Let’s be frank about the NHS

In a guest blog for The King’s Fund, Laura Fulcher explains how her poor experience as an NHS patient has prompted her to question whether our affection for the NHS as a national institution is blinding us to how it needs to change and improve.

What best represents the UK today?

Is it Britannia, with flowing mane, trident in hand, on a 50p coin? Or perhaps Lord Kitchener, his stubby finger pointing at you from World War 1 propaganda: ‘Your country needs you.’ No, such militaristic images don’t define us nowadays.

For a country devoid of a unifying religion, with nationalist pride used by some to justify racist thuggery, we must find our identity somewhere. And we find it in the NHS – that all-compassionate healer of the sick.

Yet NHS propaganda comes with the implicit threat of Kitchener’s finger. Without our zealous support, the health service could well be snatched away. ‘Save the NHS!’, the placards scream. For if we are deprived of our health service, who will cure the sick, who will deliver babies, who will save us in our hour of need?

And so we clutch the NHS to our bosom. We must protect it; ensure it doesn’t change; never a bad word must pass our lips.

I was born within the NHS for free – it’s the greatest treasure in the world!

No one could ever say anything bad about the NHS, because it’s made up of such caring, hardworking people.

With the NHS so entrenched in the nation’s psyche, it has become almost a treasonous act to call for improvements. We place the NHS on a pedestal as the envy of the western world. And as the system is now synonymous with hardworking clinicians, negative patient feedback is stifled further. We can’t possibly criticise overworked nurses, can we?

And so we don’t seek policy change or campaign for specific meaningful investment.

I too trusted the NHS once.

As a secondary school teacher, I was confident that the health service would be there for me in much the same way as I supported my students. But after the 15 months it took to fight for a cancer diagnosis at 29, that blind trust is long gone. Thousands of others are placed in a similar or worse situation every year, many of us waiting months or years to be diagnosed.

But there’s no use complaining about the delay. You’re told no mistake has been made; your treatment was timely; the only thing failing the NHS is ‘limited resources’ – something seemingly out of any one person’s hands.

‘Limited resources’ has become a catch-all of excuses; the ultimate shut-down of debate and improvement. This inertia now pervades the public, NHS workers and politicians too.

And to those whose eyes are open to the NHS’s issues, what options are there but disillusionment and disempowerment?

Certainly you can’t speak up. The formal complaints procedure is out of reach for anyone who values their mental health. Policy decisions are kept far away from patients. Not one person sits on the NHS England board in the sole capacity of a patient. Where is our People’s Champion? Who represents our views? Even NHS jargon, either purposefully esoteric or pointlessly truistic (‘person-centred care’ – I ask you!), seems set to complicate matters further.

With no opportunity to campaign for better, disillusionment breeds frustration. Harsh words are spoken. Commissioners begin to believe all patients just want to cause trouble; they batten down the hatches; they don’t want to engage. The public is perceived as too passionate, too uncontrollable.

Behind closed doors, financial decisions take priority over human life. Commissioners are told they can’t slide into further debt, so NICE guidance is overruled, services cut, waiting times lengthened… capacity never found. Propaganda states that private hospitals are the devil for putting profits first – but is this worse than an NHS at the mercy of an austerity-leaning government?

I paint a picture steeped in impossibility – everything seems just too difficult. With the menacing rhetoric, the ‘limited resources’, the jargon, the adversarial public relationships, the demonised government, the politicised system, the fact that policy decisions are all made so very far away… how can change ever be made?

The solution is brutal honesty.

The NHS in its current form is a system born of policy, targets and financial investment. Viewing it as such allows us to talk frankly about what we actually want from a health service without worrying about denigrating overworked staff or bruising our national pride.

Hard questions do not just need posing, they also need answering. And it is the public’s responsibility to do just that.

How long does Grandma really need wait for her hip replacement? A month, or two. Shouldn’t all cancer patients be diagnosed within two weeks? Yes! Do we really want our hardworking doctors and nurses run in to the ground? Definitely not. And fundamentally, don’t we all want a service that genuinely meets the needs of all?

The nation’s answers to these blunt questions must replace the current moveable targets that are so easily manipulated. Instead, they will form a transparent contract outlining what the public can expect from the NHS, with no place for blind trust in vague promises. Solid expectations would empower us all to champion ourselves.

But to reach this open and honest world, culture needs to change. The NHS should never feel faceless or corporate but should be ‘people powered’ and wholly entwined with the local community. Red pens should be wielded to cut the jargon that makes strategy so inaccessible. Communication channels should open – through social media, email, by providing open-office hours, and launching Westminster ‘fly-ins’ to engage the public in debate.

Complaints should be treated as opportunities to improve rather than pesky letters to be dismissed and ignored by departments that are so distanced from the front line. Leaders must stop seeing policy as a set of divine commandments inscribed in stone, but guidance to be challenged and upgraded.

And in all this, the public should be reimagined, not as the ‘great unwashed’ fixated on problems, but as energetic folk with the capacity to lead on improvements with innovation, passion, and resolve.

Source: The King’s Fund