Is our love for the NHS bad for our health?

Dan Wellings writing at The King’s Fund: In the run-up to the 70th anniversary of the NHS, we’ve been talking with the public to better understand their relationship with and expectations of the service and their views on who is responsible for keeping people healthy.

It almost goes without saying that there is huge support for the NHS, with the vast majority of people supporting the founding principles of a service free at the point of delivery, available to all and funded largely by taxation. As one participant at our recent discussion events said, ‘I do have a love for the NHS, it’s part of our heritage.’

We hear views like this so often that it’s easy to take public support for the NHS for granted, but our findings throw up interesting questions about what the relationship between the public and the NHS means for our wider health. Could our love for the NHS actually be bad for our health?

National Helth Service

There are signs that this may indeed be the case.

First, there’s an argument that our attachment to the NHS means that we don’t demand enough of the NHS and that we sometimes tolerate a level of service that would be unacceptable in other areas of our lives. Although ‘rising patient expectations’ is often cited as one of the pressures currently facing the service, there is little solid evidence to back this up. The premise is that in other areas of our lives we have become a ‘right here, right now’ society and we bring these increasing demands to bear on what we expect from the NHS, but this work raises serious questions over how true this is.

People we spoke to were aware that they moderate their demands because NHS staff are under intense pressure and because their expectations are largely rooted in their previous experiences of the NHS. Some people also felt that because the NHS is so well liked, people were less critical of it even when their experience was not as good as it could be:

We give private companies much more of a hard time because they make so much more profit and have more money to play with.

This begs the question: should we ask more of the NHS and does our affection for it limit our ability to be sufficiently critical of the service we receive?

Second, there is an argument that if government funding follows popular support, then other areas that don’t top the polls are left struggling with the NHS crowding out the case for increased spending in other areas.

Sarah Wollaston, chair of the Health and Care Select Committee, speaking at a recent King’s Fund event, was asked what led to the government’s seeming about-turn on NHS funding and the answer was telling: they had listened to the polling over the past year showing rising concern for the future of the NHS, with increasing numbers of people willing to pay more tax to fund it. Does the public and subsequent political support for the NHS blind us to the need for greater investment in other areas – such as social care and public health – that would arguably have a greater impact on our health and wellbeing?

In work undertaken in partnership with the Health Foundation, we asked the public about its views on the future funding of social care. The contrast with the NHS was stark – most people were unclear what social care is and even less clear on how it is funded, which goes a long way to explaining why there has not been the public clamour to fix what is an increasingly broken system and why politicians have managed to avoid dealing with it. When the current system was explained to them they were shocked and understood the case for change. At our event, Paul Burstow, former minister of state for care services, said that this year is also the 70th birthday of social care but it is not clear whether there will be a cake, what the recipe is or indeed who will be paying for the ingredients.

On public health, a recent poll conducted by Ipsos MORI asked people which areas they would prioritise if the government were to devote more money to health and health care services. Number one was urgent and emergency care, followed by spending on mental health – a considerable achievement for all those who have been making the case for increased spending to improve parity of esteem. Bottom of the list was spending on prevention, arguably the area that would have the biggest effect on the overall health of the nation. Spending on public health has endured significant cuts in recent years and Jacqui Smith, former home secretary, argued at our event that the government needs to step up to the mark. People we spoke to at our events clearly understood the case for greater investment in prevention but it was not top of mind in the same way the NHS is.

There is no doubt that public support and concern for the NHS has been a significant driver behind the recent offer of more money to the system. However, once the birthday celebrations have died down it is time for the debate to shift to greater investment in public health and social care. If not, our support for the NHS will come at a price and one that could ultimately impact directly on the object of our affections.

Let’s be frank about the NHS

In a guest blog for The King’s Fund, Laura Fulcher explains how her poor experience as an NHS patient has prompted her to question whether our affection for the NHS as a national institution is blinding us to how it needs to change and improve.

What best represents the UK today?

Is it Britannia, with flowing mane, trident in hand, on a 50p coin? Or perhaps Lord Kitchener, his stubby finger pointing at you from World War 1 propaganda: ‘Your country needs you.’ No, such militaristic images don’t define us nowadays.

For a country devoid of a unifying religion, with nationalist pride used by some to justify racist thuggery, we must find our identity somewhere. And we find it in the NHS – that all-compassionate healer of the sick.

National Helth Service

Yet NHS propaganda comes with the implicit threat of Kitchener’s finger. Without our zealous support, the health service could well be snatched away. ‘Save the NHS!’, the placards scream. For if we are deprived of our health service, who will cure the sick, who will deliver babies, who will save us in our hour of need?

