Intended for healthcare professionals


Debating the future of the NHS: Hawking versus Hunt

BMJ 2017; 358 doi: (Published 24 August 2017) Cite this as: BMJ 2017;358:j4007
  1. Abi Rimmer
  1. The BMJ

The dispute over the evidence for a seven day NHS arose again at a public debate on the NHS. Abi Rimmer reports

A speech by the eminent scientist Stephen Hawking—and the extraordinary reaction it drew from England’s health secretary—turned out to be the main talking point at the Royal Society of Medicine’s recent Talk NHS conference, which had invited doctors, NHS staff, and the public to have their say on the future of the health service.

Speaking at the event in London on 19 August, Hawking gave a very personal account of the benefit that seven day NHS services could bring to patients, but he also emphasised the need for policy making to be based on evidence.

“It has been frustrating for me personally when everything slows down at the weekend in hospital,” Hawking said. “However,” he added, “any change like this must be properly researched. Its benefits over the current system must be argued for, and evidence for them presented; and the implementation must be properly planned and costed and the necessary resources provided.”

Hawking went on to criticise Jeremy Hunt’s selective use of data to support his plans for a seven day service. “Hunt has cherry picked research,” Hawking said. “Speaking as a scientist, cherry picking research is unacceptable. Citing some studies and suppressing others to justify policies that they want to implement for other reasons debases scientific culture.”

Hawking also raised concerns about the potential privatisation of the NHS. “When politicians and private healthcare lobbyists claim that we cannot afford the NHS, this is the exact inversion of the truth. We cannot afford to not have the NHS. A publicly provided, publicly run system is the most efficient and therefore more cost effective way to provide good healthcare to all,” he said.

He added, “We see that the direction in the UK is towards a US-style insurance system, run by the private companies, and that is because the balance of power right now is with the private companies.”

Responding on Twitter, Hunt accused Hawking of being wrong on the lack of evidence for the so called “weekend effect” and of “spreading a “pernicious falsehood” about privatisation of the NHS.

Path to privatisation

The extent to which the NHS is or isn’t on a path to privatisation was a recurring theme at the conference. Before Hawking’s speech, the Conservative MP Sarah Wollaston, chair of the health select committee, downplayed concerns expressed by some members of the audience that the UK’s health services were moving away from a taxpayer funded model.

“I do not see any evidence of any political party wanting to move to an American model,” Wollaston said. When pressed on the issue by an audience member, Wollaston added, “We are not going to see the “Trumpification” of the NHS, we are not moving towards a US style insurance based model. This is hyperbole. What we’re going to be doing is move to much more area based commissioning for whole populations.”

However, speaking later in the day, Richard Murphy, professor of practice in international political economy at City University, said he didn’t believe that the government did not want to privatise the NHS. He said, “David Cameron promised us in 2010, ‘No top-down reorganisation of the NHS.’ And what did he deliver? It was a straightforward lie. It’s like, ‘We’re not privatising the NHS’—we weren’t going to have a reorganisation either.”

Workforce crisis

Another key theme of the debates throughout the conference was the NHS workforce, cited by Anita Charlesworth, director of research and economics at the think tank the Health Foundation, as one of the biggest crises in the NHS now. “We don’t have enough staff. Most critically, we don’t have enough nurses,” she said.

Neena Modi, president of the Royal College of Paediatrics and Child Health, echoed this sentiment. “I am a frontline [clinician], and I would say that the greatest risk to patient safety at the moment is the fact that we don’t have enough people in the system—we don’t have the workforce,” Modi said. “Our patient care is suffering enormously because of the decimated workforce.”

Looking at the issue from another angle was Nigel Edwards, chief executive of the health think tank the Nuffield Trust, who argued that the NHS workforce was overspecialised. “We have massively overspecialised the medical workforce. One of the reasons that everyone is under so much pressure is that we have lost a lot of the generalist expertise that we used to have,” he said.

Clare Gerada, former chair of the Royal College of General Practitioners, agreed. “We’ve got far too many specialists . . . we have far too many subspecialties as well,” she said.

“I think we need to rationalise the number of specialties and subspecialties that we have, and we need to look at getting what the Americans call a ‘hospitalist’—somebody who looks after the total body rather than a tiny bit of it.”