The National Health Service in the UK faces many challenges. Some are just an ageing population, a diversity of patients in the 21st Century, the availability of more treatments and modern day expectations. Then there is money. Yes that old chestnut.

The UK Coalition government has proposed reform of the NHS which will see funding reverting back to General Practitioners. This was the way of the NHS sometime ago. It will be a costly exercise to implement such changes. It always is. This means that money which could be better spent on patient care will end up being used for administration and planning. New posts will be created to implement the changes and they will not come cheaply.

Whether the changes will benefit patients or make real savings we will find out in the future. If they don't then it could be another costly exercise to change things once more. And so on it goes.

Already most hospital trusts are having to cut their work forces. Wards have been closed, staff numbers reduced and some services shifted into the private sector. This means that in an emergency situation many cannot cope. They are already working under pressure so an outbreak of the winter vomiting bug, which is ongoing now, can tip services over the edge.

Today there is news once more that the NHS is failing the elderly.

There have been many stories regarding poor health care of the elderly in the UK and the latest is with regard to cancer treatements.  The report follows a poll by British cancer charity Macmillan Cancer Support. SkyNews reports that:

Government Health Secretary Jeremy Hunt claims that the government is working with the Macmillan charity in order to address these issues. He accepts that there is still a great deal of work to be done to ensure that tose aged over 70 receive appropriate care. Look online though and you will see stories relating to this have been around for at least a year. That means that whilst Ministers procrastinate lives are lost.

Opinion
13 years of working in the NHS has shown this blogger that if you work there long enough you will see all reforms come around again. The if it is not broke why fix it scenario never applies. Then when it is broken change is a long time coming.

Elederly patients with cancer tend to end up on Medical Elderly Wards rather than on the modern oncology wards. This is sometimes true of other specialities such as heart failure patients. When there is a bed shortage being moved is acceptable when it is due to an emergency situation. When it is normal practice something must be done.

There may be nothing wrong with a ward you are admitted to but if it does not have the level of care or facilities you need your prognosis will be poor.

Time to cut the management tier at the top of the NHS and reopen wards which are needed with the right staff.

The current government in wanting to move services away from the NHS into the private sector must take responsibility.

Most people in the UK accept that the UK NHS is far from perfect but few want this health service "messed" about with unnecessarily. The vast majority of people in the UK want the NHS to be maintained and upgraded when needed but continue as the UKs main health care provider. It is a widely held belief in the UK that the Tories want to dismantle the NHS by whatever means possible. Look back over the last few Tory governments and the writing was on the wall. However David Cameron came to power, albeit as part of a hastily formed coalition, on a mandate of protecting the NHS.

During the Thatcher years the NHS took a battering. Waiting lists were increasingly long, staff demoralised and infection rates high. When Labour came to power in 1995 this was the state of the NHS. It took time to implement real change but gradually waiting times improved and infection rates reduced. In inner city areas strict targets were harder to meet than in sparsely populated rural areas. But positive change happened.

One personal example relates to the waiting times for Cataract surgery in the area where I live. Working for the NHS since 1999 my experience of the waiting times for such eye surgery, at that time, was a year or two for the first eye followed by up to three years to have the second eye operated on. Personal experience as an NHS patient in 2010 was a wait of around six weeks for surgery on one eye followed by a wait of six weeks for the second eye. What a huge improvement.

The Labour government tightened targets time and time again, sometimes unrealistically so but, overall, it worked. Already waiting times for that cataract surgery in the area where I live have begun to lengthen. Slowly and slightly but the signs are there yet again.

The problem is that if you work for the NHS long enough you will see each change come around again. This is often decided at local level. Each time it costs. A simple name change to the particular NHS Trust and new paperwork would be bought to replace the old. The costs were ridiculous. At last most items are now available online at each trust saving time, money and environmental waste. However change is still inflicted almost at the drop of a hat.

