Is the NHS at war? Some see this debate as “right v left”, but others as delusions v reality

In the BMJ 31st July 2015 David Oliver writes :Is the NHS at war? (BMJ 2015;351:h4127 )

Is the NHS at war? Some see this debate as “right v left”, but others as delusions v reality, and this does not mean we don’t see it as a public good. We are just pragmatic about the need to ration given the advance of technology and the demographics in The Information Age. The burnt out doctors and nurses are sometimes walking ghosts in the battlefield. …

What else could explain such repeated economy with the truth from health ministers and the Department of Health’s own “war information ministry” (or press office) when discussing NHS funding, efficiencies, and services? And the supposedly independent NHS England does too little to challenge the misinformation.

Propaganda includes confident but incredible assertions and denials, the burying of inconvenient truths, and “magical thinking” that ignores recent history.

NHS England, for example, has proposed £22bn (€31bn; $34bn) of “efficiencies”1—but economists, policy experts, and NHS leaders in their droves say that these cannot be delivered. The government’s “up to £8bn extra investment by the end of this parliament,” the most NHS England dared ask for, won’t sustain even current service levels.2 3

Nine in 10 hospitals forecast deficits, and clinical commissioning groups face serious financial hardship.4 5 Patrick Carter’s review identified only £5bn of savings at best,6 and most recent savings have come from pay freezes, not from new ways of working. Everyone—including the ministers and communications teams who repeat the mantras—knows that there’s a crisis and that the solutions proposed are inadequate.

As for inconvenient truths, take the huge cuts to social care.7 The health secretary, Jeremy Hunt, ignored them in his “25 year vision” for the NHS,8 as well as the £22bn savings and the cost of three years of reorganisation after the Health and Social Care Act 2012.9

The Department of Health, while pushing for a “seven day NHS,” has glossed over the problems surrounding recruitment in primary care and some hospital specialties. And the independent National Institute for Health and Care Excellence’s review of nurse staffing levels has been shelved10—just as Hunt announced, without irony, that the NHS should focus on patient safety.

Examples of non-evidenced magical thinking are legion. Take the projections for a 3.6% reduction in urgent activity in clinical commissioning groups, while emergency department attendance is spiralling.11 Or the notion that giving a “care plan” to 2% of patients over 75 could deliver big, quick benefits. Or the push for telecare to “transform” three million lives, leading to the end of care homes.11 Or the Better Care Fund, with its big, undeliverable expectations and even bigger spin.12

Politicians will be politicians, of course, and spin doctors will spin. But it’s come to something, in a still wealthy democracy with information freely available, that these charades continue despite having almost no credibility among the two million people working in health and social care.

If the tanks really were rolling in, I’d hope that those in Whitehall might let us know; but we’re not at war. So, how about some straight talking about funding and performance pressures? The public and the staff can take the truth—and they need to hear it.

Reply from Michael H Stone :

Yes, ‘the NHS is at war’. Those of us who see the NHS as ‘a public good’ and who want it to be funded from general taxation and ‘free at the point of use’, are permanently ‘at war’ with some right-wing politicians who would prefer for healthcare ‘to be privatised’.

Hospitals war with neighbouring hospitals, if there is a plan to close one; departments war with other departments, over resources; clinicians war with other clinicians over whose speciality is the most worthy of better funding, and the patients receiving the services join in; nurses, doctors and patients frequently seem to be ‘at war with each other’; some people from NICE have told patients to take legal action against CCGs which are not providing treatments NICE has recommended; scientists war with politicians over the concept of ‘evidence’; etc. The list is almost endless.

I myself am involved in if not a war, an ongoing skirmish, with what feels like most of the NHS, about certain aspects of end-of-life behaviour.

And Dr Oliver and I have also ‘fallen out with each other’ in the past, although I have never understood why.

‘Is the NHS at peace – and has it ever been at peace ?’ might be an equally useful question.

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This entry was posted in A Personal View, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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