A sense of perspective is needed. When steroids were first used, in the early 50s, there was a worry that these wonder drugs would bankrupt the NHS. Nasty side-effects cut down the prescriptions and saved the NHS from too much financial embarrassment, but the principle remains, and the NHS has never, in all its nearly 60 years, managed to stay within budget. If its current overspend is about £800 million, that represents — to quote a posting to one of the internet medical discussion groups — about 1% of its total budget. Each of Britain's 232 ordered Eurofighters costs £68.5 million, which is 2.5 times its originally estimated cost. We are spending £1.5 billion every year keeping troops in Iraq.
Just what is the problem in ‘bailing out’ the NHS?
NHS Chief Executive Nigel Crisp having fallen on the sword of his recently announced peerage (Lord Crisp of Spud‘u’like?), Patricia Hewitt has been in bullish mood, telling PCTs and hospitals to tighten their belts and stop moaning. Oh, and give Herceptin to everybody who wants it. ‘Efficiency savings’ have never worked before, and they won't work now. Paring money off budgets reduces efficiency as the unforeseen consequences work their way through. Cheaper disposables prove less good, so you use more of them. The only belts that will tighten are the patients'.
Sir Nigel's parting thoughts were revealing. He was proud that the NHS had achieved or exceeded many challenging targets, which is fine — and to give him his due the King's Fund acknowledged his contribution to an NHS ‘in a much better state than when he took over’. I'm less happy with his being proud ‘that old hierarchies had been broken down’. What this meant was left unsaid, but according to some disturbing television revelations about independent sector treatment centres it looks as if it is the old hierarchies who are being left to sort out the complications.
Ken Jarrold, himself an ex-NHS civil servant, listed seven qualities that the new NHS chief executive will need. Just one — his number four — needs shouting out loud: to tell ministers that not everything is affordable; that choices have to be made, and difficult decisions have to be taken. I add to Jarrold's advice that the new chief executive must then find a way to stop doctors being blamed for those decisions.
NICE has just advised obesity surgery for children who can't lose weight. Well, at least the government's new initiative for ‘health MOTs’ will give them free heart check-ups should they reach 40.
- © British Journal of General Practice, 2006.
