Reviews

Are the media losing faith in the NHS?

Amid all the debates that have raged over the past couple of decades about how to make the health service more efficient, one thing has always seemed clear: that the NHS is sacred. Even Mrs Thatcher, when her government introduced market forces to the heath service, didn't dare tamper with the idea of an NHS free at the point of use. The NHS has been likened to a theological institution, something that inspires fervent, almost religious belief (BMJ 1999;319:1588-9): any suggestion that we should deliver health care any other way is likely to be dismissed as heresy.

Or is it? Have horror stories of arduous trolley waits, filthy wards, staff shortages, and doctors and nurses at breaking point meant that we are now beginning to say the unthinkable. Two weeks ago, at a time when any paper could fill every column inch with reports on the "war against terrorism," one of the most left leaning, pro-public sector national newspapers devoted a whole page to the case against the NHS. Under the headline "Why the NHS is bad for us," the Observer's health editor, Anthony Browne, confessed that he had finally lost faith in the health service and that we needed to find new ways to deliver health care, by using insurance and charging fees.

Browne said that after two years as health editor, listening to stories of suffering and misery, he had come "to the only conclusion that my heart, intellect and integrity would allow me: we must abolish the NHS as we know it, abandon our unique obsession that all health care should be free." This is the kind of statement you might find in a right wing newspaper, such as the Daily Mail or Daily Telegraph. But from the Observer? Surely there would be a backlash of condemnation? Or now that Browne had outed himself as a non-believer would there be a flood of confessions?

Last Sunday's Observer devoted another page to the debate, this time filled with letters from readers and NHS pundits. Browne said that he had expected a barrage of hostilityfrom patients, doctors, and health care analystsbut that the criticism was overwhelmed by messages of support. Hundreds of doctors, nurses, and managers had written to say how they too had lost their belief in the NHS. Professor Stephen Smith, a senior medical practitioner from Cambridge who described himself as a "lifelong Labour party member and for years an apologist for the NHS," said, "Like most of my colleagues, I have come to believe that the system does not and will never work."

Letters of caution came from Ian Bogle, of the BMA, who said that the BMA had "no ideological opposition to involving the private sector more fully," but that these funds must "enhance, not detract from NHS provision" and from Rabbi Julia Neuberger, chief executive of the King's Fund and author of the BMJ article on the NHS as a theological institution. She wrote that "the problem with the NHS is not its ideological basis" but rather the long term underinvestment and "over-centralised political control."

So can we expect to see more expressions of apostasy in the British media? Peter Davies, editor of the Health Service Journal, felt that Browne's article might "be the first indication that left leaning newspapers are losing faith in the NHS," but he was more inclined to feel that Browne might be "out on a limb." Nigel Duncan, head of communications at the BMA, agreed that "there is a mood out there developing that the NHS is fighting for its survival as a principle and a concept," but he said that one person's view should not taken too seriously.

Alex Vass. 

BMJ