What I learnt this week: Oh NHS, you are still sick #WITLW


This is the 92nd #WILTW

“But one structural change that hasn’t been seriously tried and might well raise a cheer within the service would be to find a means to separate the NHS from politicians. There is a theory that the most politicised health services around the world do the worst. The short timetables, constant change, and demand for instant gratification that are features of politics do not sit comfortably with running a huge and complex service”

Richard Smith wrote this in 2002 in an editorial for the BMJ entitled  “Oh NHS, Thou art sick“. I think the sentiment is still shared by many almost 15 years later. If the NHS was ill then it may be considered to be on intensive care at the moment. Roy Lilley has described a perfect storm of challenges:

Clearly the debate over the imposition of the junior doctor contract is dominating both corridor and digital conversation with it being described as unsafe and unfair. At the risk of being squashed by the social media anger train I’m not convinced that what I have seen proposed is any more, or less safe, than anything that has gone before it. Unfair it is though, even for a mild mannered, sit-on-the-fence person like me. I have listened carefully to the argument put forward by Jeremy Hunt and repeatedly there is confusion between what is wanted of the NHS at a weekend and the role that junior doctors play in providing it. The NHS operates differently at the weekend but only in part because of insufficient funding to have the same numbers of doctors rostered on seven days a week. Firstly there certainly isn’t an excess of appropriately experienced ‘junior’ staff (remember the term junior doctor describes anyone from first day after medical school to just before becoming a consultant) to provide universal cover even if the department of health were willing to give all doctors a huge pay rise. Furthermore while I don’t buy into some of my colleagues frustration at mis-use of statistics (the medical profession have been arguing internally about cause and effect for the better part of this century) it is outrageous that without any form of evidence or research a national directive should be put in place that assumes slightly adjusting rota patterns will improve mortality.

Photo via @butNHS

The contagion creeping through the NHS at present appears to be more than a poorly managed negotiation though. There is a conundrum that despite ever increasing demand and expectation there is not the funding that correlates with it. Certainly efficiencies can be made but there is no breathing space in the system to implement the kind of interventions and ideas which could be transformative. The NHS is ill, and it doesn’t even have time to take its medication, let alone start any form of rehabilitation.

Health care professionals often enjoy dark humour to get them through difficult times but I sense at the moment a universal pattern of reduced resilience. While it may be that the soul of the NHS is at the whim of politicians; at its heart is its staff. They, and not just doctors but all employees, cannot remain in a critical condition  for ever. The NHS is ill and it needs to start getting better.

What have you learnt this week #WILTW

An excellent review of “The 7 Day NHS” by the BBC can be found below

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4 thoughts on “What I learnt this week: Oh NHS, you are still sick #WITLW”

  1. Taking the NHS out of politics would save money and improve staff morale . If you have not seen it please do look at the excellent paper by Lale & Temple (JRSM; 2016 109(1) 18-26) which demonstrates that ‘reforms’ waste money and do more harm than good. Once politicians have got off the back of the NHS the question of what happens at weekends could be sensibly resolved.

  2. It has been said that the NHS is the closest thing the UK has to a national religion. No politician would leave the NHS to run itself when they are still ultimately accountable to the electorate.

    However, I couldn’t agree more that the NHS needs to somehow become depoliticised. Quite how to get from A to B remains to be seen.

    1. It is a dichotomy though isn’t it. It appears that removing the financial burden and responsibility for performance of the NHS is a long term political strategy but at is at odds with maintaining its ‘icon’ power. I worry how things will unravel!

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