With both the disastrous legacy left by the Cameron and Osborne years followed by May Britain is in a time of reformation with a developing intolerance to incompetence that is linked with the Empire Cycle, This evolution is being primarily driven by the energy of expansion, of which Brexit was a national response to a decade long phase of relative decline. Within this expanding paradigm, the reform of the NHS needs to be bold and innovative in what should be a National Health Care Revolution that will help power Britain forward in the years to come.
Failure Begets Change
The announcement of reforming the NHS should not be perceived as a power grab, but should bring the NHS directly back under the control of the Minister of Health to create a more efficient and integrated response to the pandemic and future crisis. Whilst seeking to solve the numerous problems that were in evidence before the pandemic.
This is an entirely appropriate action as the greatest failure of the pandemic was in the NHS's ability to not effectively respond to its wave of entropy. This is a clear failure of Public Health England, the body that administers the NHS. This system of control has been a product of the reforms enacted by Andrew Lansley that divested government control of the NHS in a typical manoeuvre that absolved Cameron & Osborn and their cronies of responsibility for growing NHS problems in their service provision. However, that process backfired as the leaders of Public Health England and the NHS failed to adapt to the pandemic fast enough in multiple key areas. Foremost among these was Sir Simon Stevens, the head of NHS England, who must be held responsible for the poor NHS response to this national disaster. Consequently, the government could not exercise the control they wished to compensate for the mismanagement of critical medical resources vital to the pandemic response. The key areas involved were the number of hospital beds and the track and trace system upon which some £22 Billion was spent to little effect.
Public Health England And NHS Failures During The Pandemic
The biggest pandemic policy weakness was the critical national limitation of having only a small number of hospital beds per 1000 of the population, which at the start of the pandemic was 2.5 compared to Germany's 9. Despite building the Nightingale hospitals, there was then a clear failure to make plans to increase staffing levels to cope with the inevitable second wave. It was this limited number of hospital beds and staff that created a rather sticky situation.
Second was the complete failure by Public Health England to integrate the impressive private response into their plans. The call for incubators created a wave of innovation that was, in cases like Dyson, poorly appreciated and rewarded. Then there was the failure to use the Taiwanese track and trace system that was offered for free. Instead, after £22 Billion of wasted investment, we still do not have a system of comparable capability. Lastly, it was the army that impressively showed the Chinese we could match their hospital building skills by constructing the Nightingale hospitals. Yet Public Health England then failed to integrate them into their plans by failing to make staffing provisions. This included support offered by the Army.
Third, there was the failure at the start of the pandemic to notify only 60% of 2.2 million people classified as extremely clinically vulnerable who needed to shield until after the first wave peaked due to an IT glitch and due to records being 7 weeks out of date. A further 375,000 could not be reached due to inaccurate contact data. This is an alarming failure that without doubt cost lives and attests to the poor administration process in the NHS. This failure was exemplified by the wannacry cyber attack in 2017 from North Korea that accessed old software unpatched,or unsupported by Windows operating systems that should have long been replaced. This attack cost millions and was only stopped when a white hat hacker found the kill switch when he registered the domain from which the code originated.
Fourth, the Government failed to enact the obvious strategy to shield the over 65s and expose the under 50s to rapidly build herd immunity during the summer. The delay in executing an effective shielding strategy was then compounded by the NHS administrative errors as described above. Thus, Boris was then left with the only option of another lockdown to protect the NHS from saturation. This resulted in a second and even more destructive lockdown, one that should never have happened with economic consequences that have still to play out with incalculable damage to unfold.Judgment Day For The Lockdown Brigade Is Inevitable
The Cost Of Failure
Instead of the NHS protecting the population, the population has ended up being asked to protect the NHS for its failures. In addition to the loss of life during the pandemic, which to be fair would not have changed whatever the structure of the NHS, the economic cost has yet to be realised. Not only has public sector borrowing in 2020 soared to £250 billion compared to £48 billion in 2019, but the economy has shrunk whilst a huge percentage of entrepreneurial private businesses have, and will increasingly, go bust. The social impact of illness and suicide are difficult to count.
Immediate Goals For The NHS
The most important immediate task will be to increase the number of hospital beds to increase the threshold at which another lockdown might be enforced. A reasonable urgent increase would be 5 fold, commensurate with frontline staffing levels.
Next to be addressed is the fundamental problem of leadership and staffing within the NHS and its 1.3 million employees who have become top-heavy with 47% administrators and only 53% front line clinical staff.The idea of the Royal Navy being led by a non-sailing Admiral, an administrator, is as daft as having he NHS led by non-clinical administrators who have then proliferated more such administrators to the point of madness. Thus, a massive streamlining needs to urgently take place ensuring that leaders of the NHS have clinical experience and administration is increasingly driven by up-to-date software systems and AI programmes with regional management control each led by innovative and creative reformers.
Lastly, Hancock is not the man to reform the NHS. He has shown poor levels of competency in his post, but most importantly he is not a creative reformer. Rather, he is just another political footsoldier promoted way above his capabilities.
Long Term Goals For The NHS And The Health Care Revolution
The reformation of health within the nation must be broader than just the reformation of the NHS' structure and administration as it needs to extend to a vision of revolution in health of the nation. Its £130bn pre-pandemic budget needs to be used in far more efficient ways to give the taxpayer value for money to give then-greater health productivity and wellbeing to the nation. To achieve that, these are some critical areas that must change.
- Enact greater efficiency via a new technology that benefits the patients. Encourage and integrate new technology innovations from the private sector.including remote consultations and diagnostic processes.
- A shift towards evidence-based medicine and multi-discipline interaction of clinicians.
- The introduction of diagnostic networks that allow clinicians to diagnose patients remotely and then to easily provide second opinions, enhancing accurate diagnosis and increasing learning networks for clinicians as they can be scored on their diagnostics. Such platforms provide the ideal basis for programmes to build a vast body of diagnostic information that in time will become very accurate.
- A new focus on preventive medicine and national educational programmes.
- Obesity in the UK must be brought under control. The costs associated with the co-morbidities of obesity during the pandemic have been massive, adding to the saturation of the NHS and lowering the threshold of the imposition of lockdowns.
- Gut health should be viewed as part of the obesity drive, but additionally has much wider implications for health.
- Vaccines against viruses and bacteria are known to cause cancer using biotechnology created in the pandemic.
- A national shift towards a culture of self-responsibility for health and fitness, a new balance of alcohol, sugar and exercise. Fitness translates as greater wellbeing, happiness and productivity.
- Enhanced support for mental health. This was needed pre-pandemic, but post-pandemic will require massive enhancement of the capability to respond to those who have suffered during the pandemic from losses of loved ones and livelihoods.
- Improved ways to care for our elderly, encouraging productivity and engagement until death. Our current social care system is, in effect, a watch-until-death system. Part of the problem is that old people lose productivity and self-worth with age. Ensuring they are valued and integrated into society in some way would only enhance their lives and quality of life.
What the pandemic has shown us all, is that the NHS desperately needs new innovative and creative leadership, but also needs a top-down and bottom-up reformation to transform our national sacred cow into a modern and efficient health system comparable to that of Germany, that can support the nation in both pandemics and more tranquil times.