There’s a lot of pressures on the NHS at the moment. We’re going to talk about them and play a game of – and play a game of Jenga. Okay, so first thing. I want to ask you about is NHS wating times. So for A&E (accident and emergency) the NHS in all the countries of the UK has a target where it’s supposed to see 95% of people in four hours. At the moment. they’re not managing it. Referrals for treatment? That’s the other thing I hear about – what – I don’t even know what that means Referral to treatment means the time it takes you from when your GP says you really need to go and see a doctor To when you actually get seen in the hospital There’s targets that all over the UK. In England it’s 18 weeks and again not as many people are being seen in that time as are supposed to be. How many people are actually demanding to use the NHS? It’s going up partly because the population is getting bigger, partly because the population is ageing. Is social care part of the NHS? I know what you’re gonna ask- Social care is not part of the NHS, social care is for example when someone has to go into a care home or someone has to come and help perhaps an older person in their own house. And in recent years it’s been getting a bit wobbly as its underfunded (like our tower) and we think that’s probably had an impact on the NHS although it’s difficult to measure. People getting older? It’s good that people are getting older, but it does mean… that the NHS… Has more people in the groups who are most likely to have the most serious illnesses Again in this election, there’s been a lot of talk about – ok can I do this one? – I don’t think I can do this one Mental health? So the NHS has been trying to raise the priority of mental health which I think people would accept hasn’t always been as good as it should be. There are new waiting times for various areas of it, and they’re aiming spend more money… but as yet… there isn’t the information to tell whether or not that’s working. Money? The NHS has a very large budget compared to other public services, but it needs it, and actually the proportion of Britain’s national income going to the NHS is going to be falling over the next few years What are the big things we spend money on? Staff are the main cost of the NHS But an important thing to think about is that the cost of treatment tends to go up So as we invent new medical technologies like proton beam therapy for cancer It adds to the things that we can treat people for. But it does mean that costs tend to increase over time–Oh wow Ok, something politicians say that people don’t understand: what are efficiency savings? So I imagine most people will know from their own company or employment That there’s an efficiency drive from time to time, and for the NHS recently that’s been all the time The NHS has made efficiency savings –
economists have measured it – and it’s it’s Getting able to do more with less than it used to But at least in England not fast enough to keep up with the financial pressures it faces What’s happening to nurse numbers? So staff probably represent most of these jenga blocks The NHS is basically a system of staff treating people. Unfortunately there’s shortages of staff in lots of key areas So there’s a serious nursing shortage, and there’s also a shortage of GPs (general practitioners). Which is a particular problem because the NHS plans currently For more people to be treated outside hospital where GPs work. Nice jenga. One of the things that has to be done is bring in temporary staff on agency contracts and although they do provide the support that the NHS needs, that often comes at a higher cost so the shortage of staff tends to make the financial problem even worse. Kind of surprisingly given all the stuff we’ve been talking about, Staff seem to be more positive about the NHS than they were before Morale is very slightly improved There are still some pretty worrying things in the surveys that staff send back every year, and more staff say than not that there aren’t enough staff for them to do their jobs properly which is probably not what you want to hear from a doctor or a nurse So as an expert in many very boring areas of the NHS I can assure you that the NHS is much more complicated than one big tower. Even just looking at the NHS in England You’ve got hospitals in one place. GP services, mental health trusts Clinical commissioning groups are made up of GPs But they give the money to hospitals and mental health trusts to pay for what they do. A range of other quangos and arm’s length bodies. District nursing we’ve got for example Private companies that contract with the English NHS. All of these different parts pass money back and forth to each other, pass patients back and forth to each other. It’s an incredibly complicated system of something that employs 1.5 million people – one of the biggest employers on earth. There are so many different organisations doing different things to different groups of patients that you wouldn’t expect the NHS to suddenly fall off the cliff in some sense. It’s more a case that the pressure builds and builds across the whole system and shows up in lots of different ways that we’ve been talking about.

Is the NHS in crisis?
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