What do you think should be the political priorities for the NHS?BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h1808 (Published 09 April 2015) Cite this as: BMJ 2015;350:h1808
- Rebecca Coombes, head of investigations and features, The BMJ
Over the next six weeks, on broadcast and digital news, social media, and even our doorsteps, politicians will be holding forth about the NHS, defining the “issues” according to their political hue.
Funding pledges, a “seven day NHS,” investment in mental health, and a profit cap on private health firms are already features of this fledging general election campaign.
But what are the views of those who work in the NHS, for whom service failings are a daily reality? In an attempt to surface these core concerns, The BMJ has begun recording the experiences of readers working in the NHS for an audio collection, BMJ Voices, now available on www.thebmj.com. These voices—including general practitioners and emergency medicine doctors—present the problems as seen on the ground, whether that be “exit blocking” in emergency departments, primary care premises that are “bursting at the seams,” small practices pressurised into taking on yet more patients, or chronic underfunding for deprived areas.
BMJ Voices is a rolling project, but we especially want to hear your views during the run-up to the election on 7 May. If you would like to contribute you can do so by phone or email (see details at the end of the article).
You may share the views expressed by clinicians who are already part of BMJ Voices. Dominique Thompson, a Bristol general practitioner, for example, thinks politicians urgently need to target funds towards young patients.
“Young people don’t have a strong voice compared to the middle-aged and older voters, who the politicians are always keen to court, and who know their rights and the care they want.” She warns that the next generation of workers—the teachers, the carers, the parents— will be harbouring untreated eating disorders, years of early self harming, and, for those with chronic disease such as diabetes, the effects of poor transition from child to adult services.
For Jackie Applebee, another general practitioner and health campaigner in Tower Hamlets, east London, the next health secretary needs to fix the inequalities inherent in the current primary care funding model. “We are underfunded by about 33% because deprivation isn’t factored [into the model]. Healthy life expectancy in east London is 52; in more affluent areas it is 70. People in deprived areas die younger. This needs to be factored in.”
Out of London, Mark Folman, a general practitioner, and Chris Moulton, an emergency medicine consultant, highlight the difficulties of attracting funds and staff to non-city areas. Moulton, from the Royal Bolton Hospital, says: “Bolton is the biggest town in the UK, with a multiethnic, fast ageing population, but we don’t get the prestige and money of the cities.” Folman, based in Nottinghamshire, fears for his practice’s survival once older partners retire: “Our training scheme has 20% of places unfilled; people just don’t want to work up in our area. We can’t work any harder. We are at breaking point at the moment. If we can’t get people to try to support us, including more GPs, it is going to fail.”
Striking a national chord, Katherine Henderson, emergency department clinical lead at St Thomas’ Hospital, London, defines her “big issue” as chronic delays in moving patients out of emergency departments and into hospital beds.
“When it gets really bad you can’t unload ambulance trolleys so you end up with ambulance crews waiting to hand over their patient. Yesterday we had somebody who was waiting over 30 minutes to be handed over because we had nowhere for the patient to be unloaded. That is very difficult and stressful. The hospital recognises that getting beds early enough is important, but that can be difficult to achieve if you have problems getting some patients back into the community.”
Cite this as: BMJ 2015;350:h1808
What’s your big issue? To join the debate, contact BMJ Voices by phone +44 (20) 3058 7427 and leave a recorded message about your key concerns, or send a brief audio recording to. Please also leave your name, job title, and place of employment. A selection of contributors will also have the opportunity to attend a live health and care debate at the British Library, London, on 21 April, featuring the party health spokespeople Jeremy Hunt, Andy Burnham, and Norman Lamb.