Drowning while they throw bricks – what hope is there for the NHS?

We are sinking
The NHS is haemorrhaging talent – to retirement, emigration, the private sector and leaving medicine entirely. General Practice is perhaps worst hit with 40% of GPs planning to leave in the next 5 years and the shortage of GPs making it insanely difficult to access GP care. And a 2.1% annual uplift in funding when inflation is at 11% means that practices will be able to afford even fewer staff next year.

No one is coming to our rescue
The government’s response has been to demand that patients have assessment at first contact despite the lack of resources to actually treat anyone. This gives the impression that patients can get care but only really gives them a 111 style triage service while leaving even less resources for the continuity and treatment that actually makes them better. Politicians acting like heroes to their supporters by “forcing GPs to see patients” only hastens the catastrophic collapse of General Practice.

Do we head for the lifeboats or do we try and save the ship?
We can, of course, lament the loss of the NHS while heading for the lifeboats of retirement or emigration or the private sector. But what should we do if we genuinely want to save the NHS? What would help, given that pleas for more funding and less top-down management are falling on deaf ears?

Mobilise our communities
The only people who care as much about their long-term health as we do are the people who live in our community. They do not care about statistics or whether the government will win the next election. They want to be looked after and have the best chance of a good long life. We need to join with them in embracing the idea that we exist to serve them and if they want us to be there for them, they have to support us. Maximising benefit means them doing everything they can for themselves so we can spend all our time on what they can’t do.

Maximise effective long-term health
It is very easy to count appointments or waiting times or staff numbers. But unless more effective care is given, focusing on process measures may actually harm the outcomes we care about. Using nurses or physician associates to replace doctors will only improve care if the cost per fully treated case goes down. If they take longer, or are less thorough, or need more supervision, the true cost can be greater than using doctors. But we must allow long-term outcomes to override our prejudices about how we look after patients.

Reduce churn
Our staff are our key resource but the NHS treats them like dirt. The long-term costs of losing experienced staff is astronomical. If we truly want the NHS to thrive, it needs to be come a great place to work again. This is only unaffordable if you want the NHS to be trashed and replaced with something more expensive. Clinicians need to be defended against workload caused by political policy. Pay needs to be adequate to live. No one goes into the NHS to get rich but wages need to be sufficient to attract and retain the talent we need.

Use our relationships to reach across divides
Since the Thatcherite invention of the “internal market”, NHS clinicians and teams have been pitted against each other, competing for funding and defending against work dumping. These behaviours are simply a result of the rules which define others as opponents in a zero sum game. However we have a long  history of working together cooperatively with others in our  local NHS to look after patients more effectively. Clinicians need to rebuild these relationships and use them to achieve better long term outcomes with the same resources.

Revive the NHS Tribe
Refusing to waste resources on what doesn’t work is only half of the solution. We need adequate funding to actually care for people. The British NHS is one of our great achievements. We all contribute so no one loses out. We queue and take our turn and trust the system. We do our part and honour those who sacrifice to look after us. This is The Way.  Politicians are good at manipulating the public and the press. We cannot compete in their arena. We need, instead, to become the NHS tribe again, sharing the belief in free universal health care and recruiting followers to join us.

The NHS was not sinking 15 years ago. It’s time to start plugging the holes made in it since then.