Dr Louise Irvine interview about the NHS Crisis on Talk Radio this morning (interview begins 9 mins in).
Dr Louise Irvine: Good Morning James (Max, Talk Radio)
Talk Radio: Is (Jeremy Hunt’s) “Sorry” enough (over NHS Winter crisis)?
Dr Louise Irvine: “Sorry” is not enough. Patients are really hurting. Staff are really hurting. This is a dreadful crisis but it is one that happens year on year, and each year worse than the year before. When I heard Jeremy Hunt say “Sorry”, it reminded me actually of some of my patients who have been subject to domestic violence where an abusive partner keeps hurting you and then keeps saying sorry. What are you supposed to do? Keep saying, oh that’s all right then? At what point do you have to stop accepting sorry and actually start saying you are responsible. You have to take that responsibility. You have actually failed. I actually think that Jeremy Hunt should resign.
Talk Radio: You think he should resign. There are others who would say, look, he’s got a very difficult job, and the difficult job is trying to juggle an organisation that is outmoded, it is outdated in how it is structured, it wastes a lot of money, and it is a bottomless pit. You can never spend too much money on health, and we’re going to have to ration it. He’s doing just that.
Dr Louise Irvine: Those things you have listed I would say are myths. The NHS is one of the most cost effective and efficient healthcare systems in the world. It has actually suffered because of meddling by not just this government but by the coalition government.
Talk Radio: So, why yesterday, when I was speaking to various health professionals who know far more than I do, did they all say the way it is structured, the way the NHS procures its drugs, for example, the way that the NHS procures its services across the country, the way that the NHS hires people (particularly when it comes to temporary staff), all of these things and management as well, are quite wasteful.
Dr Louise Irvine: Yes. In 2012, the coalition government led by the Tories brought in a very costly reorganisation – we call it a redisorganisation – (it was) the Health and Social Care Act which did exactly that. It actually split the NHS up further. It created chaos and fragmentation. It has been criticised by The King’s Fund for being bewildering in its complexity and actually wastes a whole lot of money on what we call “transaction costs” by trying to make the NHS into a market structure. Yes, there is waste in the system. That is because of consecutive recent policies since 2012. The basic structure of the NHS is actually very sound and effective.
Talk Radio: Well, that’s your view and opinion and I understand that. If we’ve got a system that needs to be organised in a different way, you can either continue and just throw money at it or you can try and reform it, can’t you?
Dr Louise Irvine: If you compare the spending in the UK on health and social care, it is about 10% of GDP. Other comparable economies, for example, France, Germany, The Netherlands, Sweden, Norway, spend much more. They spend 11% of GDP which is actually about £18bn a year more. Now, therefore, the way that we actually organise and spend on our healthcare is one based on a principle of austerity, of cutting back on the spend. Compared with other countries that we want to compare ourselves to, we are actually underfunding our NHS. It’s gone through its longest funding squeeze. It’s 7 and a half years into a 10 year funding squeeze which is unprecedented. At the same time, we have bad planning, very bad workflow planning, not enough nurses, we’ve been making major cuts to public health. As I said, we are wasting lots of money on endless reorganisations. These are the issues. This is the bad planning that has been going on for several years now, under Jeremy Hunt’s watch. And, that is why the NHS is in crisis. It is not about the fundamental structure or the nature of the NHS. It is about what this government and the previous government have been doing to the NHS.
Talk Radio: Well, that is one argument but never, certainly in my lifetime, has anyone looked at the NHS and said it is doing everything marvellously. Even when, for example, there were significant amounts of money being pumped into it, we then had different kinds of scales. We had issues where hospitals were killing people, we had situations where hospitals were losing data, we had situations where hospitals were bungling operations. We are always going to have problems with the NHS because of its size, the huge amount of work that it does and, in essence, no politician of any political colour is ever going to get it right, are they?
