NHS pay - a mistake on so many levels...

I’ve been of the view for some time that this is a lucky, rather than competent, government. Which, if you’re an opponent of it, is a part blessing - what would be it be like if they were competent as well?

Evidence of that comes after what was a pretty decent budget in presentation terms (I hold back from any suggestion that it was a good budget in economic or political terms at this stage), in that a 1% pay rise for NHS workers has gone down so badly both with the staff concerned - not unreasonably - but with the general public too.

You could argue that, in the midst of an economic crisis, that pay restraint across the public sector is a good thing. You could suggest that it sets an example to the rest of the workforce across the private sector. Admittedly, you’d be wrong, but you could try to make the case. For, as has been proved time and time again, employers across the private sector will pay what is required to keep staff and recruit them.

If the NHS was a private business - and please don’t think that I’m suggesting that it would be a good idea - senior management would be dealing with the problems of staff shortages by offering better pay scales and various arrangements to lure people away from other career choices. In the United States, nurses get rather higher salaries, and employers have to compete to employ them.

Here, the competition within the sector isn’t as great, although it still exists, but the system encourages nurses to work agency shifts because the pay is better and, because supply of nurses is outstripped by demand, there is a high level of certainty that agency work will be available. What that means is that a chunk of money is taken out of the NHS to profit employment agencies who have an effectively captive customer base.

It is a reminder that Conservatives have a very selective affinity to the market, holding the view that the public sector is immune to it. And, if by trying to persuade NHS workers that they should appreciate applause in lieu of actual money they end up losing the nurses that they’ve promised us, it will demonstrate again that, when it comes to competence, they really can’t cut it.

But, they are lucky. A supine media, a sufficiently credulous public, a sycophantic backbench and an Official Opposition still trying to get off of its knees means that there is nobody making the case that competence matters. Where else would a Government mired in procurement scandals, which has consistently overpromised and underdelivered, and has exiled most of its talent to the backbenches and beyond be ten points or more ahead in the polls?

Chest x-ray all clear... I aten't dead yet!

I rang my doctor's surgery today, as it was the sixth working day after last week's adventure in NHS care. Don't get me wrong, I wasn't worried about the outcome (after all, what's the use of worrying?), but family and friends were asking (I love you all too...). The result - I have a chest, there are no unexpected presences or absences, and I can resume coughing as I see fit. There is no suggestion that I should return and have anything else done, or administered, so I had better get on with it.

A fellow work colleague has suggested some time in a hot, dry climate, which sounds very inviting. However, I am bound, in less than a fortnight, for a hot, polluted climate, which may not be very helpful.

I'd better pack some cough sweets...

If I'm in a hospital full of sick people, and I have an appointment, presumably I might be sick...

I've had a persistent, hacking cough for months now, and it has been annoying Ros, my work colleagues and random strangers for almost as long so, this morning I went to my local doctor's surgery, where a very attentive young doctor checked this, shone a light at that and measured the other.

His conclusion? A chest x-ray was needed. My heart sank, "That'll be weeks...", I thought, but far from it. He gave me a form with some surprisingly legible handwriting on it (is this man really a doctor?) and explained that I should just turn up at Ipswich Hospital during the opening hours for the Chest X-Ray Unit.

And so, less than five hours later, I was in a slightly dreary room with two dozen or so other people, all waiting to have their innards photographed. The receptionists were very friendly, as had been every member of staff I asked for directions - Ipswich Hospital is a bit like one of those mazes you put rats in to bemuse them - so I was fairly relaxed at being told that I'd probably have to wait for about an hour to be seen. Not bad for our 'crisis-torn' NHS, really, and I'd brought a book...

And, before long, my name was called and I was ushered into a smaller waiting room with cubicles in it, given a plastic shopping basket with a remarkably unfashionable tunic and asked to strip to the waist and put the tunic on. Eventually, I managed this (regular inpatients clearly know how this works) and took a seat for the next wait.

My name was then called somewhat inaccurately - hell, I don't always get it right first time - and I was beckoned into a slightly dimly lit room full of interesting looking bits of equipment (you may have guessed by now that I have very little experience of hospitals) where a very nice radiologist asked about the surname and we made Johnny Depp jokes (he is, it seems, welcome to visit any time he likes...).

The procedure itself was over before I really knew it, and I was packed off again to dress and hand in my shopping basket. Apparently, my surgery will get the results late next week...

Reflections on the NHS... and why we might be our own worst enemies

Yesterday, I blogged about my recent minor surgical procedure, noting how well everything went, how kind and caring the nurses were, how efficient the surgeon was. And it got me to thinking about the NHS, not something that I've had much cause to do in the past. You see, as a very infrequent user of the healthcare system - I've been pretty fortunate to remain in good health - it is the sort of thing you take for granted. It will always be there, it will be free (well, freeish), and it will cure you if you're ill, and save you when you get broken.

