So could the NHS ever have saved this eye-watering amount without patient care suffering?
Not only do I believe they could have, but I believe they might have improved both patient care and the working lives of staff. I want to tell you why and it really matters to me. It won't be short and snappy - you can't save the NHS in a few paragraphs - but I do believe it's vital.
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Before we can suggest solutions, we need to understand a little of the history of the NHS. We need to remember how it came to be what it is today.
We couldn't do much back in the 50s when the NHS was founded. A few operations, antibiotics, x-rays and basic treatment. Over the years, wonders like MRI and CT scanners have launched diagnostics into a new millennium, miraculous surgeons have developed organ transplants and left almost no cell of the human body unreachable. Brilliant professors made leaps in treatment and medicines that mean we live many years longer and survive thousands of illnesses and accidents that previously would have killed us. Premature babies can now be viable from as little as 23 weeks and a dazzling array of specialisms and medications now come together to ensure they survive.
As each of these miracles unfolded, a new department got "tagged on" to the system. New departments had to communicate with one another. If a whole new branch of medicine emerged, existing staff had to learn about it and understand how to use it. Hardly a week has gone by since its inception, when the NHS hasn't discovered something new or "tagged" something else onto the system. The many branches and tentacles and support networks and community arms swamped the modest original model decades ago.
Then came computers. A deathly slow, inefficient system from the 80s limped on for years too long and that too was added to and modified every time something new came along. Over the years, this programme or that database emerged, but soon one programme couldn't communicate with another and wards could't talk to dieticians or radiologists couldn't talk to consultants. Tests got ordered but lost or appointment systems crashed and the NHS waded on, like Gulliver, with hundreds of thousands of Lilliputians inadvertently holding him back.
Add to this politics. Short termism. Any government elected for four or five years will aim to make the most impact for the least cost in that time. Never mind what happens after the next election, as long as it holds together long enough to look effective. Never mind the patients that suffer or the nurses and doctors who want to scream all day long at the farcical systems and routines of their daily working lives. Each new government "tags on" another few modifications and make the whole thing even more complicated and inefficient.
This will NEVER take the NHS forward. It will always be run on the egos of politicians and never on the needs of those that use it and work within it.
It doesn't help that the NHS started its life in conflict. The public, the Labour Party and most nurses were fiercely in favour. Consultants, the Conservative Party and initially, GPs were fiercely against. The two were dragged together by the sheer force of nature that was Nye Bevan, but for literally decades they were uncomfortable bedfellows. Nurses were often undervalued or their skills dismissed and patients were often ignored as individuals. There was an elitist hierarchy built into the system that has often been too slowly broken down. The BMA was almost entirely self-governing and a culture of silence ensured that mistakes were usually hushed up, whistle-blowers frowned upon and the more highly qualified the staff, the harder they were to dismiss. None of this served the patient and has only worsened since "compensation culture" took a hold. Hospitals are now terrified of being sued as well.
You might think I'm scoring a cheap political point by pointing out that Labour supported the NHS while many Tories opposed it. I'm not. Combative politicians, by definition, disagree over the future of the NHS, and this conflict has ensured a total lack of stability and forward planning over the years.
This will NEVER take the NHS forward. It will always be run on the egos of politicians and never on the needs of those that use it and work within it.
The problems need enormous solutions. They need a cross party commitment to remove the NHS from politics altogether. To set up a modernisation fund that runs into 10s of billions - all of which would pay for itself many times over - over time.
Firstly,we need to design a bespoke computer system, designed from scratch, that could cope with the unparalleled complexities of providing good patient care. Systems that made life easier, that meant anyone could communicate with anyone else, that was intuitive enough to pre order regular appointments or order discharge medications so that they are ready in minutes rather than hours. Labour looked at doing this, but found that it was far too expensive and long term, Why spend all that money on the success of some future government? In the end, this would permanently save billions a year in missed appointments, double bookings, lost bookings, wasted orders, bed blocking and pointless delays. In the end
But if you really want to save big sums of money in the NHS there is only one way of doing it. Ask the people who work in it. And the people treated by it. What on earth is the point of asking MPs or focus groups or costly management consultancy firms to save the money? That's just more tinkering. The only way NHS staff will feel inspired to save that money for you is to ask them how. To really ask them and to listen to and act upon the answers. What happened to all those public "consultations" and "surveys" the coalition published online? The thousands of people who commented with suggestions on how to save money?