Dr Louise Irvine: Well, by 2008, 2009, 2010, the NHS had actually improved significantly. I’ve been a GP since Margaret Thatcher was Prime Minister so I’ve been doing this job for a long time. The NHS had definitely improved during the years of the 2,000s. It’s not perfect. I was a critic also of aspects of Labour policy. They did though start to invest properly in the NHS and we did see tangible results. The NHS had its highest score of popularity with the public by 2010. The bungling…People are unsafe now. There are people are lying in corridors. There are people who are seriously ill who are now at risk of dying. There is an increase in the dangers that they are facing. This is not something that is from the past this is happening now.
Talk Radio: So, what Jeremy Hunt has proposed then is non-essential operations are being put off in order to ease the crisis. That’s quite a sensible thing to do, isn’t it?
Dr Louise Irvine: When you say non-essential operations, what do you mean? Do you mean ones that are not immediately life threatening? All operations are essential ultimately. Nobody goes in for an operation just for fun. So, we’re talking about what we call elective or planned operations. That might be a hip replacement. It may be somebody who is in severe pain or has been severely disabled by arthritis in the hip. Their having to wait longer and longer for that necessary intervention is actually going to cause longer suffering. So, you’re going to see real chaos. Putting off operations for a month or maybe longer is actually going to cause a huge backlog.
Talk Radio: OK. I understand that. So, if the solution is whether that Jeremy Hunt has to go or more money has to go into it, or all of these solutions that people come up with, where is the money going to come from to pump into the NHS that you would like to see clearly?
Dr Louise Irvine: Austerity is a deliberate policy of our government. It is not a policy shared by other similar Western countries who have not actually….
Talk Radio (interrupting): Well, it’s necessary because we’ve spent too much money and we’ve borrowed too much money.
Dr Louise Irvine: It’s a choice. Austerity is a choice and …
Talk Radio (interrupting): OK, where does the money come from?
Dr Louise Irvine: The money comes from taxation. That’s one way…
Talk Radio (interrupting): So, you wanna put up tax?
Dr Louise Irvine: That’s one way we could do it. We could actually start collecting some of the tax that is not being collected from tax avoidance. We could start reversing …
Talk Radio (interrupting): We can’t do that unilaterally. If somebody decides to move their money overseas and offshore. Guess what? You can’t get it.
Dr Louise Irvine: Most of the private healthcare companies that are providing healthcare in the UK are actually based in offshore tax havens. All the Private Finance Initiatives companies are….
Talk Radio (interrupting): So, what do you do? You just say, right, you can’t come to this country as you’re based offshore?
Dr Louise Irvine: You deal with it on an international level. I think the UK should have been all along…
Talk Radio (interrupting): But, that’s not gonna be done by next week.
Dr Louise Irvine: Well, no because this issue should have been planned long ago. As I was saying….
Talk Radio (interrupting): It’s very easy to say we’re gonna fix this just by taxing people more.
Dr Louise Irvine: We were saying this 3, 4 5, years ago. We could have been saying this when it was clear the NHS was heading off a cliff edge. This is a predictable …
Talk Radio (interrupting): But, the NHS has not had any less money.
Dr Louise Irvine: It has had effective flat line funding of 0.1% per capita real terms increase since 2010 at a time when real healthcare costs are going up by about 3% to 4% each year. And, that is international. That’s not the UK being inefficient. That is the cost of modern healthcare for a…
Talk Radio (interrupting): So, in essence, tax more and then we can have the NHS. What about asking people to pay something towards that? You mentioned France. In France they pay various aspects of their healthcare and you go into Europe and they have these hybrid models. Is that a good idea?
Dr Louise Irvine: Most of those European countries are spending more on health altogether. The evidence is that if you ask people to pay, it is the poor and more worse off that suffer most – the people who are the most sick. Actually, it increases inequalities. A tax funded system where everybody receives what healthcare they need at the point of use is actually the most efficient way of organising equitable healthcare.