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Angela Tilby: We should be honest about the NHS

08 November 2019


THE NHS is already a significant political football in the forthcoming General Election. Labour is raising fears of privatisation and a sell-out to United States drug companies, while the Tories are promising more money, more hospitals, and more staff.

It has been said that the NHS is the nearest we have to a religion. Almost everyone claims to support it, almost everyone believes it is underfunded, almost everyone is genuinely grateful at some point for its interventions.

Yet it would be a mistake to worship the NHS, which we often tend to do. From the doctors comes a stark warning to the Government: money is a problem, but much more of a problem, in their view, is the culture of the NHS, run by politicians, civil servants, and managers on the ground, who have only a limited understanding of the needs and limitations of clinical practice.

In the medical memoirs that I tend to read at night, I am struck by how many brilliant surgeons, physicians, and nurses leave the service after years of frustration at the bureaucracy and waste; at a blame culture that leaves staff anxious and guilty; at the pettiness of some of the rules and the way in which they hinder best practice; and even at the hopelessness of IT systems.

There must be something wrong when senior consultants are retiring early to protect their pensions (only to be rehired on a part-time basis), when GPs leave medicine early because they are physically and psychically worn out, when the only GPs available at night are from agencies — and that is before even thinking about waiting times and sick patients on trolleys in A&E. It does seem extraordinary that an institution that allegedly is the biggest employer in Europe is constantly short-staffed, constantly underfunded, and constantly complaining about political neglect and interference.

There needs to be a more honest conversation about what the NHS can and cannot do. It should not be doing social care (everyone knows this, of course, but it still is). It needs, somehow, to get out of the punitive private-public partnerships of the Blair government, which are draining its resources. It needs a different funding model for some of its specialisms. It needs IT systems that work. It needs a culture of learning that is led by practitioners and free from blame and bullying.

Many already pay prescription charges; perhaps some should be paying something towards GP appointments (especially people like me, the constantly worried well!). Perhaps there is scope for some kind of insurance-based top-up to work in tandem with direct funding from government. Perhaps, above all, we need to manage our expectations.

The NHS is a blessing, but it cannot solve all our problems or ensure our personal happiness. We need to tune the religious fervour out of the conversation.

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