The UK NHS serves a huge amount of people. With 21st Century problems such as drug abuse, teenage pregnancies and an increasingly longer living population resources are under a strain. Add to that medical advances and improved diagnostics which offer a cure to so many illnesses and diseases, but which don't come cheap, and it is easy to see why the NHS struggles to keep within its budget.

Change for changes sake though is demoralising for staff and patients, costly and pointless.

The current NHS Reform Bill has many critics. It also has some who are in favour of the changes. However many in the medical profession worry about its long term consequences. It will do nothing to strip back unnecessary red tape and administration costs at the highest level. It will however cut front line jobs. Already a job freeze in many trusts has reduced working effectiveness. If a person working 20 hours a week in one job has to cover two or three jobs in that time, none will be done properly. Each will get a "half ass" job done. This will inevitably lead to mistakes and poor standards which in turn will lead to financial penalties and fuel Cameron's call for change. And on it goes.

Coalition Minister Andrew Lansley is adamant that the NHS Reform Bill will be passed. It has been returned to the House of Commons more than once for amendments, from the House of Lords. It now seems that for the government it is make or break time. In spite of calls to scrap the Bill the Coalition will see it through come Hell or high water. The changes will see the budget control of the NHS passing to GPs, general practitioner groups, rather than PCTs, primary care trusts.

Perhaps it may be worth pointing out that huge sums of money were spent creating PCTS, and their associated costs, only around eight years ago. They are now to be abolished in 2013. The same executives and management teams will be employed but by a different organisation. Setting up the GP groups needed will also cost a small fortune. 

At the heart of it is a desire to move away from traditional hospital care. If you are old enough you will have memories of Thatcher's care in the community which closed, for example, many Mental Institutions in the UK leaving vulnerable people cared for in the community. In reality the care was lacking and they were failed.

If like me you are cynical of the Tory's reasons for this latest NHS reform you may believe that it is all about privatisation. The building of privately funded hospitals and the sale of NHS ones. That to some extent has already begun. Look for who are the executives of such private hospitals and there will be few surprises. Perhaps one surpirse was a German Company involved with taking over UK NHS hospitals. This was kept fairly quiet.

Today Mr Cameron and Mr Lansley have been meeting with some of the people who will have to work with what this bill offers. However the meeting will be more remembered for the health care professionals that were excluded, than for those who attended. Put simply the only medical professionals invited were those who agreed with the planned reforms. The BMA, British Medical Association, and the Royal College of General Practitioners were excluded.

As the Guardian reported regarding opposition to the Bill, "David Cameron, facing widening opposition to the reorganisation from across the health service, sections of the Liberal Democrats, crossbench peers and fellow Conservative cabinet members, believes he has no alternative but to plow on with the health bill, and show there is a viable support base for the changes within the health service". 

What a farce!

The Guardian goes on to report former UK foreign secretary and doctor Lord Owen as saying, "He(Cameron) is clearly trying a policy of divide and rule in the hope that he can break the opposition to the bill by only asking those he believes will support him. The health service is based on much more integrated team work these days right across from nurses, doctors, commissioners and clinicians, and this is not the way to treat an integrated health service. A divided health service cannot function effectively. The prime minister may think he can outmanoeuvre or override the BMA in the same way that Clement Attlee and Aneurin Bevan did when the 1945 Labour government introduced the National Health Service in the face of opposition of the BMA. But the BMA in 1946 was much more evenly divided than they are now and Attlee had a clear electoral mandate from the British people to push through his reforms – something Cameron does not have."

Which brings us back to the start of this report. No David Cameron does not have the will of the people behind him as far as NHS reform goes. He may have a handful of cronies and the like but not the will of the general public. Neither did he have a clear majority giving him the edge in such reforms.

This blogger's conclusion is that maybe what Lord Owen said about, "A divided health service cannot function effectively", could ultimately be the Coalition's purpose. After all Cameron knows we all love the NHS so perhaps he wants to ruin it to the extent that we hate it and surrender. Do not let him win.

Remember many of the so called health care professionals happy about the reform of the NHS have monetary links to private health care and a vested interest in this Bill.