The N in NHS
The BBC’s Health correspondent, Nick Triggle, has written a blog post titled “Dropping the ‘N’ in NHS” in which he ponders:
… could the new boss of the NHS in England, Simon Stevens, be set to break the mould? Over the course of the past week – firstly in his interview with the Daily Telegraph and then in his speech to the NHS Confederation conference – one thing has stood out above everything else: his emphasis on the local.
Then this week he set out his vision in a little more detail to the conference of health managers. This is what he told the meeting in Liverpool: “We need different solutions for diverse communities. Horses for courses, not one-size fits all.”
BBC News Website: Dropping the ‘N’ in NHS
From this he questions the “N” in NHS – and fundamentally misunderstands what the N means.
He cites two examples where “local” solutions have “proved” his case:
- Stroke treatment in London where, by centralising services in a region with a lot of hospitals for its physical area, stroke death rates have been cut by 12%.
- Elderly care in Torbay where services have been designed around the predominantly elderly population.
He says there will have to be two changes to make a “local HS” work:
- A change from the current top down mindset
- Public acceptance of diversification
However he quotes Labour polling that shows the greatest concern about the NHS is the “postcode lottery”
People do not like the idea of variation from one place to another, it seems. They want the “N” in NHS to stay.
National does not mean uniform “top down”. National has to mean something to do with operating across and for the nation and owned and paid for by the nation. The postcode lottery (in terms of outcomes) does not have to apply if you localise the NHS. Health is an “end” and it is totally reasonable that the “means” to that end is local and varies from place to place.
It is entirely reasonable that all NHS stoke patients should expect the NHS to try to achieve “London levels” of stroke recovery, but outside a high population density metropolis the “London solution” will not work. Local solutions should seek to achieve national outcomes.
The “top down” should be what is necessary to ensure the national level of outcomes; solutions have to be managed locally.
The NHS is a National Health Insurance Scheme. This means that we, the “policy holders”, spread and share the risk. It is a social scheme in that our premiums are not based on factors such as where we live. Delivering almost any health outcome in the remote Pennines is going to cost more than delivering the same outcome to someone in Newcastle – but we do not believe that people in the Pennines should pay more than those in Newcastle. It’s called social solidarity.
Local Health Services challenge this spreading of risk and this social solidarity. As Nick Triggle admits elsewhere in his article you want to “put the local” in the NHS – you don’t want to remove the “N”.