And so we clutch the NHS to our bosom. We must protect it; ensure it doesn’t change; never a bad word must pass our lips.

I was born within the NHS for free – it’s the greatest treasure in the world!

No one could ever say anything bad about the NHS, because it’s made up of such caring, hardworking people.

With the NHS so entrenched in the nation’s psyche, it has become almost a treasonous act to call for improvements. We place the NHS on a pedestal as the envy of the western world. And as the system is now synonymous with hardworking clinicians, negative patient feedback is stifled further. We can’t possibly criticise overworked nurses, can we?

And so we don’t seek policy change or campaign for specific meaningful investment.

I too trusted the NHS once.

As a secondary school teacher, I was confident that the health service would be there for me in much the same way as I supported my students. But after the 15 months it took to fight for a cancer diagnosis at 29, that blind trust is long gone. Thousands of others are placed in a similar or worse situation every year, many of us waiting months or years to be diagnosed.

But there’s no use complaining about the delay. You’re told no mistake has been made; your treatment was timely; the only thing failing the NHS is ‘limited resources’ – something seemingly out of any one person’s hands.

As a secondary school teacher, I was confident that the health service would be there for me in much the same way as I supported my students. But after the 15 months it took to fight for a cancer diagnosis at 29, that blind trust is long gone.

‘Limited resources’ has become a catch-all of excuses; the ultimate shut-down of debate and improvement. This inertia now pervades the public, NHS workers and politicians too.

And to those whose eyes are open to the NHS’s issues, what options are there but disillusionment and disempowerment?

Certainly you can’t speak up. The formal complaints procedure is out of reach for anyone who values their mental health. Policy decisions are kept far away from patients. Not one person sits on the NHS England board in the sole capacity of a patient. Where is our People’s Champion? Who represents our views? Even NHS jargon, either purposefully esoteric or pointlessly truistic (‘person-centred care’ – I ask you!), seems set to complicate matters further.

With no opportunity to campaign for better, disillusionment breeds frustration. Harsh words are spoken. Commissioners begin to believe all patients just want to cause trouble; they batten down the hatches; they don’t want to engage. The public is perceived as too passionate, too uncontrollable.

Behind closed doors, financial decisions take priority over human life. Commissioners are told they can’t slide into further debt, so NICE guidance is overruled, services cut, waiting times lengthened… capacity never found. Propaganda states that private hospitals are the devil for putting profits first – but is this worse than an NHS at the mercy of an austerity-leaning government?

I paint a picture steeped in impossibility – everything seems just too difficult. With the menacing rhetoric, the ‘limited resources’, the jargon, the adversarial public relationships, the demonised government, the politicised system, the fact that policy decisions are all made so very far away… how can change ever be made?

The solution is brutal honesty.

The NHS in its current form is a system born of policy, targets and financial investment. Viewing it as such allows us to talk frankly about what we actually want from a health service without worrying about denigrating overworked staff or bruising our national pride.

The NHS in its current form is a system born of policy, targets and financial investment. Viewing it as such allows us to talk frankly about what we actually want from a health service without worrying about denigrating overworked staff or bruising our national pride.

Hard questions do not just need posing, they also need answering. And it is the public’s responsibility to do just that.

How long does Grandma really need wait for her hip replacement? A month, or two. Shouldn’t all cancer patients be diagnosed within two weeks? Yes! Do we really want our hardworking doctors and nurses run in to the ground? Definitely not. And fundamentally, don’t we all want a service that genuinely meets the needs of all?

The nation’s answers to these blunt questions must replace the current moveable targets that are so easily manipulated. Instead, they will form a transparent contract outlining what the public can expect from the NHS, with no place for blind trust in vague promises. Solid expectations would empower us all to champion ourselves.

But to reach this open and honest world, culture needs to change. The NHS should never feel faceless or corporate but should be ‘people powered’ and wholly entwined with the local community. Red pens should be wielded to cut the jargon that makes strategy so inaccessible. Communication channels should open – through social media, email, by providing open-office hours, and launching Westminster ‘fly-ins’ to engage the public in debate.

Complaints should be treated as opportunities to improve rather than pesky letters to be dismissed and ignored by departments that are so distanced from the front line. Leaders must stop seeing policy as a set of divine commandments inscribed in stone, but guidance to be challenged and upgraded.

And in all this, the public should be reimagined, not as the ‘great unwashed’ fixated on problems, but as energetic folk with the capacity to lead on improvements with innovation, passion, and resolve.

Source: The King’s Fund