An Irish NHS!

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Denis Doherty
Denis Doherty

The suggestion of an Irish NHS didn’t go down well. I would even hazard a guess that we’ll have our own Las Vegas in the Hills of Donegal before we have an Irish NHS, writes Denis Doherty.

Nye Bevan, who spearheaded the creation of the NHS was once asked why Britain needed an NHS? “If we could afford to pay our doctors, we wouldn’t need an NHS,” was his reply. Seventy-five years on, I wonder what he would make of the plethora of problems and controversies engulfing the NHS for some time now?

He would have been appalled, I expect, at the sight of NHS Consultants and their junior doctors sharing picket lines in support of their claims for salary increases. The London Times, reported earlier this year, that NHS Consultants are paid an average of £128,000 a year; hardly a king’s ransom! That said, the Rubicon has been crossed.

Strikes have been an ongoing feature across the professional staff grades in the NHS this year. When doctors have gone on strike, only Christmas day staffing levels have been provided. Shortages that arise from understaffing on the scale involved in arrangements of that sort add to already lengthy waiting lists.

As of May 2023, there were almost 7.5 million patients, out of a population of 56.4 million in England, on waiting lists for treatment. In Northern Ireland, 416,000 of the population of 1,900,000 were awaiting a first consultant appointment. Relatively speaking, that’s a higher percentage of the population than in England, Scotland or Wales.

The much-vaunted universal entitlement to free health care at the point of delivery becomes meaningless if the available resources are insufficient to meet the needs of patients and there isn’t access to private healthcare. Similar problems arise when the pressure release valve of private healthcare is unable to satisfy the pressure on both systems.

When the NHS came into existence in 1948, most voluntary hospitals became NHS hospitals. Following the war, most would not have been able to meet the rising costs they were facing. Here voluntary hospitals were treated very differently. They rely on public funds to pretty much the same extent as public hospitals but have retained the status of public voluntary hospitals and are governed differently to their public hospitals counterparts. Good luck to an Irish NHS in integrating those hospitals into a new system.

If a single health service for the entire island is ever introduced, it will face many problems that have existed since the 1970S.  Both parts of the island have failed to face up to the fact that we have too many hospitals, many of which are too small and others are in the wrong places. The hospitals at greatest risk are adored by the communities they serve who will not willingly agree to changes, let alone closure of their hospitals. Communities North and South tend to behave in very similar ways to proposed changes. When our health services are referred to as black holes, the failure of politicians to tackle the hospitals networks, North and South, is rarely discussed. The impact of the under-resourcing of the Health Services in Northern Ireland in recent years has become very apparent.

This has been a particularly bad year for the NHS. It will have to be repositioned after that experience, perhaps under the leadership of the recently appointed Health Secretary. In any event, it will inevitably feature prominently in the upcoming general election. 

There are lots of good reasons why there ought to be more collaboration between the NHS and our health services than there is at present. A recent highly critical report by the UK Ombudsman found that there are about 250,000 cases of sepsis a year in the UK. Sepsis is often treatable with antibiotics but the death rate is 25%.  Last year, for example, the Care Quality Commission, the NHS Watchdog, warned that 2 out of 5 maternity units in England were providing substandard quality care to mothers and babies.

Generally speaking, if we were sufficiently curious, we would wish to make greater use of comparisons, where they are relevant and appropriate, between how our figures compare with those published for the NHS. In that way we could

develop greater  closeness to our nearest neighbours. Already we benefit from some public health information campaigns on UK television stations we receive here.

The view that major changes to our health services are required may not be well founded. The priorities of health services users may be more affordable, more manageable and more effective than some of the major changes being proposed.

The following two pieces of advice from recent major healthcare studies are worth considering:

A) The Kings Fund Think Tank- June 2023

There is little evidence that one individual country performs consistently better than another across a range of performance indicators. Even countries such as Germany and Singapore that score highly on several high performance measures, are facing the challenge of rising demand from a growing and ageing population and the need to improve health care outcomes.

There is no evidence that one ‘type’ of healthcare system or health care financing model achieves consistently better results than another.

And the costs of transforming from one system to another can be significant. As a result countries predominately try to achieve better outcomes by improving their existing model of healthcare, rather than by adopting a radically different model.

B) ‘Public Health” March 2021

“What studies concluded is that  what patients value most  is choice  and low out of pocket costs and these are determined more by funding policies than ownership arrangements”.