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A moral shield for our own failings

 

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Monday, 8 March 2010

A moral shield for our own failings

Everywhere you look you see a mad rush to solve problems that should never have been allowed to develop in the first place.

Taking action six months or a year ago wouldn't have made much difference. We should reproach ourselves not for our failure to predict the current situation but for behaving as though it would never come. Quality and productivity should not be temporary solutions to a problem or occasional responses to financial crises but a way of life. Unless we believe that, we're saying that it's only bad to waste public money and deliver substandard services in a recession. The rest of the time it's okay.

Earlier this week Jim Easton told a meeting of clinical leaders that the period of correction would not be a short spell in the doldrums but an era of financial constraint that could last five or 10 years.

He went on to point out that holding the NHS at current spending levels isn't a cause for relief but a matter for profound concern. If we failed to move forward during an era of record investment, how can we even hope to stand still at a time when the best we can hope for is zero growth?

It is axiomatic in the commercial world that throwing money at a problem won't solve it. That simple truth has taken a long time to permeate the NHS. The inevitable whining response will be that we can't possibly do more with less. Well, we couldn't do more with more, either. Being forced to do it with less might turn out to be instructive.

It is about now that a pall of indignation will be raised around the public services – and not just the NHS but local authorities, which face enormous cuts of their own.

Frontline services will be axed, patients will suffer, the weak and defenceless will pay the price, uncollected bins will overflow with rats…the predictable onslaught of tabloid rhetoric is already ringing in our ears.

Before we start using patients as a moral shield let's remind ourselves that we are never more keen to defend their interests than when our own are under threat.

Let us also be candid about what could really be done to make the back-office and managerial savings that would make cuts in services unnecessary; what radical changes to patterns of health investment might do to redress woeful health inequalities and improve outcomes; what different models of care might do to realign spending with need; and what different approaches to commissioning and management might do to end the wasteful adversarial culture that pits primary against secondary care, commissioner against provider, and the service both against itself and – at times -- against the real interests of patients and the public.

The good news is that we won't need courage to make many of these changes. They are coming whether we like it or not.