Intended for healthcare professionals

Rapid response to:


Commentary: “The political response has been dismal”

BMJ 2017; 356 doi: (Published 03 January 2017) Cite this as: BMJ 2017;356:j5
Read all the articles in this series on the NHS in 2017

Rapid Response:

Re: Commentary: “The political response has been dismal”

Dear Sarah

I am writing to you after reading your Commentary piece in this week’s BMJ. I have been an NHS Consultant in Child Mental Health for over 20 years and have also seen a number of family members struggle through their experiences as a patient in the last few years.

It’s great to have a doctor as chair of the House of Commons Health Select Committee. But I also find it incomprehensible that you can somehow be a member of a government which from my point of view at least is deliberately de-funding and destabilising the NHS. In your own article you acknowledge the misleading data which your party must take responsibility for. The Prime Minister frequently talks about correcting social injustice, but continues to lead a government that further underfunds health and social care. The population is growing, and growing older, and more treatments (and preventions) than ever before are available to not only keep people living longer, but with a higher quality of life.

This, then, costs even more than it used to. It has to be paid for from somewhere. Whatever the ‘real’ cost of health care, it has hugely outstripped what the government provides. Health either needs paying for from the public budget, or the private one. The more the public shortfall, the less fair and ethical it is, and the more that, simply put, wealthier people will have better treatment.

Every month I sit in our management meeting where we have to work out our ‘Safe Release of Clinical Funds’ – as much of an Orwellian Misnomer as the “CIP” it used to be called, a process repeated in every Department in every Trust across the nation. It is NOT safe to release clinical funds. It’s just another way of cutting budgets. Sure, the system isn’t perfect, there are still too many managers and other people – often political appointees – in senior non-clinical positions. NHS England has, I believe, lost credibility as it presents as simply another government mouthpiece. Many CCGs are, astoundingly, hiring firms to filter through GP referrals to specialists. The clinical basis for decision making is being increasingly eroded.

Worst of all, there is no accountability from government. It simply denies responsibility for the problems. Yet only the government, in reality, has the power – the chequebook – to properly fund health care, to stop spinning underfunding as ‘overspending’. This in turn probably means more public funding and more taxes, not a decision you’re likely to make. But without this the NHS’s death throes will be irreversible. The prognosis is terminal.

I would really love to read a real reply to this - and on a bigger stage, as you suggest, find decision-making ministers who will really listen to us clinicians rather than continue the arrogant and professional-undermining approach Hunt epitomises.


Malcolm Bourne

Competing interests: No competing interests

09 January 2017
Malcolm J Bourne
Consultant Child & Adolescent Psychiatrist
Blackburn, Lancs