It’s time that politicians of all persuasions were asked some searching questions about what they would do about our health services, our correspondent believes

Governments often seem to be obsessed with targets: targets for inflation, public borrowing, reducing the deficit, and, of course, the NHS. It’s quite easy to dismiss targets as job creation for the number-crunchers – obscure and often seemingly meaningless. But behind every target in the NHS is a patient and their family, anxious about their health, uncertain over their future. The Nuffield Trust has recently published a disturbing report about targets, or, rather, the failure of NHS Trusts to meet them. The trend is heading inexorably downwards.

But it’s not only poorly performing trusts that are missing key targets – on A&E services, diagnostic tests, planned procedures, and cancer care – now even the top-performing trusts are failing to meet them. Currently, there are nearly 3 million people waiting for routine hospital treatment; the target for patients needing surgery to be seen within 18 weeks has not been met for the past year; and the target for patients to get diagnostic tests within six weeks has not been met since the last quarter of 2013. This winter, the A&E waiting times target was missed every single week.

This downward trajectory is across the board: as you might expect, poorly performing trusts have been getting worse for a while, but now performance is declining in the ‘top’ hospitals too, suggesting the problems are not down to local circumstances or managerial failings. The whole system is tottering. The last quarterly monitoring report from the King’s Fund reveals that, despite additional spending of nearly £1 billion over the winter, 42 per cent of trusts are forecasting a deficit by the end of this financial year and six in 10 are dependent on additional financial support from the Department of Health.

The King’s Fund’s chief economist, John Appleby, says: “Services are stretched to the limit. With financial problems endemic among hospitals, and staff morale a significant cause for concern, the situation is now critical.” “Well,” you might be tempted to say, “we are in a period of austerity; difficult choices have to be made.” I accept that.

What I can’t accept is government obfuscation that attempts to deny the extent of the problem. I’m sick of hearing the mantra that gets drummed out time after time: “Health spending has been protected, and has increased year on year.” That’s true, up to a point. But the increase in spending has not kept pace with increased demand on the NHS, nor with the inflation that exists within healthcare as new diagnostic tests, procedures, and treatments are introduced.

And then there are the disastrous ‘reforms’, which have actually made matters worse. With an election looming, it’s time to put candidates of all parties on the spot, asking searching questions about their intentions for the NHS, its organisation, and its funding. I suspect their answers will be largely predictable, but, please, don’t let them palm you off with the usual non-answers that politicians like to give. If they don’t answer your question, embarrass them by saying: “That’s very interesting, but, actually, you haven’t answered my question. In case you’ve forgotten, my question was. . .”

Pharmacists in surgeries: a bit late!

It seems ‘an army of pharmacists’ is poised to step in to help GPs across England. The plans have been proposed by the Royal College of General Practitioners and the Royal Pharmaceutical Society because GPs need help to cope with the demands being made on them. The pharmacists would be prescribers, and be based in the same premises as the GP and offer advice and treatment for minor ailments, and become involved in the management of long-term conditions. The suggestion has been welcomed by patient organisations and by NHS England, which said the idea was in line with their plan to increase staffing in GP surgeries. Even shadow health secretary Andy Burnham is in favour, as long as it is not seen as ‘medicine on the cheap’.

I can’t help wondering whether GPs are only agreeing to this as long as they can stay in control

 It’s an interesting suggestion and could mean that patients are offered a choice of appointment with a GP, practice nurse, or pharmacist. The attitude of Andy Burnham is noteworthy. According to the BBC, he said: “I think it is a good idea. There is certainly more pharmacists can do to take the pressure off GPs.” His comments are welcome, but, isn’t he a bit late coming to the party – as indeed, are politicians of all colours?

How long have we been saying that pharmacists could take on this role? If it’s so desirable, why wait? Many of us could train as prescribers and offer such services directly from our pharmacies – which are more accessible – and IT systems could allow us access to patient notes if and when needed – providing the doctors agreed, which, so far, they haven’t.

I may be slightly cynical, but I can’t help wondering whether GPs are only agreeing to this as long as they can stay in control, with the pharmacists under their supervision, as their employees. I agree completely that pharmacists can and should take on this role, but as for keeping it within our pharmacies, I fear we may have already missed the boat.

Pen name of a practising independent community pharmacist.

Withering’s views are not necessarily those of ICP