Panorama and the NHS - the perfect missed opportunity
Last night’s Panorama on the problems facing the NHS was public service broadcasting at its most disappointing.
The programme - ‘NHS – The Perfect Storm’ had been due to air in early June but was postponed at the last minute by the BBC, prompting speculation that the politicians needed a look at the final edit before it was aired.
When it did surface last night, the programme undoubtedly packed an emotional punch. How could we not be moved by patients’ touching stories and the dedication of our NHS staff?
But – lacking any real insight into what’s really going on in the NHS - the overall effect was sensationalist, with the narrator's fatuous comments adding nothing.
There was just one brief mention of the situation I see many of my patients struggling with - left ‘stuck’ in hospital or struggling on at home in worsening health, hit by 40% cuts to the home support they used to receive from care assistants and social workers.
The programme's talk of 'care in the community' glossed over how the bits of the NHS that always have supported patients in the community are being cut to the bone. There’s been no investment in General Practice for the past five years. Community services such as district nursing, occupation health and physiotherapy have been amongst the hardest hit by cuts – with a 40% fall in the number of district nurses in the last 10 years, for example – so again, patients become sicker and more vulnerable in their own homes.
And the programme-makers then appeared to muddle up ‘social care’ with ‘community services’ – not leaving the viewer much faith that the hype about the benefits of ‘integrating’ health and social care, and delivering it ‘in the community’, would be critically examined. As indeed it wasn’t.
Instead, most of the hour was indeed given over to how patients being old, demented, unemployed and obese were the main reason for the NHS crisis.
It was as if these problems had just begun in recent years and the NHS was only now struggling because of them.
But the world shown in the Liverpool slums is a world Jeremy Hunt and David Cameron will never visit or acknowledge. They have no understanding of the reasons behind these patients chaotic and unhealthy lifestyles. And even less interest – not much profit for 'insurers' and 'healthcare providers' in these people, after all; they're more interested in cherry picking the state cash to treat the cheap and easy patients and procedures.
So the answer we were presented with for the fat, old, unemployed or simply poor, was more ‘self-care’. But there was no mention of how public health services which focus on preventing ill health are being decimated, with a further £200million being stripped from their budget. No evidence from public health professionals, who are decrying ‘austerity’ as worsening health outcomes and leaving people malnourished, over-stressed, and little able to focus on ‘healthy lifestyles’.
The smiling GPs in ‘leadership’ roles on the local Clinical Commissioning Group were presented to us as the last chance for the NHS. The programme ignored how Lansley’s Health Act wrote hospital consultants out of planning local healthcare – a shortsighted move that has led to many of the unproven, untested and unevidenced ‘care in the community plans’ we now see planned by these ‘GP leaders’ across the country. The plan put forward by Liverpool CCG is being replicated across every CCG in the country. Some are already taking the rhetoric of 'self-care' to its extreme, attempting to deny all routine operations to patients who are overweight or smoke, or telling dementia patients to 'treat themselves'.
We know that doctors will get the blame when things go wrong – oh, and patients, of course.
But - though you wouldn't know it from last night's Panorama - it is the politicians, not the doctors and patients, who are culpable for the mess the NHS is in. It’s the politicians who have overseen falling NHS expenditure – confirmed by the UK Statistics Authority – and across the board cuts of 10% to the money hospitals receive for treating us.
It’s the politicians who have created an English NHS ‘market’ that wastes an estimated £10bn a year or more on bureaucracy, just to enable their private health industry friends to ‘compete’ with our NHS hospitals (and rich pickings for the armies of lawyers, accountants, management consultants and bankers creaming off fees, too, of course).
It's the politicians who have also created the Private Finance Initiative scandal – also unmentioned last night, even though Liverpool is still building hospitalsunder this expensively flawed, wasteful model.
It’s the politicians who have wasted billions on agency workers, as they treated the NHS workforce with contempt, slashing training, increasing workload, reducing pay, and accusing them of ‘normalising cruelty’.
It's the politicians who have overseen a halving in the number of hospital beds in the last 30 years, and maintained a level of healthcare spend lower than just about anywhere in the developed world.
And who’ve nonetheless wasted a further fortune - £640million in 2014 alone – on management ‘consultants’ to draw up further ‘care in the community’ plans which even Panorama admitted were ‘untested’ – and which often seem drivenmore by a desire to free up hospital land for sell-offs, than serious evidence about what is an cost-effective and efficient way to deliver healthcare.
It was a huge disappointment to see prime time TV on the BBC filled full of such tripe, blaming unwell patients for the failings of politicians, and perhaps softening us up for the misguided idea that we simply can't afford a comprehensive health service. But then again the BBC are under the cosh with their Charter Renewal coming up….
If only those of us who have spent years campaigning to save the NHS from the misdemeanors of politicians were given an hour of prime time TV to get our message across. Imagine what we could do with that!