The NHS needs reform to flourish

The NHS has been dominating local headlines of late. The Whittingon's A & E is threatened with closure. The Royal Free's physiotherapy department is going out to private tender and its award-winning stroke unit has just ceased emergency treatment. There is talk of the Free and Whittington merging. We read reports of substantial job cuts at the Free. The Ham & High has taken up the baton and is leading campaigns on these issues.

In the 62 years since its birth, the NHS has become a much-loved national institution. Its founding principles were put well by Aneurin Bevan: "No longer will wealth be an advantage, or poverty a disadvantage. Healthcare will be provided free of charge based on clinical need and not on ability to pay." I agree with him.

The NHS of today looks very different to the one Nye Bevan set up in 1948. It is now the world's third largest employer, behind the Chinese Red Army and Indian railway (some say fourth largest, depending on how you count Wal-Mart's staff).

So why, 62 years after its foundation, are so many local services apparently under threat? Could it be lack of money from taxpayers? Emphatically, no. One positive thing the current Government has done is spend on the NHS. As a Conservative, I agree that the NHS should be properly and fully funded. I was delighted when David Cameron recently said that he would protect the NHS budget. There is no doubt some serious savings will have to be made from the national budget, but the NHS is not the place to cut.

The scale of the spending increases over the last 13 years has been vast. NHS spending went from £37 billion in 1997 up to £120 billion today - more than tripling. Camden's economic contribution to NHS spending works out at £12,000 per household on average.

So has this extra money been wisely spent? According to Office for National Statistics, it has absolutely not. The ONS reports that NHS productivity has in fact fallen by a shocking 10% since 1997 - at a time when private sector productivity has been dramatically growing as a result of better management and use of technology.

Around 60% of the spending increases have gone in cost inflation, and so hasn't even resulted in more resources being deployed. One thing that has grown is the number of Managers and Administrators in the NHS: they have grown at a rate three times faster than clinical staff.

So what's going wrong? A former nurse with many years service, said: "I knew I had to leave when the paperwork became more important than the patients".

In the last 13 years, the current Government have tried to run the NHS as a vast centralised bureaucracy. They have set targets that deny doctors, nurses and GPs control over how services are run. Professionals' careers depend on satisfying Government targets, not delivering patient welfare. This vast bureaucracy soaks up money and actually makes the system less efficient. The pressure group Doctors for Reform put it like this: "Doctors are beset with political targets and central direction, distorting clinical priorities. The monolithic structure of the NHS simply does not allow the effective transmission of resources to frontline services."

This is why so much of the money is not well spent. It has simply disappeared into a huge centralised bureaucratic system. This is why local services are under threat, despite ever increasing amounts of money being poured in at the top.

If only the system consumed less in administration, then the Whittington's A&E would not now be under threat. If only the Government had spent our money more wisely, we would not now be contemplating staff cuts at the Royal Free.

What is the solution? The answer lies in radical reform. Instead of the Government trying to run the whole system centrally via targets and micromanagement, let's give doctors, nurses and GPs the freedom to deliver the service local patients need - to make the patient more important than the paperwork once again. Let's allow hospitals freedom to run their own affairs, and put GPs back at the heart of commissioning what they believe is best for their patients.

This needs to be accompanied by proper patient choice for elective care. The money will follow the patient. So instead of the Government telling us which of our local services will expand or close down, instead patient choice and local GP commissioning will drive it.

This will be a radical improvement in the way the NHS operates - instead of running from the top down according to diktats from headline-hungry politicians, local people and their GPs will become its heartbeat once again. No longer will we see important local services closing down on orders from Whitehall. And the money saved by radically slim-lining the current bureaucracy can go back into front-line care.

The NHS could once again be a great institution. But like anything, it needs reform to flourish. The recent threats to local services show why that reform is so important.

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