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Margaret McCartney: Politicians: if you love the NHS then set it free from your non-evidence based meddling

BMJ 2015; 350 doi: (Published 23 February 2015) Cite this as: BMJ 2015;350:h860
  1. Margaret McCartney, general practitioner, Glasgow
  1. margaret{at}

The leaders of all UK political parties profess great love for the NHS. Everyone has ideas about its weaknesses and how to fix them. Many political commentators see the service as key to the imminent general election: it’s the closest thing we have to a national religion, which—at least in public—we all agree to believe in.

Danny Boyle’s dancing nurses at the Olympics’ opening ceremony gave us permission to be proud of the NHS. Healthcare staff (including me) often plead for less political interference in our day to day work. Can politicians understand what it’s like when our elderly and multimorbid patients need more care, when we are in a recruitment crisis and under pay freezes, with daft targets and a blameful media, all of which result in staff working under overwhelming pressure with early retirements and bleak morale? Danny Boyle’s pride is so often based on aspiration rather than reality.

Political narratives tend to omit the staff who really are the NHS. Every day these people choose to do things the right way, rather than the quick or easy way. Think of the staff who answer the phone when they are not on duty, and the staff who arrive early and leave late so that patients get decent care. The political response to the pressure on staff has been to publish league tables of failures, and to atomise blame by placing it on individuals, while failing to look at the stressed systems that enabled these problems to arise.

For too long politicians have forced policy on us that lacks evidence of benefit but that can do harm—for example, independent sector treatment centres, screening for dementia, health checks, the friends and family test, private finance initiatives, or the leagues of management consultants. These divert time, energy, and morale away from evidence based interventions that serve our patients well—ones that we are vocationally driven to perform.

So, how can we reduce political interference in the fabric of our work? Politicians could still have a role in the NHS by declaring how much of the gross domestic product they will spend on it. Then, with full transparency, with no financial vested interests allowed, and with clear analysis, NHS policy could be devolved out of direct political control. Instead, we should find wise people who either already serve in the NHS with kindness and compassion or who use it and know the value of human care. And these people should be nominated: those who push themselves forward or who are seeking honours should not be allowed.

It would be better to entrust our NHS to people who believe in its values enough to devote their lives to it. If politicians really loved the NHS they’d stop kicking it around.


Cite this as: BMJ 2015;350:h860


  • Competing interests: I have read and understood the BMJ policy on declaration of interests and declare the following interests: I’m an NHS GP partner, with income partly dependent on Quality and Outcomes Framework points. I’m a part time undergraduate tutor at the University of Glasgow. I’ve written two books and earn from broadcast and written freelance journalism. I’m an unpaid patron of Healthwatch. I make a monthly donation to Keep Our NHS Public. I’m a member of Medact. I’m occasionally paid for time, travel, and accommodation to give talks or have locum fees paid to allow me to give talks but never for any drug or public relations company. I was elected to the national council of the Royal College of General Practitioners in 2013 and am chair of its standing group on overdiagnosis. I have invested a small amount of money in a social enterprise, Who Made Your Pants?

  • The BMJ’s readers can buy Margaret’s new book, Living with Dying, for £7.99 (RRP £11.99) including UK delivery from with checkout code BMJ799.

  • Provenance and peer review: Commissioned; not externally peer reviewed.

  • Follow Margaret on Twitter, @mgtmccartney