Neil Shastri-Hurst is a former British Army Officer, and is a doctor and a Conservative activist in Birmingham.
There is open warfare in the United Kingdom at present. It is taking place amongst the corridors of Whitehall, the meeting rooms of the Department of Health, and the wards and clinics of numerous hospitals and general practices. The munitions take the form of speeches and protests. Social media provides the insurgency, and briefings from both sides promulgate the propaganda. But, what is being fought for? “The future of the National Health Service”, cry both opposing forces. However, the real question should be: is the current NHS worth fighting for?
My question is provocative. It is intentionally so. However, that does not mean it is anything other than judiciously posed. There is so much focus on plastering over the problems without treating their fundamental cause.
I find myself in a somewhat lonely position. Somewhere out in No Man’s Land. A Conservative – but also an NHS doctor. There are others scattered around me, but their voices are drowned out by the cries of the opposing factions. It is not a comfortable place to be. Despite this, perhaps, it allows one to be receptive to the ideas and concerns of both sides and try to look for a solution.
We need to have a very honest debate. A debate so brutally honest that, understandably, elected politicians consider it kamikaze. A debate that the medical profession has yet to – publicly at least – voice in any great number.
In 2006, a quote attributed to the now Lord Reid, then Home Secretary, described his new department as “not fit for purpose”. This is a phrase that could quite readily be applied to the NHS today. This statement is meant in no means to denigrate the exceptional hard work that those toiling within the National Health Service offer every day. Their efforts, in challenging and often trying conditions, are remarkable. However, the present structure, its demands, its misuse, and the lack of trust between the medical professionals and their governing masters, and vice versa, has led to a system that, if not ungovernable, is struggling to retain its fundamental principles.
The Beveridge Report led to the creation of the National Health Service. It recommended the creation of a “comprehensive health and rehabilitation services for prevention and cure of disease”. No one would argue with such a sentiment or principle. The danger is that now we are fighting purely for the principle without considering how this is best achieved in a vastly different nation. The public expectations, the service demands, and the evolution of medical technologies mean that the NHS cannot be a bottomless pit of money. Health rationing has always taken place, but perhaps it is time to be more up front about what we can realistically afford in a public system. Put simply, the public cannot expect that all treatments are available through a nationally funded healthcare service.
The vast majority of patients value the service that is provided. Sadly, a minority abuses the resources to such an extent that it has a disproportionate impact on those who respect those very same resources. As a result, the deserving potentially miss out on treatments and investigation. The answer is not simply providing more resources, spending more money, or employing more staff. It is soul-destroying and frustrating to know that, as a healthcare provider, the selfish actions of a few are contributing to the destruction of the NHS. We must be bold and address this issue head on. No government, Left or Right, has been able to effectively manage the nation’s health resources. However, drastic action is now required.
Meanwhile, there are valid arguments on both sides of the war I describe. There has been propaganda from both the Department of Health and the British Medical Association. Jeremy Hunt, intentionally or otherwise, raised the spectre of senior doctors downing tools on a Friday afternoon and return bright and early on a Monday morning. To anyone who has stepped foot near a hospital recently this is patently untrue.
Furthermore, statistics cited with only a passing glace at the evidence base are not helpful in informing the lay public of the issues at hand. No one would argue with providing high quality emergency care 24 hours a day, seven days a week. We must question, though, how realistic the public expectation is for routine work outside normal hours. Do the inevitable financial costs and workforce demands make this policy credible, effective, and sustainable in the long term?
The BMA, however, has moved away from its traditional position as a representative body of the medical profession and taken on a role more akin to a trade union. In doing so, it has fanned the flames of an already combustable situation. Withdrawing from the negotiating table was a mistake. However, the Government’s threat to push the reforms through regardless is grossly unhelpful. There have been well rehearsed sound bites on both sides, but there has also been a lack of leadership – of resolve to tackle the failures of the current system.
Morale is at a low ebb at present – I refrain from stating its lowest ebb as I am afraid that the graph is still heading in the wrong direction. It is entirely reasonable for professionals to consider themselves to have a value. Healthcare and its provision is no different. It is a commodity to be bought and sold. Let us not pretend otherwise. Doctors and nurses will therefore consider that their skill sets have a monetary value. They care and they should, and do, strive to provide the best care they can within the framework they operate in.
However, to consider that high quality candidates will be attracted to or remain within the profession if their working hours and remuneration are at odds is farcical. Purely and simply, they will walk. This is not about money per se, but more about a quality of life – be it increased remuneration for longer, anti-social working or vice versa. Until professionals feel valued, their loyalty to the service will continue to wane. It is a fundamental understanding within a fighting force: and let us make no pretense that the NHS is anything other than a healthcare army.
The war raging over the NHS is based on a principle set up almost 70 years ago. Whilst its core tenants hold some truth, its current format is no longer meeting the demands put upon it. There is a real risk that it is viewed through rose tinted glasses. The view is based on the concept that “the NHS is the best system in the world”. This has held credence for such a long time because it is compared, quite correctly, favourably with the US system. But reality is not so binary. There are many examples of other successful publically funded universal health care systems across the world – many, too, with outcome measures better than our own. Given the current standoff, perhaps the only way back to the negotiating table is by being bold, brave, and honest about what any publicly funded health service can offer in the 21st century.