“The NHS is Broken”, “British Politics is Broken” and lots more is broken some say. Being broken is a common extreme refrain heard in the media from some politicians, journalists and commentators. The emotive “broken” exaggeration is designed to create feelings of disgust with those who the users of the term would blame for a state of affairs needing improvement. A sceptic might think that the “broken” sayers have an agenda which their extreme language is promoting.
Rather than things being broken in the UK, there are problems, some major, to solve and improvements always to be made. This article, the first on the “broken” subject, addresses the unbroken NHS. It cannot do the solving of its issues, but it promotes the idea that some answers lie in the hands of people and changing attitudes.
THE NOT BROKEN NHS
Far from broken, the NHS serves hundreds of thousands of people well every day. It is not a national treasure immune from criticism and change as some might propound for their own ends, but it does huge good. An institution which removes a brain tumour, while the patient plays a violin as depicted in recent reports; which, as also so depicted, leads in advanced robotic surgery applications; and to which people come from far and wide for numerous advanced treatments, is not broken.
But it has faults. For example, it eats money , because it can always fall back on the politics which feeds it with cash for votes at times of crisis; some hospitals are too old, and some are overcrowded with excessive waiting times; the NHS is mismanaged in parts (e.g. where system failure, with bad practice, results in high, and so shocking, avoidable infant mortality rates amongst other things); many GPs and medical staff are overworked; plus much more. Throwing money at it is not a long-term solution, but deeper attitudinal changes can make a difference – a few are observed here.
BEST PRACTICE TRANSFER
There are highly efficient and admired hospitals and GP practices. To what extent are best practices shared across the institution, and transferred into action to the less successful? Perhaps not sufficiently. If one NHS Trust can balance its books or can have acceptable waiting times, can others learn from it and so do better? Cohesive knowledge sharing and being open to learning and change is a management and senior professional attitude which engenders a culture of learning and costs very little but can reap huge rewards; does the NHS have that in its veins? Should there be a stronger attitude of transfer of learning across hospital and practice?
Instead of the NHS being a political football, about which an honest critical conversation is almost taboo -e.g. on funding – a spirit of encouragement of free thinking and innovation, might help heal some of the cracks in the system. There may be much to learn from systems in other countries. No doubt there are some senior medical practitioners who are forward thinking and open to new ideas, but professionals such as lawyers and doctors tend to have a high degree of belief in their own wisdom and methods, seeing change as threatening, and being reluctant to admit someone else knows better. Attitudinal shift here may be relevant.
Free medical care – that is one which is financed by working taxpayers for the benefit of all people- is a benefit of massive proportions, a privilege for those lucky enough to live in the UK. However, it seems to be viewed as an entitlement, a birth right. Perhaps if that attitude changed, there would not be the millions of cancellations of appointments every year at huge cost; or 50 million unnecessary visits to GPs and A&E each year? Are not vast amounts of unnecessary drugs prescribed and binned every year? There is a risk with anything that is regarded as free it will be taken for granted. The truth is nothing is free, as someone’s labour always pays for it (to illustrate: if the NHS costs £100 billion a year ,then at a tax rate of 25%, taxpayers must earn £400 billion to fund it, and at say an average wage of £20 per hour, that is 20 billion tax payer manhours a year): maybe referring to it as a free health service should be the taboo.
SELF-INFLICTED PUBLIC WOUNDS
Here is a statement of the obvious: if a lot fewer older people could be looked after outside hospitals and if the number of sick people could be seriously reduced, then the NHS itself would be a lot healthier. Social care of the elderly needs sorting but it is really a sub-set of health care, and maybe it will in future be addressed as such. Many old people end up in hospital due to disability-maybe falling over- coupled with dementia: if they were healthier in the first place the day of non-self-help may be considerably delayed.
The ill health of a great many people is caused by self-inflicted wounds, whether through smoking, drug or alcohol abuse, or poor dietary choices and neglect of own physical and mental well-being. These wounds are surely not primarily the fault of Government; they are the result of ordinary people making choices which sadly damage them, and then relying on the NHS to look after them. Healthier eating and drinking, regular exercising of body and mind are generally recognised, among other things, to reduce diabetes, reduce cancer, reduce obesity, reduce heart diseases and reduce dementia risk. Taking exercise costs no money (the gym is not a necessity). How many hip and knee operations, where there are big waiting times, could be avoided or at least delayed by people being less overweight? If people did more to prevent damage to themselves and their dependents, the NHS would become more affordable . However, it is recognised that making the necessary changes can be hard for the individual for numerous reasons, and a lot of effort will have to be made by Government and business as well as individuals to make progress.
GOVERNMENT AND COMMERCE CAN SET THE FRAMEWORK
What more can be done by Government and commercial enterprises who make or sell or promote products for consumption to create a framework where it is easier for people to make better choices, through for example, education and incentivising the adoption of better habits and cut the self-infliction? Government websites show the problem is understood. There is growing publicity on need for wholesale lifestyle change but little clarity on what it entails, with fashionable but faulty diets abundant. Intense and consistent publicity and persuasion campaigns are needed (and perhaps consider having sellers of harmful processed food and drink fund them).
In schools daily regular exercise, teaching all children to shop and cook sensibly, and clear healthy dietary education and practices could be rigorously implemented across the board. A nationwide education programme for parents on how to teach children good health habits could be adopted. Bizarrely, our hospitals even serve up menus of largely unhealthy food and drinks; to change that solely to healthier food with limited options should not be difficult and bring savings. There are no health warnings around take away and processed food. Why not? Some say the less well-off cannot afford wholesome food (not a view shared by Sherbhert), but healthy food and drink could be subsidised, funded by disincentivising taxes on damaging processed food. Why not? Of course, there will be many better ideas, but where are they apart from committing more money? A sugar tax barely touches the sides of the issue. This should arguably be treated as a national emergency. But the effects of any change will take years to show through meaningfully and so there can be no delay. The commercial food sector will have to start caring for its customers, not just saying so, while behaving solely to make profits from them. Whatever Government does however, even if it can demonstrate the tough love required, individuals will have to buy into their own responsibility to stop self -harming and harming their children. See also Sherbhert article https://www.sherbhert.com/resilience-stress-and-bouncing-back/ and in particular the following extract: –
“A starting point to get a perspective is “Poverty Safari”, a book by Darren McGarvey. His experience leads him to conclude that, even in the most dire of upbringings, a dose of self-help is a necessity and nothing is solved by merely blaming others. Acquiring the tools of self-help, being the qualities of resilience, is relevant even to the most extreme stress situations.”
SELF-HELP: A NATIONWIDE PROGRAMME
A national attitude of self- help and mutual help around lifestyle issues, with a nationwide commitment of institutions and commercial enterprises could change everything. This would result in greater productivity and wealth across the country, and critically, fewer sick people and fewer needing social care. To engender it will require painful choices and backbone. That this is difficult is no excuse. It just needs people to do it. Perhaps this would contribute to the NHS thriving and progressing rather than living a constant hand to mouth existence.