Its status as a national institution is such that it was showcased in the opening ceremony of the London Olympics, and was protected from cuts by the incoming government - David Cameron promised that, you will recall.

SInce then, the NHS has come under pressure. Yes, the budget has been ring-fenced, and has kept pace with inflation. However, funding a national hearth care system is more complex than simply ensuring that it has the same amount of money in real terms. Inflation in the healthcare sector is traditionally higher that it is generally, and you can't manage demand in the same way that you might otherwise. And, as we find new and exciting ways of prolonging life, whilst more and more of us adopt lifestyles that make us more vulnerable to illness, injury and disease, the demands upon the system change.

You can deal with that in a number of ways, I guess. You can simply increase the funding available, you can charge for some services, you can seek organisational savings or you can just axe some services altogether. You might attempt a combination of some or all of these. But, the problem is that if you raise taxes, the opposition attack you. If you charge for services, or reorganise, or axe services, likewise. And, if you're a politician, you might conclude that it's all too difficult and give up.

Unfortunately, like any successful organisation, the NHS has to change to face the changing circumstances as they emerge. How many expensive pieces of kit can you have, and where do you put them, how do you incentivise your staff to be more efficient whilst maintaining service coverage, how do you address the demands of local residents, who have differing priorities in different parts of the country? All of these things require thought and the ability to adapt, and yet we protest about change, condemning it as meaning the end of the NHS as we know it when we know that, after every supposedly radical (and widely opposed) change in the past, it has still been there, still dispensing healthcare to all at a cost far lower to the public purse than it does in places like the United States.

But, if we continue to have opposition parties blindly oppose change whilst not engaging with the creation of a vision for the future of such a critical public service, we risk preventing changes that could save the NHS for decades to come. Instead, we need political parties and campaign groups to come together to create a shared view of what we need as a country, rather than treating the whole thing as a football to be kicked from one end to the other whilst the rest of us look on.

We will probably need to be pretty creative about the future shape of the NHS, we may even have to make some compromises in order to secure the broad principle of free at the point of access healthcare, but with an aging, increasingly unfit population, we're going to have to do something...

My own personal NHS experience, and not one that I'd seen coming...

I had, since the New Year, been suffering from a series of cysts in and around my eyes, and although my left eye had healed up, my right eye had become more and more ugly. Prescriptions of increasingly powerful antibiotics had done little to solve the problem, and it was eventually decided that I needed to be referred to the eye clinic at Ipswich Hospital, which might involve surgery.

My situation wasn't life threatening, or even particularly inconvenient, but as weeks passed, I developed a red growth which protruded out from under my upper eyelid and increasingly into the line of sight. The four weeks in which I was told I could expect to hear from the eye clinic with an appointment came and went, and Ros became increasingly concerned, especially as I might then have to wait another eighteen weeks to actually be seen.

And so, rather grudgingly, I returned to my GP to see what might be done. He examined my eye and concluded that it might be necessary to chivvy the eye clinic along, and after a brief exchange of telephone calls, he assured me that I might hear soon.

Two days later, my phone rang. It was the eye clinic, who advised that they had had a cancellation, and could I come in tomorrow morning? Naturally, I said I could and so, the next morning, Ros dropped me off at the entrance to the Outpatients Department at 7.40 a.m. on her way to Harwich for a meeting.

I was, perhaps unsurprisingly, the first person to arrive at the Opthalmic Day Care Unit, and was welcomed by a nurse, who confirmed my identity and asked me to sit in the waiting area whilst she organised paperwork. But before long, she led me through to the patient area, where she asked a few more questions, explained what the process would be, and set me up for events to follow.

I wanted a black eye patch...

Before too long, the surgeon, Ms Murthy, called me in for a brief examination, explained what the problem was, and what would happen, which involved the injection of an anaesthetic directly into my eyelid. it would, she said with rather more candour than I might have expected, be pretty painful for five to ten seconds, but that after that I wouldn't feel anything. I was then returned to my seat whilst other patients were dealt with.

Soon enough, I was asked to move to a new seat, on what looked like it might be a motorised wheelchair, where my blood pressure was taken (123/83 for those of you who understand these things) before I was wheeled into a prep room where the chair was, by dint of motors, converted into a surgery table (I was impressed, I must say). I chatted with the nurse who applied some anaesthetic drops and talked me through the next few minutes and then the action started.

