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ROBIN AITKEN: The NHS is on the critical
list; laid low by a combination of a shortage of money and increasing patient
demands. Despite the devotion of its staff the service is fraying at the
edges and public faith has been shaken. Like their colleagues elsewhere
in the country the staff at the Intensive Care Unit at Walsgrave Hospital
in Coventry have coped with a difficult winter; a slightly worse than
average 'flu epidemic made the limitations plain for all to see.
The problems of the NHS
are now common ground. The government acknowledges that there are too
few beds and staff shortages. There's a recognition too that some patients,
with serious conditions, are having to wait much too long for treatment.
To put these things right more money has to be spent and the government
has chosen the average health spending of our European neighbours as the
target we should be aiming for.
According to the most
recent figures the United Kingdom spends just six point eight per cent
of the nation's wealth, or GDP, on health care; only Ireland, among EU
countries, spends less. The Germans spend most with ten point seven per
cent, Holland spends eight point five per cent. The EU average is eight
point six per cent. Tony Blair's ambition to match the EU average means
the UK would have to spend up to a quarter more on the NHS.
The victims of Britain's miserly
health spending have often been people experiencing crisis in their lives.
Last February Duncan Shepherd suffered an angina attack. In September he
was told he needed a heart by-pass operation but that he might have to
wait 14 months for it. Rather than risk it he decided to go private.
He had to re-mortgage his house to meet the bill of eleven thousand six
hundred pounds. It destroyed his trust in the NHS.
DUNCAN SHEPHERD: I felt I'd been shunted into
a corner after paying supposedly national insurance contributions to protect
the very problem that I'd got, I felt really frustrated about that and
I felt very very scared as well. Because I knew if I didn't do something
or if we didn't do something I was probably gonna die before Christmas
last year. And it would have left my family unprotected. We had to do something.
AITKEN: At the cardiac unit at
Walsgrave Hospital in Coventry they are conscious that they are struggling
to keep abreast of demand. Dr Stephen Evans and his surgical team perform
twelve hundred open heart operations each year - about the maximum that
facilities and staffing allow. Even so it means tolerating waiting times
that make the doctors uneasy.
DR STEVE EVANS: We don't let anyone wait
more than twelve months by and large for cardiac surgery although in some
parts of the West Midlands that is pushing out to eighteen months which
is the maximum limit that the government have said we should run to. I
personally think that's too long.
AITKEN: Because people presumably
die while they were on that list?
EVANS: Well they... the worst scenario
is that some patients will die and of course they've also got a disabling
and unpleasant condition which is relatively easily fixed.
AITKEN: Perhaps Holland shows us
what the NHS could be like if we spent more. Dutch spending on health care
is just about the EU average and what you get for money like that is hospitals
like this. This is the University Hospital in Groningen and it provides
an enviable level of health care.
ACTUALITY:
AITKEN: As the man in charge of
the Thoracic centre in Groningen, Professor Tjaek Ebels usually gets what
he wants. These state-of-the-art facilities are typical in Holland's Health
Service. Professor Ebels doesn't claim the Dutch system is perfect - but
when people need major surgery they get it. Fast.
PROFESSOR EBELS: The government has put more money
into cardiac health care. Increased the operating facilities, cath labs
and what have you so in conjunction with diminishing of coronary heart
disease, which is obvious right now the waiting lists have virtually disappeared.
AITKEN: The statistics show the
extra money other countries spend works. According to the most recent coronary
heart disease statistics in the UK there were two hundred and forty-three
deaths per hundred thousand men aged between 45 and 64. Compare that to
the Western European average of one hundred and fifty-three and Holland
with just a hundred and thirty-six. Of course it's not just health care
that matters but diet too. Even so, we compare badly even with our northern
European neighbours.
Doctors at the Walsgrave
hospital would like to be able to provide the level of health care delivered
by European hospitals. This week the government will unveil a National
Service Framework for coronary heart disease (it's already published the
ones for cancer treatment and mental health) - the aim is to provide better
and fairer treatment right across the country.
PROFESSOR GEORGE ALBERTI: I have tremendous faith in the
National Health Service frameworks as a principle because what they aim
to do is to set uniform standards of care across the country. I think
that a lot of the problems will take a long time to resolve. For example
with heart disease where we need to be doing double the number of operations
we are doing at the moment. That takes time to build facilities, train
staff and so forth. But with reasonable resourcing increases now we can
start to rectify some of the immediate problems.
AITKEN: For all its sophistication
some of the NHS's needs are very basic. Britain has fewer doctors, nurses
and beds per head of population than most other EU countries. For hospitals
like the Walsgrave the National Service framework for coronary heart
disease could mean more demand because there'll be more referrals by GPs.
And the Coventry Hospital already runs at maximum capacity.
EVANS: I'm an intensive care consultant,
it's one of the hats that I wear and it's actually very difficult to find
beds for patients. We're constantly shuffling patients between intensive
care, high dependency and the wards and running virtually a hundred per
cent occupied the whole time. With that kind of occupancy the whole system
starts to break down I'm afraid.
PROFESSOR HOWARD GLENNERSTER: It's too tight in a whole number of respects
and you know the crisis at Christmas and afterwards is an example of that.
