017, p 1783)1 that it is “intellectual delusion” to suggest the National Health Service (NHS) is in crisis is surprising considering that this conclusion has been reached by many commentators. Unlike Horton, we are front-line clinicians and see first-hand the human cost of a struggling service, which has been termed a “humanitarian crisis” by the Red Cross,2 and a “burning platform” by Sir Michael Richards of the Care Quality Commission.3 We make no apology for drawing attention to the adverse effects of the erosion of the founding principles of the NHS. Introducing market values into health care distorts clinical decision making, widens health inequalities, and wastes money, all of which we are witnessing in the UK today. Department of Health figures show that last year, £6·6 billion was taken from the public purse to pay private health providers, and NHS Private Finance Initiative repayments cost about £2 billion each year. Services are fragmented across the four nations of the UK, and in England, 853 independent-sector organisations now contribute to a growing patch work of care. Health disparities in the UK are widening and the State of Child Health report4 by the Royal College of Paediatrics and Child Health shows the stark relationship between socioeconomic disadvantage and poor health. Since the 2012 Health and Social Care Act diminished the responsibilities of the Secretary of State for Health, it is unclear who is in charge. We work in the NHS; we know that it is not perfect and is slipping in its provision of effective care. Regardless, the NHS has been shown to be the most cost-efficient and equitable health-care system in the world.5 It is legitimate to ask why available solutions are not being implemented. There is no longer any doubt that UK health care is under-resourced, yet politicians continue to revert back and forth with www.thelancet.com Vol 390 July 15, 2017
funding decisions. UK health services are affordable through public taxation, and pegging the UK health budget to average EU health expenditure is as good an approach as any to raising funding incrementally and enabling stable forward planning. The National Institute for Health and Care Excellence was established to identify treatments that should be provided by the NHS on the basis of evidence of effectiveness and predefined cost– benefit boundaries. A prime example of undermining this innovative approach to managing demand equitably and affordably is the now discredited Cancer Drugs Fund, which poured more than a billion pounds into the pockets of the pharmaceutical industry. Private Finance Initiative repayments could be renegotiated centrally follow ing the lead of Northumbria Trust, which saved £66·5 million on a single hospital (Hexham General Hospital, Hexham, UK). The ideology of the supremacy of market forces in health care has been successfully challenged by the NHS since its inception. In large part this has been because of a stable workforce who are proud to work in the public sector. Yet a generation of NHS doctors was alienated in a damaging dispute predicated upon a misleading use of mortality statistics, and no Brexit reassurances have been given to the 55 000 staff who are EU citizens. Paediatrics is contending with rising demand and an average of 14% of junior doctor positions and 5·4% of consultant and other non-training positions in this specialty are vacant, despite it being foremost in adopting new models of working, interfacing with general practitioner colleagues, and offering other ways forward.4 Our approach is not one of “mental laziness”1 but a well considered analysis that concludes that the principles of the NHS model are sound, but investment, ability, integrity, and vision are needed to take UK health care into the 21st century, rather than fines, fragmentation, and marketisation.
In pointing out the stark discrepancy between what is being said (the NHS is safe in our hands) and what is being done, we advocate for all patients. Horton says “Any voter listening to this debate would have been disturbed by what they heard”. We agree. JW is Chair of the BMA Junior Doctors Committee. BW declares no competing interests. NM reports grants from the Medical Research Council (UK), National Institute for Health Research (UK), British Heart Foundation, Westminster Medical School Research Trust, HCA International, Bliss, and the Healthcare Quality Improvement Partnership; an institutional research donation from Nestlé Research; commissioned work from NHS London, NHS Improvement, NHS Litigation Authority, and the UK Department of Health; conference travel and accommodation fees from Prolacta; personal fees from Alexion; and has a patent pending for Infant Body Composition. NM is President of the Royal College of Paediatrics and Child Health.
Reuters - LM1E767173X01
Response to Offline: Is the NHS in crisis?
See Editorial page 203
Jeeves Wijesuriya, Ben White, *Neena Modi [email protected] Hackney Vocational Training Scheme, Homerton Hospital, London, UK (JW); Department of Medicine, Royal Hampshire County Hospital, Winchester, UK (BW); and Royal College of Paediatrics and Child Health, London WC1X 8SH, UK (NM) 1 2
3 4
5
Horton R. Offline: Is the NHS in crisis? Lancet 2017; 389: 1783. Campbell D, Morris S, Marsh S. NHS faces ‘humanitarian crisis’ as demand rises, British Red Cross warns. The Guardian (London), Jan 6, 2017. Donnelly L. NHS standing on ‘burning platform’ as current model is not fit for future. The Telegraph (London), March 2, 2017. Davis K, Stremikis K, Squires D, Schoen C. Mirror, mirror on the wall: how the performance of the US health care system compares internationally. New York: Commonwealth Fund, June, 2014. http://www.commonwealthfund.org/~/media/ files/publications/fund-report/2014/jun/1755_ davis_mirror_mirror_2014.pdf (accessed May 10, 2017). Royal College of Paediatrics and Child Health. State of Child Health. Short report series: the paediatric workforce. London: RCPCH, 2017. http://www.rcpch.ac.uk/system/files/protected/ page/State%20of%20CH%20series-The%20 Paediatric%20Workforce.pdf (accessed May 10, 2017).
Crisis in the National Health Service: a call to action The Lancet’s Editor-in-Chief, Richard Horton, criticised National Health Service (NHS) front-liners in his
Submissions should be made via our electronic submission system at http://ees.elsevier.com/ thelancet/
225