Well done to Dr Morgan for stating the obvious: the NHS is broken, and I echo is his call for ‘midlife’ crisis with one caution. Let us not then waste the crisis, the reality is whilst it may be broken what is not clear is what should replace it? Having followed various recent debates and reports (1-4) I had distilled my thinking in terms of 12345 as follows:
1 NHS –sadly there is no one NHS, it is a set of organisations behaving as separate kingdoms. Frank Dobson managed to get the Blue NHS logo in an attempt to unite it and even that has now lost its currency. I am not talking about the challenges across UK with devolved nations.
2 Design Principles – over the years two have struck me: Darzi and Nicholson reports (5,6) which said Quality (patient safety, patient experience and cost-effectiveness) should be the organising principle and Lansley’s: No decision about me, without me (to empower patients) (7), and these should be the foundations.
3 Must Have’s – introduce the H (Health- and move away from Illness) in the NHS, inject the ‘right’ amount of money, and no micromanagement from the Parliament, without these three ‘pre-conditions’ there is little hope.
4 Wicked issues – health: social care and primary: secondary care separation and massive fragmentation now; unwillingness to confront the inevitable (and covert) issue of ‘rationing’; constant restructurings; and a lack of professional leadership are the four problems we keep shying away from.
5 Years – for two reasons: first is about taking it out of the election cycle (not that the fixed term parliament rule is being followed), basically the Opposition uses and the Ruling party abuses the NHS whilst the underlying ideology has not changed since Thatcher; and more importantly 5 years is what it will take to build any consensus on where we go with the NHS.
Sadly, the NHS is an old institution which has not kept up with the times and there are no clear and agreed rules for what to do with it – everything to everyone, free, was never possible in 1948 (as events showed soon after, and anyway the NHS was one part of the overall societal reforms) and certainly not in 2021; it may have to be Less and Better. We need to start from the beginning – accept that the NHS is broken and its original premise needs a review and find a way of uniting the factions by (re) establishing some clear rules.
Of course, it will take time and there will be turbulence, but if we are serious and want to be remembered, not as the generation that destroyed the NHS, but as people who loved it and have done their best to preserve it for times to come, then let us start afresh, openly and systematically. Sticking plasters and workarounds over the decades have got us into the present situation, which apart from a tiny minority of profiteers and idealogues serves no one well.
Do not go away yet Dr Morgan, stick around and help us fix it here; 'the grass may not be greener' elsewhere!
Rajan Madhok
Retired Public Health Doctor
Ruthin, Denbighshire
NOTE:
1. I applaud the NHS workers for their work during the pandemic and am disappointed by the lack of political recognition of this.
Rapid Response:
Re: Matt Morgan: The NHS needs a midlife crisis
Dear Editor
Well done to Dr Morgan for stating the obvious: the NHS is broken, and I echo is his call for ‘midlife’ crisis with one caution. Let us not then waste the crisis, the reality is whilst it may be broken what is not clear is what should replace it? Having followed various recent debates and reports (1-4) I had distilled my thinking in terms of 12345 as follows:
1 NHS –sadly there is no one NHS, it is a set of organisations behaving as separate kingdoms. Frank Dobson managed to get the Blue NHS logo in an attempt to unite it and even that has now lost its currency. I am not talking about the challenges across UK with devolved nations.
2 Design Principles – over the years two have struck me: Darzi and Nicholson reports (5,6) which said Quality (patient safety, patient experience and cost-effectiveness) should be the organising principle and Lansley’s: No decision about me, without me (to empower patients) (7), and these should be the foundations.
3 Must Have’s – introduce the H (Health- and move away from Illness) in the NHS, inject the ‘right’ amount of money, and no micromanagement from the Parliament, without these three ‘pre-conditions’ there is little hope.
4 Wicked issues – health: social care and primary: secondary care separation and massive fragmentation now; unwillingness to confront the inevitable (and covert) issue of ‘rationing’; constant restructurings; and a lack of professional leadership are the four problems we keep shying away from.
5 Years – for two reasons: first is about taking it out of the election cycle (not that the fixed term parliament rule is being followed), basically the Opposition uses and the Ruling party abuses the NHS whilst the underlying ideology has not changed since Thatcher; and more importantly 5 years is what it will take to build any consensus on where we go with the NHS.
Sadly, the NHS is an old institution which has not kept up with the times and there are no clear and agreed rules for what to do with it – everything to everyone, free, was never possible in 1948 (as events showed soon after, and anyway the NHS was one part of the overall societal reforms) and certainly not in 2021; it may have to be Less and Better. We need to start from the beginning – accept that the NHS is broken and its original premise needs a review and find a way of uniting the factions by (re) establishing some clear rules.
Of course, it will take time and there will be turbulence, but if we are serious and want to be remembered, not as the generation that destroyed the NHS, but as people who loved it and have done their best to preserve it for times to come, then let us start afresh, openly and systematically. Sticking plasters and workarounds over the decades have got us into the present situation, which apart from a tiny minority of profiteers and idealogues serves no one well.
Do not go away yet Dr Morgan, stick around and help us fix it here; 'the grass may not be greener' elsewhere!
Rajan Madhok
Retired Public Health Doctor
Ruthin, Denbighshire
NOTE:
1. I applaud the NHS workers for their work during the pandemic and am disappointed by the lack of political recognition of this.
REFERENCES
1. LSE-Lancet Commission Report, 2021: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00232-4/fulltext
2. Reform Report, 2021: https://reform.uk/research/whats-next-nhs-building-resilience-health-and...
3. IEA Report, 2021 https://iea.org.uk/publications/viral-myths-why-we-risk-learning-the-wro...
4. Oliver D. 2021: response to the IEA report: https://www.bmj.com/content/372/bmj.n697
5. Johnson A (led by Darzi A). High quality care for all, 2008. https://assets.publishing.service.gov.uk/government/uploads/system/uploa...
6. Nicholson D. Quality in the new health system, 2013. https://assets.publishing.service.gov.uk/government/uploads/system/uploa...
7. Lansley A quoted in The Guardian, 2010. https://www.theguardian.com/uk/2010/jul/12/andrew-lansley-nhs-informatio...
Competing interests: No competing interests