Who’s afraid of the evidence about what works in the NHS?

Politicians have imposed evidence-free re-organisations on us health workers for years. Now they tell us that it's too late to change the mess they've got us into.

Hannah Basson
25 March 2016
jeremy hunt_3.jpg

Image: Health Secretary Jeremy Hunt - latest in a line of ministers accused of putting ideology before evidence

After many years working in the NHS and several years of campaigning for a publicly-owned health service, I have come to realise a big truth. A systematic experiment has been imposed upon the NHS for over 30 years.

I am puzzled by MPs who tell their constituents that they support the NHS - yet refuse to entertain the only piece of legislation in decades that makes a serious attempt to reverse the costly experiment of privatisation, marketisation and out-sourcing. This month, the NHS (Reinstatement) Bill was presented in parliament by Caroline Lucas – but few MPs showed up to support it, meaning it was easy for others to talk it out.

After many years as an allied health professional I do know a couple of things. I know that health treatments are based upon evidence of efficacy. I know that no reorganisation during my career has made the NHS more efficient.

Does that mean that ALL reorganisations are anathema to NHS staff, as many MPs seem to believe? That we can’t get rid of all the flawed reorganisation of recent years, because that would mean yet another reorganisation?

Let’s talk about evidence.

Throughout university and all my years of continuing professional development and training, everything I have done for and to my patients was carefully selected according to the research available that showed the best outcomes.

I can use new or even slightly experimental treatments if they are done in a controlled way, are unlikely to cause harm and the patient explicitly understands this.

If I started to try new things that have no evidence base and I have not discussed this with the patient and then my outcomes start to fall, I would be sacked. And quite rightly so.

If I was a welder and all my welds were rubbish, I would lose my job.

The NHS restructurings of recent years have been, frankly, rubbish.

They’ve resulted in increasing costs, reduced availability of treatments and a furthering of distance from what is best for our patients at a clinic level.

Each reorganisation has created more fragmentation, more bureaucracy and more money being diverted from patient care to upholding a system that prioritises the buying and selling of healthcare over quality and over the care itself.

And yet, there was no evidence for any of this. No decent evidence that incrementally changing the system to allow competition between different NHS organisations and increasingly the private sector too, would do anything to improve healthcare. (Though ministers have repeatedly cited one lone weak study that made some ‘heroic assumptions’ and mostly showed just that more hospitals=better care).

In fact, there is no health system in the world that has been shown to result in a fairer and more equitable health service coverage than that of a fully tax-funded, publicly owned one. The World Health Organisation upholds this view, as do OECD comparisons.

On this basis and on the complete lack of evidence to the contrary, the current direction of travel of the NHS is higher costs to the public and poorer health service provision. My only conclusion can be that constant reorganisations thus far have been experiments. And experiments on the public on this scale are morally corrupt and costly to life.

So – are we stuck with the system that has been so wrongly imposed on us?

If we leave it to the politicians, it seems so.

Politicians who do not wish to support a non-privatised health system by supporting the NHS Bill often say, “staff do not want yet another reorganisation”.

Well, the NHS Bill is supported by Unite the Union following unanimous support from health staff elected to represent its 102,000 health members.

Whilst my union has actually given me a say, none of these politician types have asked me as a health worker how I feel. Instead they tell me.

Apparently I’m terrified of another reorganisation.

Well actually, it depends.

Yes, I am scared of the kind of reorganisations we’ve had over the last few decades.

Not because they turn my own working life upside down. In fact many staff I talk to, as a colleague, campaigner or union officer, don’t even notice the latest in a never-ending string of reorganisations.

But because each of the reorganisations we’ve had in recent years – and continue to have - has brought with it a reduction of who I am allowed to treat, not to mention a huge increase in administration.

And because none of these re-organisations have been remotely evidence-based.

I’m not scared of the NHS Bill that campaigners have been trying to get through parliament. It is only a restoring of the NHS to its founding principles. It is based on an understanding of the evidence of what works, and what doesn’t. It would save money whilst enabling better spread and fairness of care across society.

What’s not to like? What could be on the mind of a politician that would not support this?

The ideological experiment that sets so much faith in a privatising, marketised system in the NHS has failed. It is robbing patient care of billions of pounds a year, and it is harming people. It is time to restore the NHS to its founding principles.

It is time politicians spoke out for their constituents and supported the NHS Bill, putting patients and evidence before vested interests and ideology.


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