The present Health Secretary appears to be within touching distance of the elephant in the room which has thus far eluded each of his post war predecessors. This morning, Jeremy Hunt launches an attack on excessive pay within the NHS. Apart from wishing him luck in this ambitious venture, I feel that he still hasn't grasped the real problem. Certainly, pay restrictions for the high earners would be a great starting point. Who knows, such a measure might even allow him to employ more nurses. With care and compassion being the central themes of the Francis Report, it's hard to see how hospital managers and health consultants can help. Nurses on the other hand should be the priority.
To address levels of pay though is to avoid the the more logical solution. For fear of sounding like a long playing record, it is the subject of final salary pensions which must be addressed. If nobody is going to be honest and brave enough to dispense with them, they at least need to change the goal posts. It is just not sustainable as an economic model to promise these deals any longer. Granted, human nature dictates that current workers will demand what their predecessors had. Demands like this are not based on fair argument. Their predecessors had considerably lower life expectancies for one thing. Their predecessors were also not subjected to the European Working Time Directive.
The huge pension deficit will one day be the death of the NHS unless somebody takes the bull by the horns now. The problem is that we have a political system in which votes at the next General Election are the be all and end all. Herein lies the flaw. Its highly likely that the current Coalition will make way for the big spenders of Labour because the cuts have exerted levels of discomfort which people don't like. They don't like them because they've not had to live with them during the Labour administration. The truth is that the Labour years cost us. Nothing is for nothing. The years of plenty came on the back of huge levels of public borrowing. Not sustainable. We can either face up to that reality or continue to live in denial.
Aspiration is admirable. I'm glad to see a health secretary seeking to address the allocation of funds within the NHS. The problem is far bigger though than the one he is currently trying to fix. His proposals concern secondary care whereas he really needs to widen his focus to include primary care as well. It is the latter which will best alleviate the strains on the former. The world over, health systems which prioritise funds to primary care boast the best health outcomes. There used to be a game where a frog's head would pop up and you had to quickly try and hit it with a hammer. By the time you had done so, a new frog's head had emerged nearby. That is a fairly good analogy of the way secondary care currently runs in our country. Primary care seeks to sort the frog out before it gets to that stage.
If we continue to build bigger hospitals and close more comunity hospitals and GP practices, the new hospitals will quickly become filled. This is pointless and is sadly already happening. If we restore investment to local health provision, we stand a better chance of connecting back to local communities and, in so doing, address the problems with our patients before they get out of hand and require hospital admissions. If we see the light and adopt the latter approach, GPs will be able to continue working their current hours with out of hours services being handled on local rota systems.
Where Jeremy Hunt really needs to address his focus though is with the members of our society whose health outcomes can best be influenced. He needs to engage with health education of our children. Only then will the tripartate addictions of sugar, smoking and alcohol be addressed. We aren't doing enough about these three simple problems. Engaging with families needs to be the starting point with school engagement following on from that. It will also mean him coming down hard on the big food manufacturers who exert such profound influence on our existing society. Their penchant for lobbying will render such a task highly challenging.
Jeremy Hunt has asked bosses of Quangos to address the numbers of people being paid salaries in excess of £100,000. This almost says it all. It is plain wrong that so many people are milking the NHS cash cow. This has been allowed to carry on unchallenged for too long now so its great to see a government minister getting involved. Its easy to give people money but its the devil's own job to take it away so I wish him well. To give a scale of the challenge ahead of him, nearly 8,000 NHS managers and consultants were last year paid six figure salaries. Its the NHS not a charity. Nobody is questioning the committment and training required of a modern day NHS consultant, but there surely comes a level of pay above which reality is lost. It has to operate like a business like any other and the current model has frankly lost sight of reality. The national average wage is barely a quarter of that so its to time to wake up. If we don't, we simply won't have an NHS free at the point of access for all. Restricting pay at the highest levels like this might reap some other benefits. It is alarming how many people are now pursuing a medical career principally for the money. Restricting the wage of the high earners might just be sufficient to deter some of these. If we end up with a more altruistic, compassionate cohort of medics, Lord Francis might one day see the sort of NHS which his recent report called for. In the meantime, the measures needed are likely to lose votes for the party brave enough to take them. Only a moral approach will arrive at such measures. The alternative is more of the same political inertia and this will serve nobody.
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