The NHS – the ‘S’ is for ‘Service’ not ‘Slave’

With an election looming it’s no surprise that the NHS is once again in the headlines with the BBC reporting that waiting times are the worst now since records began. The way politicians talk about the NHS, those working within it might be be forgiven for being confused. In recent years there has been both talk of ‘weaponising’ the NHS, like some all powerful superhero, and also of it being treated like a naughty child who is to be sent to bed with no supper for causing all those ‘avoidable deaths’.

It seems the NHS is not so much a service that is offered but rather a slave that is used – and abused – by those who would seek to master it for their own, often political ends. But it’s not just the politicians who behave like this. Nor is it only the pharmaceutical industry who use it to push their products beyond where there is a genuine need. Patients too, and that includes all of us, can sometimes also use the NHS inappropriately, arrogantly proclaiming that it is ‘our NHS’, demanding it meets ‘our wants’ in a manner which we deem appropriate and in a time scale we consider acceptable. It’s time we appreciated that the NHS is just that – a ‘service’ that we are privileged to have offered to us, not a ‘slave’ we own and can demand of what we will.

A different perspective is required, the current situation is no longer sustainable.

It’s really is time to free the NHS.

Free it from political interference, pharmaceutical manipulation and unreasonable consumer demand

Free it to become the genuine service that we require – one that seeks to meet only the genuine health needs of the nation.

So what exactly will this emancipated NHS offer us? That is something that needs to be decided upon, without political or pharmaceutical interference, by guardians of the service appointed because they are wise enough to see that there is a difference between what medicine can do and what medicine should do. They need to be clear headed enough to appreciate that advances in medicine have outstripped the capacity that exists to deliver healthcare, both in terms of finances and workforce, and that decisions on what services will and won’t be offered have therefore to be made.

Those decisions need to be made, not because they are politically expedient or serve an individual’s self interest, but because wisdom dictates that they are so made. Not all such decisions will be popular but they need to be made, and accepted, none the less.

Of course, where inefficiency and poor practice exists there needs to be improvements but the fact remains that with the body of medical knowledge increasing exponentially, and more and more expensive treatments appearing on the market on a daily basis, it is simply no longer possible to know all that there is to know, or fund all that could be funded. Finances are limited – as are the human resources within the NHS. Constant promises by our politicians and demands by its users of what the NHS will provide, along with often unwarranted criticism and blame when these impossible targets are not met has a human cost on those who try to do their best in an increasingly difficult workplace – a workplace that is threatening to become a battleground*. No wonder there are casualties.

It’s true that the NHS is ‘not the Messiah’ we would perhaps like it to be, but neither is it ‘a very naughty boy’. To coin a phrase – ‘I think you’ll find it a bit more complicated than that’.

It seems to me that the fundamental problem lies in the fact that we as a society continue in search of the holy grail of a never ending life of perpetual happiness – death and sadness must be avoided at all costs. And we have charged medicine with delivering this dream. So certain have we become that this is possible, that when death does rear its ugly and unwelcome head, the appropriate response so often is deemed to be one of moral censure of those who failed to deliver the impossible. When things go wrong, it seems, we are more comfortable attributing the problem to the moral failings of those who have tried to help, than the reality that death and suffering are part of the world we live in.

And here is the irony of it all. By treating the NHS as our slave, demanding it deliver us from our inevitable death, we have made medicine our master and have become enslaved by it ourselves. By making the meaning of life the avoidance of death, we are in bondage to the health parameters that we have imposed upon ourselves, even as we strive to impose them on others. As Augustine wrote:

“What does it matter by what kind of death life is bought to an end? When man’s life is ended he does not have to die again. Among the daily chances of this life every man on earth is threatened in the same way by innumerable deaths, and it is uncertain which of them will come to him. And so the question is whether it is better to suffer once in dying or to fear them all in living.”

We need to spend less time and energy striving not to die – and more on learning how to live.

And so, rather than being forced to offer answers that won’t work, thereby adding to the futility that all too many, both within and without the profession experience, medicine must be allowed to stop trying to be the solution to the problems for which it is not the answer. Less may well be more. Rather than requiring the NHS to continue to vainly try to deal with the consequences of unhealthy lifestyles and the broken society in which we live, we would all do well to look to enable lives that are worth the living. Because however hard the NHS is made to work, whilst the highlight of a person’s day remains yet another evening sat in front of the TV watching another box set accompanied only by a bottle of scotch and a Happy Meal, it will never succeed in improving the health of the nation in the way we all would like.

A manifesto that, rather than promising and demanding more from the NHS, seeks instead to unburden it, lifting from it the unrealistic expectation that weighs it down, is a manifesto that might just get my vote.

Because the answer is never merely more medicine.

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*For why General Practice is still my battle grown of choice, click here

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