NHS Blasphemy | Tudor Skelly


Our worship of the NHS and our inability to differentiate the administrative and bureaucratic elements from the healthcare providers, will blind us to its failings and ultimately assist it its demise.

In Britain we know there are serious problems with how our NHS is run, but we are always grateful for our healthcare it is literally a lifesaver. But the rest of the countries of the world also appreciate their healthcare system and they also have their own serious issues and problems with the system that provides it.

What makes us different in Britain is our relationship with the NHS. Our adoration has been built up over seven decades, yet since its inception there was media speculation to whether it would last. In every general election since its creation the threat of the NHS in crisis surfaces, baseless speculation that it will be scrapped, collapse or be sold off; public atmosphere hits paranoia at any moment politicians discuss the organisational structure. Discussion of reform has been made politically toxic and yet it is so desperately needed.

In recent years this has reached a fever level, comments from Ed Miliband called for “weaponising the NHS” in the 2015 election, this kind of language employed by those even on the moderate left stir fearmongering among the public. Cameron’s government attempt to reform the NHS was to devolve decision making power to a more local level, where decisions would be made that were best suited to the needs of the locality. Yet even this simple suggestion was met with huge indignation from the left-wing pundits and organisations. Accusations that the Conservatives were privatising or “selling off” the NHS are unsurprisingly regurgitated at every discussion and debate, ignoring the fact that it was a New Labour policy to outsource certain care provisions to private contractors.

But reality can’t obstruct the emerging fear fest in far-left politics. Indeed, the Jeremy Corbyn campaigning strategy was to bombard social media by striking fear (into anyone still listening that is) that the Conservatives would kill off the NHS once and for all. Yet again history will prove them wrong. Unfortunately, the result of such campaigning is a mounting fear of losing the NHS. If a politician does talk of reform, it always begins with a politically defensive ploy at the start of any statement, they must first praise the NHS and even then, must concede that all problems are ultimately the Governments. Any criticism that does not follow this pattern risks public vilification veering towards career ending territory.

The issue of spending has been exploited too as the Brexit referendum campaign and both main political parties have gallantly attempted to out-compete one another in spending pledges, as if it were a great offering to a national wishing well to win public support. Campaigns have indeed benefitted from such a strategy. Yet political discourse constantly asserts a lack of funding for the NHS.

The reason for this is be two-fold: the first an acceleration in broadening of services offered from mental health to IVF units; and secondly, the vast bureaucracy nested within the NHS which governs its operations and accounts for its operations. It is a vast organisation, the third biggest employer in the world, so it is no surprise that organising its operations is complex. Looking at the organisation structure is the key to improving the service and allowing health care providers to do their job. Yet during this Coronavirus Pandemic the political punditry about reports on lacking provisions of PPE placed the key blame squarely on government, rather than asking more pertinent and nuanced questions about why some Procurement Managers had not secured enough PPE and why others had failed to deliver.

The most notable insight was a leaked report from the Army, who wanted to take over the logistics of procuring and distribution of PPE, as they were appalled by the NHS mismanagement. Again, this was not against the nurses and doctors but the bureaucratic nightmare governing the NHS. Whilst statistics released by the NHS appear to indicate a fall in Management spending by percentage of the overall budget. This was contradicted, when in 2012 a Parliamentary question to the Health Minister revealed that shockingly, the cost of primary care spending on management from 1998 to 2010 rose by 449%, a rise in spending of £852 million. This statistic does not even include the cost of administration and consultancy fees. Now consider that we are 10 years on: how much larger will that statistic be now? Could it be any clearer that the organisational element of the NHS needs desperately attending to?

Yet it is extremely difficult to venture into such discussions about the problems within the NHS as the distinction between the healthcare providers and the managers, administrators, accountants and lawyers has disappeared. To constructively criticise one section of the NHS is viewed as blasphemous and an attack on the whole institution. The political toxicity is so rampant that even though key NHS workers may agree that the management has serious problems, they themselves don’t like to speak of openly. Under such conditions it’s easier to exert frustration at the government for any failings. We should not be surprised when politicians too are reticent to talk of NHS reform, far easier to praise the NHS for its work hoping this will give confidence .

All of which compounds this issue as whenever we praise the NHS and its workers, commentators blast the government for any real or perceived failings. No room is left for a real scrutiny of the NHS organisation in public discourse. As I clapped outside like everyone else in solidarity, I am also aware of how it can appear as a new age form of modern worship, resoundingly sanctifying ‘our NHS’ that will permanently bar it from critique.

The political toxicity of fear and frustration compounded with the conflating of caregivers with the rest of the bureaucratic structure means no meaningful genuine forensic assessment of the NHS efficiency will take place. Even if it does happen the political will and courage to carry out reform is rapidly fleeting, if at all still there. Any reform would be a big project, unlikely to take place soon when another huge project of Brexit is already underway. I say this because if we do truly love our NHS and care about its future then such reforms will have to take place at some point to avoid a genuine collapse. For this we must detoxify the debate of NHS reform. We can start by recognising that all sides of society and the political spectrum want to protect and help our NHS.


Photo by Mackem Magic on Flickr.

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