Even the most casual observer couldn’t help but see through the NHS’s obvious ruse to meet Health Secretary Wes Streeting’s target of lower hospital waiting lists.
With well over seven million people waiting to start NHS treatment in England, the Government is hell-bent on getting rid of the queues which are a terrible blight on its management of the health service.
They have already tried to do so by paying hospitals £33 for every appointment cancelled. The NHS also rewards GPs £20 per patient if they seek ‘advice and guidance’ from a consultant on their behalf, without the need for a follow-up face-to-face hospital appointment.
But these incentives have not proved successful enough. The latest – and the most dangerous – ploy is to tell GPs to delay one in four patient referrals and thereby reduce ‘unnecessary’ hospital appointments, effectively rationing consultations to keep the queues down.
The scheme is part of a Government strategy to reduce the number of hospital outpatient appointments by 30 million each year.
It is a sleight of hand that will further corrode public trust in the NHS.
At a moment when the Government is locked in stalemate with the British Medical Association – after Sir Keir Starmer withdrew the offer of 1,000 more doctor training posts because the association has refused to call off a six-day resident doctors’ strike next week – that trust is already at an all-time low.
There is no doubt that Wes Streeting’s rationing of referrals will make things materially worse in terms of patient wellbeing as well as undermine the professionalism of family doctors.
Fully fledged GPs undergo years of specialist training in general practice after gaining their medical qualifications. They are supremely educated in how to be the first point of contact for patients and coached on whether to offer treatment themselves or to refer those patients on to a specialist.
They are taught that hospital referrals should be made when necessary or pertinent, not dictated by a Government desperate to save its blushes.
An elderly or vulnerable patient with shingles, for example, should be seen immediately. Someone showing symptoms that might be indicative of early-stage chest cancer should have a detailed hospital scan within two weeks. Similar action should be taken if the GP suspects, say, bowel, bladder or prostate cancer.
With many diseases, time is of the essence. But under the changes, family doctors must now seek ‘advice and guidance’ from consultants in those mandatory one in four cases before they make any referral, a process which can be desperately time-consuming and bureaucratic.
Some doctors say consultants’ responses to requests for advice from GPs can take months. They also warn that by deliberately delaying a quarter of patients’ referrals to reduce Mr Streeting’s waiting lists in this way, doctors immediately open themselves to claims of professional malpractice on two fronts.
First, they could be sued for failing to act in their duty to put patients’ interests first.
Second, by faithfully following the instructions of their NHS paymasters, doctors are flying in the face of their ethical duties, which could lead to them being hauled before the doctors’ regulatory body, the General Medical Council (GMC), where they could be disciplined or even banned from practising.
Doctors are fully aware that a percentage of people who come into their surgeries are malingerers, hypochondriacs, lonely people who need attention or the ‘worried well’. And they will deal with them appropriately.
Does Mr Streeting think so little of GPs as to believe they clog up specialists’ waiting lists on a whim?
If the GMC takes its role as the guardian of medical ethics seriously, it should protest that family doctors are being prevented from doing their best for patients by these arbitrary quotas being imposed by politicians and bureaucrats with no medical training.
It is not as if hitting the political target of lower waiting lists will save lives.
As GPs have argued, the Government’s plan simply pushes waiting lists from hospitals into the community, which does not have the resources to cope.
Of course, the entire NHS system is stretched to breaking point. Its outcomes for cancer treatment are some of the worst in the Western world, for example.
But instead of investing in real improvements that could save lives, the NHS at Wes Streeting’s behest will be making cosmetic ‘improvements’ that could well result in more people dying of serious diseases because their access to specialist help has been rationed.
In turn, this will mean NHS oncology outcomes will become even worse and Britain will slip further down the international league tables.
The Government may boast that waiting lists are falling, but the people who actually rely on the NHS know from personal experience that things are bad – and are getting worse.
Patients are already frustrated by the delays they experience in seeing their GPs. Their fury has only increased since much-needed hospital appointments or even operations are arbitrarily cancelled at little or no notice. At the root of all this is the short-term thinking that prioritises a quick and dirty political fix above long-term patient care.
Part of the enduring problem of our healthcare system is that successive health secretaries are long gone from public life by the time the real effects of their tinkering become clear.
They all think they can cut the financial cake in different ways, as if that’s some sort of miracle cure. But snake oil never works.
The much-vaunted internal market, introduced in 1990 to bring in competition within the NHS and increase efficiency, actually increased regulation, was not cost effective and was then quietly dropped.
Similarly a whole series of bureaucratic structures have come and gone without making a blind bit of difference to the NHS’s decline – the latest being the abolition of NHS England.
Junior doctors have been paid more, and billions in additional funding have gone into the health service black hole, but the quality of care in the NHS, as measured by patient outcome statistics, has stubbornly refused to improve.
This latest stunt will fail as well – and it deserves to fail because it is an underhand trick for which GPs are being set up as the fall guys.
I have no time for the resident doctors’ strikes, but the BMA union behind them is right to object to this abomination of a plan.
I predict it will be a damaging political failure for Wes Streeting and the Government, because the only possible result is a loss of public faith in the NHS, a rise in voter anger at Labour – which has so often promised to be the only political party that can be trusted on health – and ultimately a painful punch on the nose at the next general election.
Meanwhile, the only thing that really matters in all this – patient outcomes – will get worse year after year.
All for the sake of a piece of here today, gone tomorrow political grandstanding.