There's no slack to take account of emergencies.
AITKEN: One of the government's
objectives must be to avoid replays of stories like that of Mavis Skeet,
the Yorkshire woman who was diagnosed as suffering from cancer but had
her operation postponed four times - and was then told it had become inoperable.
Such heart-rending cases undermine faith in the NHS.
Cancer treatment - like
the radiotherapy department at Walsgrave - is now subject to new standards
laid down in a National Service framework; but it too is likely to drive
costs up
The Government has designated
coronary heart disease and cancer treatment as priority areas. But for
that to be anything more than a pious hope significant sums of money have
to be spent. The new generation of radiotherapy machines like this can
cost up to two million pounds - and even when you've taken that decision
in principle there's inevitably a time-lag before better results show through.
STEPHEN THORNTON: If you look at the next financial
year much of that money is already fully committed. We have to pay an
increased pay bill as a result of the pay review bodies. We've got to pay
the impact of the European working time directive, we're paying - staff
pension contributions that have gone up by one per cent. There's a whole
series of cost pressures that NHS trusts face next year and by the time
they've paid for all of those there is precious little money left to invest
in modernisation. And what little money there is, is going to have to go
in cutting waiting times and making sure we can manage any potential emergency
care crisis next winter. There's virtually nothing left for investment
in some of these areas. For instance in Coronary Heart Disease and in cancer
care and in mental health.
AITKEN: The Prime Minister set
the target of matching EU average spending within five years. A judgement
on whether that's going to be achieved will be possible this July when
the government unveils its Spending Review. But many in the NHS believe
that it needs a generous cash boost now on top of the planned increments
if patients are to notice any difference.
SIR GEORGE ALBERTI: I feel that to really kick
start things, to cheer everyone up to get a safe service running we would
probably need about ten per cent now and we could spend that without difficulty.
There are people in the training pipeline who could be appointed and for
example over the last couple of years only half the number of new consultant
appointments have been made that have been allowed by the government and
that is because trusts have not had the money to make the appointments
but the people are in the pipeline training.
JULIA NEUBERGER: I suspect that there will be some
interesting negotiations between Gordon Brown and the Prime Minister as
to precisely how the money is going to be found and indeed how much of
the money is going to be found quickly. Because the other thing that I'm
sure the Prime Minister is frightened about is if he doesn't get some money
going into the service this side of the comprehensive Spending Review then
frankly we're going to have another winter crisis next year and it'll probably
be as bad as this.
AITKEN: Money is also needed to
address the NHS's guilty secret; rationing, even of drugs for vital cancer
treatment, has been a hidden reality in the service for years. At the
moment decisions about the treatment are taken by individual doctors and
health trusts according to what they can afford. Some critics now argue
it's time for the politicians to be up front about rationing.
NEUBERGER: I have no doubt that the public
should be involved in these decisions. It seems to me quite ludicrous for
politicians to say either that there is no rationing when there patently
is and what has been happening is that it's being done surreptitiously
and it's been rationing by postcode if you like. And secondly however much
money you put into the system you'll always have to make some hard decisions.
There will always be one lot of priorities to be set against another.
AITKEN: In future it's going to
be more difficult for trusts to deny treatments because of the National
Institute for Clinical Excellence. This new body will tell the NHS which
treatments work and which should be made available.
THORNTON: The National Institute
for Clinical Excellence will undoubtedly recommend that there are new drugs
and new techniques, which in their view are both clinically and cost effective
and if you like should be part of the National Health Service and should
be available for patients. The problem for the NHS is going to be when
that happens are we going to be able to afford it. At the moment NICE is
doing a study looking at taxons, the class of drug used for seriously ill
cancer patients. And I think the likelihood is they will come out and they
will say that in certain circumstances those drugs probably are clinically
and cost effective. Many of my colleagues in the service fear that decision
because they know the impact that it will have on them financially
AITKEN: For the patients at the
Groningen University Hospital spacious modernity is part of the package.
Single sex wards are the norm. This is a system which has found the money
to attend to the details. But in its rush to raise standards some feel
that Tony Blair's government is trying to do too much, too fast.
THORNTON: One of the problems with
the government's approach though is that there are too many initiatives
there are too many priorities. So in addition to coronary heart disease,
we also have mental health which is another pressing priority, then there
is managing the waiting list, then there is managing the winter ah, emergency
crisis, then there is building up primary care and so on and so forth.
And the problem that those of us who have responsibility for management
of the health service find is, there is that there is an ever increasing
number of initiatives and priorities and only a limited amount of money
to go around.
GLENNERSTER: Expectations are rising faster
than the Health Service has been able to keep up with. It's not that the
Health Service hasn't spent more you know, significant increases as the
governments always telling us, all governments tell us, that's true. But
it's not keeping pace with the kinds of convenience, kinds of standards
of personal care and all the rest that people have come to expect.
AITKEN: In order to quell the chorus
of criticism in recent weeks the government has been trumpeting announcements
about extra beds, more staff, higher standards and significant new money.
Inevitably this has raised expectations sky high. The political cost of
failing to deliver could be very high too.
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