Why we HAVE to start thinking the unthinkable about the future of the NHS I love

(This article was published by Mail Online)

hospital ward

This article first appeared in The Daily Mail

We need to talk about ‘our’ NHS. It is quite clear that it is at breaking point and that radical reform is needed to ensure its survival. And yet anyone who dares say so risks provoking hysteria. 

Hospitals in England are desperately understaffed. A report this week by the Commons Health and Social Care Committee revealed that we need 12,000 more doctors and more than 50,000 nurses and midwives. 

By the start of the 2030s, the NHS is expected to require 475,000 more workers, with another 490,000 jobs projected for carers. 

But these services are already heavily pressed. One carer in three quit last year and the number of full-time GPs has fallen by more than 700 since 2019, with the majority now only working part-time. The average waiting time for an ambulance is a staggering 51 minutes.

Continue reading this article in The Daily Mail


  1. [email protected] says

    Important discussion. It might be useful just to rewind a little bit and to remember that after WW11 we had no money but we set up a health service that became the envy of the world. A lot of that was to do with genuine political will for a more caring sharing society –tax was progressive. Today we hear that it’s all about tax cuts though there is scant no evidence that tax cuts create healthier or happier societies, in fact all of the evidence is that it creates unequal societies, greater social injustice, more unhappiness, poverty, crimes and so on. So the question is do we try and squeeze more money out of people to fund the health service at the point of use or do we think more carefully about why we are not prepared to fund the health service as we dreamed of in the 1950s. I’ve worked in the NHS for over 40 years and I have to say that the waste of billions from political NHS reorganisation after reorganisation after reorganisation is absolutely tragic. We went from regional and district health authorities through to these broken up structures called trusts which compete with each other. Although they were presented to be for patient choice actually it was always about forcing management to operate in financial envelopes. One of example is that patients actually want local hospitals if they break a leg or are having a baby –mega hospitals really are for the more severe and serious conditions. My GP colleagues of my age are in despair about the shift away from family medicine –and their is much evidence that it (along with community medicine) has preventive effects to — and you can be on the phone for over an hour just trying to book a telephone conversation. If you were to do surveys of patients, while many value their GP, they would also talk about the intense frustration in the service now. Time wasters there are, along with the hypochondriacal anxious and depressed, but they are not the problem. The creation of an internal market of commissioners has been a waste of money, many of them have little clinical idea what they are commissioning anyway and simply go for the cheapest option.
    Many think it all started to go wrong with the Griffiths report back in 1984 -when Thatcher was so intent on tax cuts that she had to find ways in which she could save money from an increasingly effective with amazing advances and therefore expensive health service — bringing in somebody from the private industry, CEO of Sainsbury’s brought a completely new way of thinking about service delivery much as you would deliver baked beans or joints of beef. There’s a general appreciation that the power structures moved away from clinicians towards managers with financial targets and also wanting to open up private companies — so privatising seemed to be a good option to enable tax cuts –although once again there is no evidence that if you don’t cherry pick your patient aliments -and stay clear of chronicity –you can actually create a better system with privatisation and skimming off money to shareholders.

    there is no doubt that other countries can have more efficient services than we can because of investment pure and simple and also greater clinician led decision making. Mixed models have also always been on the cards such as combining private care with basic services — people have compared this to transport where you can pay more and get a better seat on a plane or a train but the plane and technical skill of the driver/pilot is the same for everybody — it is the comforts that change -and sometimes speed of access. clearly those who can pay and want to pay for more frills above market value to allow reinvestment –is an idea –bring the profits of private care into the NHS
    there’s a whole area of discussion about how and why health services have become less responsive and are experienced as less compassionate (Trzeciak, S., Mazzarelli, A., & Booker, C. (2019). Compassionomics: the revolutionary scientific evidence that caring makes a difference (pp. 287-319). Pensacola, FL: Studer Group)

    for many staff caseloads have simply spiralled.
    Crawford, P., Gilbert, P., Gilbert, J., Gale, C., & Harvey, K. (2013). The language of compassion in acute mental health care: Qualitative Studies in Health Care. 23(6) 719–
    727 DOI: 10.1177/1049732313482190.

    Crawford, P., Brown, B., Kvangarsnes, M., & Gilbert, P. (2014). The design of compassionate care. Journal of clinical nursing, 23(23-24), 3589-3599. https://doi.org/10.1111/jocn.12632.

    The fact of the matter is there’s an awful lot that can and should be done to support staff not just about funding –Many are leaving the NHS not just because of pay but because they feel exhausted unsupported, un appreciated and confronting increasingly frustrated -and at times fearful patients. if we want a decent NHS then it is more than just funding
    Albright, B. (2021). HEALING THE HEALERS IN A POST-PANDEMIC WORLD. Physician Leadership Journal, 8(4), 23-25.

  2. marobinson71 says

    Thank you for that! I have now taken out my eyeballs scrubbed them thoroughly and put them back in following having had to go on the Mail Online.

    Joking aside, a crucial debate that needs socialising far and wide, so well done.

    And how else would I have got to know that Justine Bieber has recovered from Ramsey Hunt syndrome!

  3. Stephen Gwynne says

    As long as the UK population continues growing, then the amount of required health professionals keeps on growing.

    If this requirement is fulfilled by immigration, then not only do we need to consider the economic harms of brain drain but also the continued ecological harm of population growth and in turn the vicious cycle (positive feedback mechanism) of continued immigration in order to provide the necessary health professionals to fulfill immigrant’s needs.

    This demographic dynamic is the ecological basis of a Health Service that is always perceived as inadequate simply because demand is always outstripping supply.

    This demographic dilemma becomes even more problematic considering the negative fiscal impacts of immigration which not only reduces per capita health resources but also reduces per capita tax revenues and in turn erodes the consensual basis of taxation.



    This leaves a political Right that does not want to subsidise through taxation migration led economic growth which actually creates per capita impoverishment. And leaves a political Left who similarly does not want to subsidize through taxation migration led economic growth which actually creates per capita impoverishment but rather than critique the cause, chooses instead to deflect to self righteous virtue signalling about the xenophobia of the Right.

    This of course leaves a stalemate of inaction with the Right blaming migration led population growth and the Left blaming the xenophobia of the Right with neither prepared to pay more taxes so insideously leaving a political Left that is hypocritically unprepared to walk their talk.

    Thus the NHS crisis is actually a symptom of a political crisis which dare not mention its own name.

    Where is a politically expedient Monarch when you need one in order to bang some heads!

Leave a Reply

Published by

Mail Online

The Author
Latest Related Work
Follow Us