Ms Murthy made sure that I was comfortable and I didn't even see the injection needle coming. And, whilst I knew that she was inserting something into my eye, I've actually had more painful experiences giving blood. But, with one eye closed and the other unseeing temporarily, she went about her work before telling me that there would be a smell of burning whilst she cauterised some minor blood vessels in the eyelid. I have to tell you, the smell of burning bureaucrat is not particularly unpleasant.

And then it was all over. I was returned to the patient area where I was offered tea and biscuits whilst I recovered from the procedure - not that I had much to recover from. The nurses were friendly and kind, I was checked to see if i was alright, and they then gave me my discharge letter before calling a taxi company so that I could get home.

This was my first experience of surgery apart from the removal of wisdom teeth nearly ten years ago, and I have to say that I was impressed. The attention to detail and kindness of the nursing staff, the skill of the surgeon, everything worked, it wasn't soulless or uncaring - all in all it was an experience that reassures you that, when you need the system to work, it generally does.

And it led me to think a bit...

NHS Reform: everybody's shouting, but is anyone paying attention?

If, as Andy Burnham claims in Liberal Democrat Voice, this weekend sees the last opportunity to 'save' the National Health Service, then I find myself in the eye of the proverbial storm. Which, all things considered, is an intriguing place to be.

If, as is suggested, most people have taken sides, then my support will be somewhat in demand, as I genuinely haven't made up my mind.

As a fiscal conservative, I look at comparative rates of inflation within the health sector and the economy as a whole, and I shudder. We will, as a society, have to decide what we are willing to provide and what we can afford to. And, with increased longevity and the additional costs that go with it, the demands on the NHS are bound to outpace growth in the economy. Such a debate will not be pretty. New 'superdrugs' and complex but lifesaving medical procedures don't come cheap either.

Therefore, finding new, more cost-effective ways of doing things is an imperative. But this isn't like widget manufacturing - people's lives are at stake.

And because of that, all changes to the NHS are emotive. Private versus public, access to treatment, questions of waiting times and rationing, all provoke an awful lot of heat and very little light, it would seem to this rural bureaucrat.

And this is where our coalition with the Conservatives makes reform difficult. Sadly, nobody trusts them with the NHS, and despite some fairly herculean attempts to address the issues that have been most difficult, we are left with some major problems;

1. The Coalition Agreement seems quite clear that there would be no top-down reorganisation. You can argue that all the change is actually bottom-up, as change will be driven by local GPs, but few people really believe that, and there are plenty of GPs who would rather not be empowered, thank you very much.
2. Andrew Lansley has the bedside manner of Dr Crippen. It has become so bad that I suspect that if he was announcing record new investment in the NHS (genuinely record new investment, that is, not the spin master version), he would still cause a drop in support for the Coalition.
3. The Opposition have every incentive to wave shrouds and none whatsoever to engage. And, as everybody loves the NHS, and nobody remembers what they did to it when they were the Government, they can get away with it.
4. The original bill was clearly drafted by people who go private, or would be happier if more people did. Given Andrew Lansley's links with the healthcare industry, one perhaps shouldn't be too surprised.

As a Party, we haven't been terribly sure-footed either. The political antennae of our leadership were evidently not operating well before the initial draft came out. Someone, somewhere, should have spotted the various bear traps and sent it, and Mr Lansley, back to the drawing board.

It must be admitted that, at that stage, there was little sense still that when it came to converting ideas into deliverable legislation, the Conservative policy wonks were a menace to society due to their apparent failure to understand how real people behave in real situations. After all, we test our policies at Party Conferences, where people get up and make comments such as, "I think you'll find that the requirements of the 1885 Paper Clips (Amendment) Act are a barrier to progress in that direction." - and are often right.

As a result, the proponents of the legislation start any argument with a significant disadvantage. Having conceded the pause in the legislative programme, and encouraged people to express their fears, the Coalition fell foul of the widespread misunderstanding of the word 'consultation', a personal bugbear of mine.

There was still time to withdraw the Bill, put it out to pre-legislative scrutiny, preferably in the Lords, and see what emerged. It might not have been what those behind the original Bill would have liked, but it would have been something more circumspect and obviously coherent.

Instead, opposition to the Bill has been allowed to grow unopposed, and whilst Liberal Democrat Peers have sought to build in safeguards addressing any reasonably based concerns, the likelihood of reasoned argument getting a look-in at the public debate is either slim or none. Indeed, that might be slim leaving town as I type...

So, I'm hoping to hear the arguments, find out more about the legislation, and weigh up the politics of where we are.

But somehow, I'm not minded to do it because Andy Burnham wants me to. After all, if he and his friends hadn't opened up the NHS to the private sector in the first place, we wouldn't even be having this argument now...