Why are we here…

Training Primary Care NHS GPs Why Are We Here...

The more you look at the numbers, the more you delve, the more you can see the problem.

There’s a huge divide developing between the north and the south.

Although government spending is roughly even across the country, because of communication and nearness to markets, many businesses are attracted to setting up in the south.

This creates a bow-wave of wealth in the south and a difference in social and economic conditions.

This fact, alone, was quietly identified as the root-cause behind the disaffection with government that, in part, expressed itself in the Brexit referendum.

The vote was not so much about being in Europe as it was, being in a dead end job, or being unemployed, or being in rotten housing or being in despair of a life that didn’t seem possible to improve.

Higher unemployment, lower house prices. Lower life expectancy, lower educational attainment. All-too-real symbols of the actuality of the divide.

Fixing it isn’t easy. Devolution is the first tool in the box. Give people the money and let them sort themselves out.

Looking at Manchester, it doesn’t strike me as working too well and, not surprisingly, there seems little appetite for employing the tool elsewhere.

Rebalancing funding? That doesn’t work too well in an economy struggling with austerity.

Investing in infrastructure? Yup. In 2014 the government announced it would invest £15bn on improving and expanding roads. Twenty five billion will have been spent, by the end of the year, on upgrading the railways.

CrossRail in London is way behind and HS2? I wouldn’t bet the farm on it.

For all of that, I don’t see getting to Brum, or out, on a Friday, is any easier. Getting from Lincoln to Liverpool on the train? Forget it. Go to London and start again.

Globalisation, the internet and deindustrialisation all defy government policy.

Privatisation, or not. Deregulation, more regulation. Enterprise zones and attempts to gear-change national productivity. Not much of it touches the lives of ordinary people. Even less, changes lives.

It’s probably right to say, the internet and access to it, destroys as much as it creates.

The high street and what it means for communities and jobs… disappearing because we now have access to a global corner shop whilst sitting on the sofa. From phone to home, in hours.

It’s impossible to ignore these influences when we plan for the future of our health services. Planning for ten years is as preposterous as it is necessary. We have no idea what the future holds but we must take a stab at it.

Future bed demand; the volatility of the healthcare landscape and promised improvements that may never be delivered, makes it useless. In consequence, we have no reliable way to calculate the number of staff we shall need and as a result, no forecast of training, recruitment needs and costs.

When I see CCGs and others struggling to deliver another change I’m left to wonder; what difference will it make?

I’ve seen umpteen reorganisations, some have been structural and others fiddling. Each one of them has brought us to this moment and at this moment we are reorganising, again.

England’s, northern excess-mortality has been consistent among those aged <25 and 45+ for the past five decades. Fifty years and we are still defeated, still reorganising.

English seaside towns? Decimated over the last 20 years. Irrecoverable?

The latest wheeze is ‘criteria based healthcare’, which as far as I can see has no clinical foundation, the criteria arbitrary and has no purpose, other than to reduce access to treatment, save money and annoy and worry people in equal measure.

National economic policy, health system reorganising;

• How and when will any of it touch the lives of ordinary people, for the better?

• How and when will it make it easier to get in, get diagnosed, get fixed up, get out and get on with a life.

• How and when will any of this create jobs, safe places to live and environments of harmony and happiness?

If we can’t answer these three question… why are we doing it? If we are not here to create peace of mind. Why are we here?

Contact Roy – please use this e-address – roy.lilley
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Reproduced at TrainingPrimaryCare.com by kind permission of Roy Lilley.