Bernard Ingham: Many questions face NHS but who has the answers as junior doctors go on strike?

HOW do you become an NHS manager? Are accountancy whizz-kids preferred or will any old management diploma do? Alternatively, do they rise via Buggin's turn? Are they vetted for their concept of public service and responsibility to people who are at a low ebb?
Junior doctors on strike at Leeds General Infirmary.Junior doctors on strike at Leeds General Infirmary.
Junior doctors on strike at Leeds General Infirmary.

I ask because I am confused. A visitor from Mars would conclude that the NHS is a busted flush, what with hospital scandals such as those in Mid Staffs and Morecambe Bay; the provision for legal actions over neglect; failure to meet targets; waiting lists; hospitals’ weekend performance; A&E departments overwhelmed; alleged shortages of doctors and nurses; failure to operate within budgets and now junior doctors’ strikes.

Incidentally, does anybody know the ins and outs of this dispute?

Not much effective communication there, I fear.

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This is not to mention the propensity for some shameless NHS managers to overpay themselves and give themselves golden handshakes when they resign to take another NHS job.

Yet the latest NHS inpatient satisfaction survey, published with new key facts last week, found the vast majority (87 per cent) felt they had been well-looked after. Twenty-seven per cent gave their hospital 10 out of 10.

That certainly coincides with my own personal experience. Broadly the same goes for GP surgeries.

So what is going on? Has the NHS got a bad name and so is duly kicked at every opportunity? Are its patients so surprised at their treatment, in view of all the criticism, that they mark it generously?

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I doubt whether either of those ideas explains the enigma of constant criticism and overwhelming public satisfaction.

The plain fact is that after 70 years the NHS is a bit set in its ways but the public think it is a very good thing and tend only to kick it when ambulance-chasing lawyers persuade them that there is gold at the end of the rainbow.

This is no basis for a viable NHS.

It now costs £113bn – nearly a quarter of all government spending.

It faces a rapidly growing population, thanks to uncontrolled immigration, and an ageing one – the number over 85 is expected to double to 3.64m by 2037.

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And then there is the exponential growth of medical treatments. Together all this demands a rethink. We cannot go on as we are.

Is the current management capable of shaping the future and carrying politicians with them?

I sympathise with their problems.

The NHS has become a sacred cow and it is always difficult to reform something thought to be a good thing.

It is even more difficult to do so when it is publicly funded and when some staff think it is there for their benefit and blow the patient.

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We are entitled to ask whether the BMA, now leading strikes, has ever heard of the Hippocratic oath?

But even if some genius came up with a 20-year plan to make the NHS a world-beater, they would be up against governments seeking re-election every five years. Only brave governments court unpopularity over the NHS.

Gordon Brown threw money at GPs in the hope of collaring their vote. It was only later found that this exacerbated hospitals’ weekend staffing, but by then he was gone.

I would not presume to offer a blueprint for an affordable top-class NHS for our grandchildren. But I might usefully ask some questions.

How is the NHS to be funded?

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Should part of the strain be taken by the National Lottery (even if gambling could be a cause of ill-health)?

Should those who refuse to reform their unhealthy lifestyle and week-end drunks who clutter up A&Es be charged?

And how do we stop health tourism and illegal immigrants demanding instant service?

Can any service free at the point of delivery ever cope financially?

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After all, Aneurin Bevan, architect of the NHS, was soon bemoaning “the cascade of pills down the nation’s throat”.

Is the NHS too big to manage and can its current unfathomable structure with all the mumbo-jumbo about assorted trusts, foundations and commissioning groups be the pattern for the future?

Do staff, including some doctors and consultants who, I am told, prefer to golf at weekends, need re-education in the public service ethic?

Should all of us who can afford to do so be urged to take out private health insurance to ease the strain on the NHS?

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Should any employees in essential public services have the right to strike?

Surely some managers know what is needed? Their job is to safeguard the viability of the NHS. Come on, bosses, give our timid politicians a lead.