Despite the hype, the effect on healthcare was only modest because acute care was excluded and GPs predominantly purchased care from their traditional, geographically based hospitals. Waiting times for the first outpatient appointment (ambulatory care) following GP referral and for admission to hospital rose. Election campaigns focused on a few high-profile and probably totally atypical cases such as “Jennifer’s ear,” where a young girl whose grommet surgery had been unreasonably delayed was wheeled out to the media to highlight the inadequacies of the NHS. Spending on healthcare was historically low compared with our European comparators.
Increased Funding—and Performance Targets
In 1997 the return of the Labour Party with Tony Blair brought new hopes and a vast increase in spending with an almost two-fold increase of the proportion of GDP devoted to healthcare. Salaries at all levels increased with an expansion in all groups of health professionals (including a 30% to 40% increase in the number of rheumatologists). There was also a massive hospital-building program, funded by public-private partnerships. The fact that such initiatives will be paid by future generations is ignored, but for politicians seeking a quick fix, the sight of giant cranes in every major hospital in the land showed “something was happening.”
The creed of Blair’s “New Labour” was that there had to be “delivery.” The problem was how to measure it. In the past 10 years, we have been faced with an ever growing list of targets for performance, with published league tables of the good guys and the bad guys (whether it is waiting times for cataracts or response times to dealing with complaints). The job security and rewards for the new breed of hospital chief executives depended on their meeting the latest bunch of targets. Professional activity started being managed to meet these targets in the teeth of great opposition and some incentives.
One new feature of this landscape was the waiting-list initiatives. In order to meet targets of specific waiting times for new (but not follow-up) outpatient appointments, hospital managers required extra evening or weekend clinics, paid for at premium rates. The incentive to see extra patients during the working day declined and paradoxically (though predictably) waiting times for new patients rose as many providers had to increase the number of slots for the follow-ups of these extra referrals.
The crude data for the past 10 years are clear: massive expansion in funding, many new hospitals, reduction in waiting times, and increases in salaries. The problem is that everyone is unhappy. The government’s solution has been to relinquish control of the hospitals, freeing them to become independent businesses (but remaining within the NHS) and encouraging those responsible in primary care for the purchase of secondary care to choose from a range of providers—both within and without the NHS.
Americanization of Healthcare
“Patient choice” has become the slogan of New Labour, and automatic referral to your local hospital confined to previous generations. As a consequence, some hospitals with established reputations are losing money and face a downward spiral of staff loss, low morale, and decline in service. These self-governing hospitals are staring bankruptcy in the face and may wither despite the political fallout even if alternative providers can fill the gap. A Mayo Clinic in London or a Scripps Clinic in Manchester could provide the NHS-funded healthcare of the future. This “Americanization” of healthcare in theory should not lead to a two-tier service. The goal is to ensure uniform quality and, possibly in contrast to the U.S. situation, British public opinion across the social divide still supports equality of access to the best care.