Despite vast increases in funding and staffing, the NHS, an increasingly unmanageable behemoth, is in meltdown – its A&E services overwhelmed and productivity collapsing. The Government will unveil a package of reforms tomorrow in an attempt at steadying the ship; one of its more striking ideas is to drastically expand so-called “virtual wards” to allow tens of thousands more elderly and vulnerable people to be treated at home. While some may balk at the idea of video links and monitors replacing stays in hospitals, harnessing technology in this way is actually a good idea, if it’s handled carefully.
Heart attack ambulance waiting times reached an average 93 minutes in December, and the hospital crowding crisis is made worse by patients who are medically well being stuck on wards for lack of care at home. Moreover, hospitals have become notoriously uncomfortable and unhealthy to stay in, even dangerous, and no doubt many patients would welcome the option to recover at home. That’s on the proviso that they are genuinely well-monitored and that ancillary services, such as the district nurse, are properly available. When GP surgeries shifted to remote consultations during lockdown, it was sold as being in the patient’s interest, and can often be – but many readers said they could no longer get physical appointments at all. Virtual wards must not be used to take the heat off hospital management rather than providing choice based upon a patient’s genuine need.
Likewise, doing more work outside of hospitals cannot distract from the serious problems that exist within them. This ranges from asbestos to absurd levels of paperwork. Then there is neglect – as indicated in the recent case of Wynter Andrews, a baby who died after just 23 minutes of being born at Nottingham University Hospitals. The trust was fined £800,000 after admitting failings in care.
The NHS needs both technological innovation and structural reform; it’s not an either/or. There should be an epoch-defining, bipartisan discussion – preferably in the form of a Royal Commission, as called for by Lord Saatchi – that looks objectively at what other countries do and what we could learn. Nations with hybrid systems of public and private provision enjoy better health outcomes. So long as we stick with our present model, rationing will be inevitable – and will likely take the form of some kind of waiting list, be it for a bed or a home visit.
The Tories have long been terrified of appearing to tamper with the Nye Bevan vision of the NHS, but the longer they dodge the fundamental issue, the more territory there is for Labour to occupy. Ministers should follow the logic of this sensible reform and go further.