I am feeling a sense of learned helplessness about what the coalition government are doing to the NHS.
Learned helplessness is a phenomenon associated with depression. A classic animal model of depression, learned helplessness occurs when an animal is repeatedly hurt or subjected to a nasty situation that it has no power to change. For a while it tries to change things until eventually it gives up. After this point, even when presented with opportunities to escape or change the situation, it doesn’t take them (e.g. Seligman, 1972). This has been shown in dogs subjected to shocks, in rats forced to swim (rats dislike swimming) and is thought to be seen in humans with depression too, who feel helpless to change their situations even when sometimes it might be possible to make changes.
The coalition have been buggering about with the NHS since they first got into power. Even now it feels to me, as an NHS employee, that the cuts which are being made in the NHS are talked about far more behind closed doors than they are in public media, as emphasised in a recent article in the Independent.
The danger is that I have become so weary of the relentless bad news about different governmental policies about the NHS, which seem to me to undermine the ability of the NHS to deliver what it was set out to do: free health care for all on the point of delivery, that I have started to feel that it is pointless to try to change it. In the spirit of resisting learned helplessness I am least writing some lists.
The changes that seem to me to be occurring include:
- Cuts to how much money is available to the NHS, resulting in cuts in staff and yet no modifications in expectation of quality. This is impossible and results in dangerous situations and staff burn out
- Increased emphasis on making the way that the NHS works more like a private business, including devising care pathways which can be clearly charged for and audited. There is absolutely nothing wrong with this in principle, but in practice more complex cases are not yet catered for in this sort of modelling. For example, in mental health services, someone with a chronic mental health problem and multiple diagnoses might need long-term service input, which won’t be accounted for by an “off-the peg” package.
- Increased emphasis on opening up tendering opportunities for NHS and private and third sector (charity) organisations to bid for services. These services are no longer commissioned by the same primary care trusts, but by consortia which are mainly GP led. We are yet to see the impact of this, but my misgivings come mostly from tendering every few years meaning that costly tendering processes will be continually undergone, and that long-term service planning and coherence will be undermined if not impossible. In addition, GPs, whilst expert at being GPs, do not have specialist knowledge of specialist services, and will be making decisions they do not have experience of. This is more likely to result in post code lottery than any previous system.
What should they be doing instead?
- Putting money in, instead of taking it out
- Concentrating on supporting the positive changes in evidence based practice, for example in mental healthcare, which has been improving outcome measures and implementing initiatives like IAPT (improving access to psychological therapies)
- Concentrating on measuring the efficiency of money put in so that results can be seen clearly.
- Trying to make the NHS more efficient, yes, and drawing on private models to do this to some extent, e.g. trying to work out the costs of healthcare more specifically. But introducing more complex tendering processes and essentially passing the buck in terms of commissioning is not the answer. Better, surely, to try to make provision more consistent across areas or somehow tie it to local population statistics, rather than leave it entirely down to local decision making. Surely everyone no matter where they live should be able to access certain minimum standards of care.
Sadly, I think the Conservative ideology is clearly seen in the coalition policies here. Tory governments have historically prioritised commercial interests over welfare. The more they undermine the NHS the more they pave the way for an increasingly privatised model of healthcare. I wish they would be more up-front about what they were doing though, so we could at least debate the relative merits and disadvantages of the sorts of systems they have in the shadows. As it is, they are silently undermining a national service, which whilst far from perfect, is impressive in its breadth of reach and quality.