A big con-sultation?

The government has launched its ‘Have your say on the NHS’ consultation. Before looking at how this is set up, I thought I would have a consultation with myself first—before I find out if the official consultation is merely a tick box exercise with multiple choice questions combined with a surfeit of prompts. Clearly my problem is jaundice. Perhaps this exercise will cure me of it.

So the first thing that comes to mind is that human bodies are irredeemably analogue and the idea that care can be safely handed over to digital systems is never going to be sufficient. I say ‘sufficient’ because I am not denying a role for digital solutions for routine, explicable problems, but my fear is that there will be a tendency towards chatbot style answering systems that merely delay real interactions with fully trained professionals. A mechanised response may be cheaper than putting in the resource to get e.g. the doctor/patient ratio to a better level, but accurate diagnosis I suspect never comes cheap. Such diagnosis should also be delivered in a timely fashion, which currently it is not, with an NHS waiting list over 7 million long (and that’s only the ones who actually get onto a waiting list). In this last regard the solution is to recruit more staff, such as radiographers, and that costs money. The government should say ‘we’ll do whatever it takes.’ Is Streeting up for that?
 
Tony Blair, of whom it was suggested he could barely operate an electronic calculator is one of the biggest pushers of artificial intelligence as the universal solution for challenges such as the ‘broken NHS’ (© W. Streeting). It was of course in his time in government that the Post Office Horizon scandal began its long road to disaster. Many other government computer modernisations have failed to deliver what they promised. But it is also true that investment in computer technology in the NHS has lagged behind, leading for example to malware crashes and the like. Oh, that’s another thing—perhaps one of the biggest risks– hackers, always on the lookout for the next ransom opportunity. One of the issues with new computer systems is the length of time they take to introduce and the likelihood that the specifications will keep on changing, not least because of new government priorities. I doubt that the private sector fares much better, although Amazon seems quite efficient. There’s an avenue of investigation, Wes! Ughh, my jaundice seems to be getting worse . . .
 
Another thing. For non-city dwellers access to some forms of treatment is becoming more remote—for Scarborough residents a trip to York may be required for even minor surgery. For emergency cases that’s a trip of at least an hour by road with blue lights flashing. Scarborough has a hospital, but it’s been argued that it doesn’t have the demand to justify having standing teams of consultants  to deal with many forms of need. So large centres which can attract a critical mass of patient (customer?) is the preferred answer. It is said in this way consultants will be better able to manage and improve their skills. Bigger is very much better. But is this the only way to run a service? I suspect it is as much about managing costs as anything to do with ‘excellence.’ Once again a resources issue. Or perhaps we should rely less on charity to pay for air ambulances and have them on the government’s books as part of the official ambulance service. More air ambulances, Wes!
 
One wonders how genuine this consultation is when only a few days before it was launched the government was talking up injecting fat people with weight reducing drugs so as to get them back to work. I’m looking forward to how consultation respondees fare on the subject of drug company interactions with the NHS. It is a sensitive subject in the light of how some dementia patients will be denied very expensive drugs that could slow down their disease’s spread. The big question is to what extent drug companies profit from public investment? Drug companies’ huge profits often start with publicly funded programmes. Will Streeting challenge this institutional imbalance? Drug companies took a lot of credit for delivering the Covid vaccines. Without publicly funded research I think we’d still be waiting.
 
Talking of Scarborough, a town of 60,000 to 70,000 people, try finding an NHS dentist. It’s an old problem. When a new dentist opened about a dozen or so years ago a queue formed around the block. It was so long it made the national news. I registered there eventually. The retirement-aged dentist was very good, but he had limited English. It’s said that he flew home to Germany every weekend. The surgery has since closed. My original GP surgery also closed down. This wasn’t due to a lack of suitably qualified ill people, but a lack of staff. When exactly did austerity start? So now the answer has to be let’s have more dentists! Will that be the answer the government wants? Or will AI magic up a brilliant new distributional model based on supply and demand statistics using stochastic measurement predictability algorithms that demonstrate how on any day (within a flexible period) an appointment may be found within a spatial tolerability range? Utter garbage I know, but the cynic in me suggests it  can be the case that a bigger ache can get rid of a smaller one.
 
Well, I’m quite getting into this consultation. Here’s a positive suggestion. Given how many people feel compelled to look for solutions outside of the NHS given the waiting times, what we need is a NHS provided service assessing the benefits and/or risks of all the products which claim to cure your problem in the meantime. As waiting lists grow longer, so market opportunities arise for snake oil merchants. I may have been a victim of this myself. So this new NHS service would act like the Consumer’s Association. It would be free to damn the charlatan products without fear or favour. It would be more reliable (hopefully) than Trustpilot.
 
Perhaps that’s enough for now. Thank you Wes for letting me get this off my chest. I feel better already! (Now I will look at the actual consultation and prepare to take my medicine like a man.)
 
P.S. Wes: Yes, more money! Get on with it!