#TalkNHS – the past, present and future of the NHS

A few years back, I attended a very similar structured talk at the Battle of Ideas in the Barbican. The issues raised then were similar to the ones raised now, just in a different environment and upon a different climate. Hosted by a range of educated and passionate professionals, the programme today was well worth attending and truly topped off with a keynote finale held by Professor Stephen Hawking himself.

As the title suggests, the talks were all based around our National Health Service, what its current state is, how we got here and what the next steps are; a very neat way of structuring a debate concerning the past, present and future of the NHS. With a variety of speakers from multiple backgrounds alongside a very passionate audience, naturally it quickly became a very heated yet informative day.

The first group of panellists held the discussions in response to the question ‘What is the state of the NHS?’. They raised a few very interesting points. The first being the division of health care and social care. Ms Liz McAnulty, chair of Patient’s Association, stated ‘care is care’ as regardless of what type they both address an individual’s needs. The fact that they have been classed as two different brands of care, which is understandable since they both address two entirely different perspectives, in the era we currently live in whereby the two are so intertwined, maybe it is time we see both as one in order to reduce this belief that one is more important than the other when we are increasingly starting to see the need for both to work together. Secondly, there has been a reduction in patient and public engagement. As Professor Richard Murphy goes onto say later, it is the people that pay for the NHS and are also the users of the NHS, hence covering both ends, but nowhere do they get a say or some form of engagement from their local commissioning groups which is supposed to be tailoring care for them. As a result, decisions are made that do not accommodate the public. Thirdly, as Ms Liz McAnulty stated ‘the same problems are happening time and time again’ due to the failure of the system to listen and learn from complaints. The same mistakes being made are costly and ineffective. Finally, there is the issue of a constant service transformation. The speakers clearly highlight that due to the above factors and many more, the NHS has reached a point whereby it is not able to deliver the care it aspires too, and as Dr Rachel Clarke put it, it is the ‘human cost of those statistics that are horrifying’.

Unfortunately, as the system is being drained of funding and resources, we know that this has also meant morale amongst staff is low. As a result, it has led to ‘burnout’ and a huge portion of valuable NHS staff leaving the profession hence causing further damage to the service. The government and many believe the solution to this issue is to just recruit more individuals but as Dr Sarah Wollaston, MP for Totnes and Chair, mentioned, ‘it is not just about recruitment but also retention’. The pressures and the challenges in the NHS have created a very unattractive environment for current and future healthcare employees to want to work in. The individual drive due to the core principle of compassion and the staff wanting to be there for their patients, is the reason why the NHS still stands today. But as Dr Clarke wrote in her book, which I recalled in my last blog post, there is only so much one can give without becoming exhausted. Personally, as a medical student, I am scared for the future. I know the reasons as to why I came into Medicine and I hope these reasons stay with me for the years to come. However, considering what is going on, I fear that this constant battle between healthcare professionals and politicians, with one party trying to explain the situation and the other not wanting to listen, may create an environment that will inevitably mass produce a future workforce that may not retain the same compassion the NHS staff now hold. Why would the future workforce try to give it 110% when inevitably their efforts will not have an impact? Would it not be easier for them to come in, do their job and then just leave? That is what low morale will lead to, a drain in determination and passion to genuinely want what is best for the patient, because it is this cohort which will be tired of fighting against an unresponsive system.

One member in the audience posed the question “Should we dissuade individuals from the NHS?”. A great question which encompasses what many would think considering the state the NHS is currently in. Dr Clarke made a valuable point: we cannot proceed to stigmatise individuals especially when they need the care. I completely agree with her. In a system which is being let down due to the government’s decision to poorly fund a complex service and hence not provide patients with community alternatives, we cannot place the fault of the government upon the patients. The public have a right to healthcare and hence the government have a duty to provide this healthcare. Through trying to dissuade people to balance the numbers, we risk pushing away those that may need vital and immediate intervention.

Time and time again, as is the case with any complex situation, when it comes to finding solutions to the problems the NHS faces, they are never clear-cut. When organisations, politicians or even individuals have their eureka moment and think they have sorted the issue out, they find they have just scratched the surface. It is like cutting garden weed off the surface but not pulling it out of its root, it will always grow and hence will always continue to be a problem. The NHS is facing a similar scenario. It is difficult to pinpoint where in the timeline things have gone awry and what needs to be done to undo the actions of previous individuals, hence in each attempt to fix the problem we can sometimes be doing the complete opposite. Naturally, this is expected of a service which is very complex and caters for the needs of millions. Over the years, like an old house, there has been renovations and decorations, but the foundations upon which it was built in 1948 were not accommodated for the society and the demands we have today. What would be great is to break the whole thing down and start again, however this is not possible. Therefore, our only course of action is to continue doing what we have done, which is to make gradual changes. Hopefully this is a with a much more evidence based approach and not like Ms Lara Carmona, Associate Director at the Royal College of Nursing put it, an ‘evidence informed’ approach which is usually adopted, i.e. the evidence is there but it is chosen not to be looked at.

Considering the fragmented service that exists today, where one service provides mental health support, another provides the physical support and so on, in an era whereby people are living with multi-morbidities, Anita Charlesworth, Chief Economist for Nuffield Trust, mentions the fact that inevitably this means individuals are being treated as body parts rather than holistically. As a result, in response to the question ‘what next?’, she suggested four things: funding needs to be increased on a sustainable level, the social care system must be secured, the workforce matters should be put first and inequalities must be addressed. Very broad but clear goals to achieve, which would hopefully begin to dig at the bigger issue.

‘Your voice is important’ – whether Stephen Hawking meant it in the literal sense as prior to this he was explaining how the weakening of his larynx led to a tracheostomy which meant he lost his voice hence realising the value of oral communication. Or if he meant it in the metaphorical sense, that our voices need to be heard in order to bring about change. Regardless, this short statement really stuck with me. He then went onto mention that there are multiple forces of different interests looming above the NHS and ultimately the future will be dictated by which force is the strongest. Hawking believes the balance of power currently lies with the profit making private companies but the power of the public and democracy exists too, therefore we need to take advantage of this. Which brings me back to why the four words Professor Stephen Hawking spoke, stuck with me. I did not realise how strong and how much of an impact simply speaking your mind and open communication can have, but after sitting in a room full of passionate professionals and campaigners and hearing how they have all made their mark through standing their ground and vocalising the values and belief they strongly hold onto, I think this is a great step forward in ensuring we protect the service we treasure the most. As Professor Richard Murphy responded to one of the audience members’ question ‘What can we do for the future of our NHS?’ – “Talk.”.

As I sit here, reflecting upon the fantastic day I have had, learning all about the NHS and its people, I am left wondering what I, as a medical student, can do for the future of our NHS. And I think I will simply start by talking. Talking about issues the NHS faces. Talking about the politics surrounding it. Talking about what the possible next steps are. The more knowledge I can gain on the topic, the more I can raise awareness amongst my peers too, and hopefully this will mean a greater interest is taken, across the board, to try and help save our NHS.

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