Our correspondent wants the major parties to stop playing political football and unite behind the five year forward view for the NHS

Among other things, Albert Einstein was famous for his many aphorisms, two of which seem apt in the morass into which the NHS is fast sinking. The first is: “Imagination is more important than knowledge.” The second is: “You can’t solve problems using the same thinking that created them.” You might be tempted to dismiss them as homespun wisdom. To solve the many problems that beset the NHS we need clear thinking, far-sighted strategies and a clear vision. Yes, we do, but we might do better if our thinking were guided by Einstein’s impeccable logic.

A good dose of imagination is sorely needed by all the stakeholders involved in commissioning and delivering healthcare. We have been given a very strong lead by NHS England’s ‘Five-Year Forward View’. Imaginative? Definitely. New thinking? Absolutely. But unfortunately we are caught in the shifting sands of politicial expediency, self-interest, and the need to abase ourselves before the false god of competition, which was made compulsory by the infamous Health and Social Care Act that paved the way for clinical commissioning.

Weasel words

I recently berated the three major Westminster parties for their weasel words about their commitment to the NHS. They all seem incapable of the imaginative new thinking that’s required. All that concerns them is money, and none of them is promising enough. 

However, at this moment in time, both the Conservatives and the Lib Dems seem wedded to the model of commissioning they instigated and which has been, frankly, disastrous. Will they do a volte-face before the election or would the implicit admission that they had got things badly wrong be a step too far?

Clinical commissioning was supposed to create the right conditions for competition, with any qualified provider able to bid to provide a service. I have never been in favour of this, because it seemed obvious that the end result would be fragmentation of services and a loss of continuity of care.

In practice, many CCGs have been reluctant to put their own interests to one side and allow competition to develop, with numerous examples of CCGs resisting moves by pharmacists to provide new services. Pharmacists have been urged to talk to CCGs about which services they could bid for only to be met with blank looks or obfuscation. Pharmacists? Bidding for services? Why would we pay them to provide services when we could do it ourselves?

Pharmacists have been urged to talk to CCGs about which services they could bid for only to be met with blank looks or obfuscation

In the future, pharmacists working closely with GPs could certainly be an imaginative step forward, but it wouldn’t be viable if the pharmacists ended up working for GPs rather than with them.

Imbalance

There has always been an imbalance in the relationship between the two professions, with the GPs holding much more power. However, medicines are the most common intervention in healthcare and, as we know, their use is far from perfect and is often fraught with problems and unintended, even negative, consequences. When it comes to medicines, it’s obvious who should have the biggest say. Would that be pandering to the vested interests of pharmacists, or would it be a better solution to an obvious and chronic problem?

Conundrum

Then there’s the conundrum of trying to extricate ourselves from the thinking that put us in the mess we are in. I’m talking about the Health and Social Care Act. Well, it seems the first step may have been taken in consigning this ill-advised piece of junk to history. In a recent interview with the Health Service Journal, Secretary of State for worsening healthcare Jeremy Hunt as much as admitted that the Act was moribund: it simply hasn’t lived up to its hype.

He said that he didn’t think that “the market will ever be able to deliver in the top priority of integrated care out of hospital”. Seriously? There’s more: “There are natural monopolies in healthcare . . .” Really? How about: “Choice was particularly irrelevant in emergency care” and “market forces would not create good integrated community care”.

It’s perhaps revealing that the right honourable gentleman hasn’t repeated any of this to other interested parties like the Health Select Committee or to the mass media. Is he testing the water, or is this too hot a political potato to let loose in the months leading up to a general election? Can you imaging the headline? “It’s official: Secretary of State for Health admits that health policy for the past five years has been built on wishful thinking and that billions of pounds of taxpayers money have been wasted as the NHS was sent to hell in a handcart.”

The playing of political football with our country’s most prized asset has to stop. What’s needed is a consensus approach. The running of the NHS should be left to the people who understand it. The ‘Five-year Forward View’ is our best hope. It should be endorsed by all the major parties whose job, should they win the election, is to find the funding, and stop meddling in how it’s run. It’s not rocket science.

Pen name of a practising independent community pharmacist. Withering’s views are not necessarily those of ICP