I imagine they suddenly realised that a genuine consultation of staff and patients would take years. Every job in the NHS, from porter to professor, is packed with farcical wastes of time and money every day. One will never improve without the other, because the system relies on each separate department to work together in order to function. The porter waits hours a day because of bad communication, a professor has research grants pulled by new governments or because of cuts. Nurses end up spending more of their time trying to sort out the messes created by it all than they do caring for patients. If every last person in the NHS was asked "What is wrong and how do we fix it?" we would get the answers we need. We wouldn't get them immediately, but in the end we could create an NHS fit for the 21st century that really was the envy of the world again. In the end.
Finally there must be a mass standardisation of care across every trust, in every GP's surgery up and down the country. At the moment, a brilliant surgeon can develop a procedure, use it successfully for decades, but it might never filter out to the regions or be used by his or her colleagues. Care on one specialist ward can differ wildly from another. The NHS must decide best practise in every discipline and roll it out everywhere. Regulation should be in the hands of an independent body, not thousands of independent boards all doing their own things. The "postcode lottery" is not all about money, it's also a symptom of disparate groups - who will always vary in expertise and vision - behaving like independent states.
As an excuse for demolishing the NHS altogether and replacing it with a private system, we are often told that enormous, institutional public services like the NHS will never provide good customer service. We are told it gets bloated and lazy. What an enormous heap of claptrap that is.
Let me give you another reason why the NHS can't always provide excellent service. This is a vast workforce with no say over the direction of their company. Every 4 or 5 years they get a new set of bosses, who muck everything about without asking if it's a good idea. They hire people you don't need or fire people you do. They decide your wages or demand that you work harder with fewer staff. None of the managers or CEOs of the company get a say, none of the staff, just a new "board of directors" from the remote bubble of Westminster that never visit any of the branches. When you put it like that, it's ridiculous isn't it?
Here's an idea - why not suggest that the NHS runs itself? No more politicians, just a cross party agreement on future policy and then a Co-Operative of the staff? For every efficiency found or system improvement taken on, the department responsible could earn a percentage of the saving to use to make their own improvements, or to offer as pay incentives or bonuses. Finally, once and for all, why don't we empower the people who know the system best to get on with running it? Why don't we give them a stake in their own futures, allow them to plan for the future, give them back a pride in what they do and show that we value and trust them rather than constantly undermining them?
No-one else can do it, only the staff, but on the whole they are way beyond trusting any new scheme or consultation. They've been let down so often they've learnt to be a pretty cynical bunch.
How about patients? How often do you watch Newsnight or SKY News or the Daily Politics and see a debate over healthcare taking place between two or three patients? Politicians never ask us either. Some hospitals however, make great attempts to involve patients on their boards, or in planning staff training. Many have done endless studies into mental health care or chronic care or elderly care and their expertise and best practises can - and must - be rolled out across every hospital. Imagine asking hundreds of thousands of long term patients where the system wastes money? We know! We see the £1000 bags of liquid feed get lost or wasted, we see the £2000 ampoules of drugs thrown away because doses are prescribed wrong or they're not stored properly.
The NHS is our largest expenditure and will only cost more and more as people live even longer, even more miraculous discoveries are made and even more efficient treatments are developed. The answer is to get it fit for purpose now. If we carry on using it as a political football, it will just become less and less able to cope with the ever increasing pressures it will certainly face in the future.
People will read this and say "Oh, that will never happen. Politicians working together? Co-operative of the staff? Spending Billions of pounds up front?
Well, it could happen. We could make it happen. If Nye Bevan could set up the entire NHS in less than a year, in the face of violent opposition at a time when we had the largest deficit of all time then we could decide to end the short term mentality that so weakens the NHS today. We could invest the money to make it happen and know that all those IT contracts and all that private sector involvement would boost the economy and create jobs.
We could take the NHS away from politicians. We could make them agree. We were promised a "new politics" after all, so lets demand it. Of all the issues we vote on, the public (if not the politicians) agree overwhelmingly that we love the NHS, we're proud of it and we don't want to lose it. We could stand up and say that enough is enough, that we don't want politicians and their quests for glory holding our NHS back any more.
Will we? I hope with all my heart that we do.
**Please help me suggest this to the rest of the country. Once again, please link, tweet, share or write to your MP. If our politicians are too timid or blinkered to propose radical solutions to enormous problems, then I believe, it's time we showed them how. Thanks
