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Doctor, I’m in trouble

22 January 2016

Angela Tilby on the culture of the NHS

I AM increasingly baffled by the junior doctors’ dispute. Ostensibly, it is about the new contracts designed to enable a 24-hour NHS. But it carries much extra baggage.

Some of this comes from a nostalgia for Trotskyite 1970s activism, as medical staff apparently relish the chants and banners of the Winter of Discontent. But the doctors are also protesting about a fate that they share with other professionals in the judiciary and in teaching: the loss of status.

Doctors are no longer treated with reverence. Increasingly, they have to earn respect rather than expect it. None of this is helped by the culture of the NHS, which is hopelessly resistant to reform.

It is as though the whole institution has taken on the reverence once given to doctors, and resents outside interference. It has a point. Successive governments have tried, and failed, to improve its efficiency, but patient demand and the cost of new treatments constantly outstrip capacity.

The public are overwhelmingly in support of the NHS. It is the religion to which all conform. But, even so, public support is not unquestioning. Everyone can see how easily executives could be tempted to overspend in order to claim that they were underfunded. “You want a solution? Give us the money.”

Although the public are inclined to support the demand for more funding, they are not prepared to write an open cheque. They know that there is something rotten at the core; and, while they are disposed to blame politicians, they also suspect that the NHS could do better.

Public unease manifests itself in the feeling that it is not safe to complain. The system can bite back, as it has against whistle-blowers and patients who query bad practice. So people raise eyebrows when things go wrong, but rarely argue; while, if things go well, they are almost over-lavish with praise.

There is, of course, much to praise in the humanity and care of many NHS staff. But the doctors are being disingenuous as they present their case as being wholly to do with patient safety. It is, frankly, as much about money and status. They know that there are faults, but blame it on the Government. Meanwhile, they hint that they might accept change if they are bribed to do so.

When the NHS was founded, Aneurin Bevan persuaded resistant consultants to agree to his scheme by, as he put it, “stuffing their mouths with gold”. But, today, the gold has run out, and the case for a modern 24/7 NHS is overwhelming. The doctors need to look beyond self-interest; but a culture of aggrieved entitlement within the NHS makes it almost impossible for them to do so.


The Revd Angela Tilby is Diocesan Canon of Christ Church, Oxford, and Continuing Ministerial Development Adviser for the diocese of Oxford.

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