So why do we need to Big Up the NHS?

Let me start by being very clear – I don’t believe the NHS is perfect. As part of my job I see all the complaints for my hospital and they are heart-breaking. There is no doubt that some patients receive poor treatment, that staff can sometimes be uncaring and that on occasions things can go very wrong. I know that the NHS complaints process is clunky and ineffective and that it often leaves patients and relatives more distressed than when they started. I accept that we find it difficult to learn from our mistakes and that whistle-blowers can get a rough deal.

Yet the NHS has a lot to commend it. It is the only health service in the world that is completely free at the point of need without any reference to financial means. Our outcomes are world class though we spend much less per head than most equivalent countries. National surveys show that more than 95% of users would be likely or very likely to recommend the department which performed their treatment to Friends and Family. It is one of the things that makes the United Kingdom a civilised country.

Nobody can deny that the NHS has had a bad press over recent years. A firestorm ignited by the horrors of Mid Staffordshire and fuelled by a series of subsequent scandals. Knocking the NHS seems to be a national pastime. It sells newspapers and builds viewing figures.

Sometimes even good news is reported as bad. Don Berwick in his report on safety in the NHS said “At its core, the NHS remains a world-leading example of commitment to health and health care as a human right” and that we should “abandon blame as a management tool”. The  headline in the Telegraph was “NHS staff will be prosecuted for ‘reckless neglect’ of patients.”

Currently the vast majority of national media coverage is bad while the service is recognised internationally to be largely good – and this is a problem.

Why is unfair and unbalanced reporting of the NHS a problem?

The main issue is that our patients’ experience of treatment is coloured by their expectations. If you think you will receive poor treatment you will focus on the negative, see the problems, be more frightened and probably have a worse outcome. Imagine you are about to board a flight and you read in the newspaper that the airline has faulty equipment, pilots are poorly trained and that you have a high chance of crashing. At the very least your enjoyment of the flight will be curtailed. Most people would decide not to fly or to switch airlines.

NHS patients do not have this luxury. Avoiding necessary treatment is harmful in its own right and few have the means to go elsewhere. They will have a more distressing experience as a direct result of the negative reports. Worse than that, there is good evidence that patients’ outcomes are influenced by their expectation of success. Complication rates will be increased and some may even die. The casual unjustified swipe at the NHS in the media will cause REAL HARM to REAL PEOPLE.

And there is also the effect of staff morale. The vast majority of NHS staff is caring, dedicated and sensitive. Indeed most clinicians are selected for these qualities at the start of their careers. Unjustified bad press is hurtful, it damages morale and desensitises the sensitive. Sickness rates increase, staffing levels fall and patients have a bad time. The press gets even worse. We hit a relentless downward spiral.

Is there a political agenda?

Many believe that the bad press is deliberately orchestrated by the government to undermine the credibility of the NHS as part of a plan to sell it off to the private sector for profit. This graphic has been widely circulated through social media. I am not a natural conspiracy theorist but I can see the logic of the argument.


I think is more likely that journalists simply do not realise the harm they can do. Sections of the public enjoy the feeling of righteous indignation that comes when they read of failings in others. We pick away at the scabs for the pleasure of the picking even though we know this is likely to be damaging and may cause permanent scars.

NHS bashing is a form of societal self-mutilation. The service is one of our greatest assets, we all depend on it from birth to death, yet we seem to want to cause it harm.

In the final analysis it is irrelevant whether there is a conspiracy to damage the NHS. The legal framework for privatisation is now in place and this will progress at a pace whatever we do. Bad press will make it happen more quickly with less predictable results. We may even have to endure a complete collapse of services. Positive press will give us more control of the process. It can help us sit up and take notice of what is happening.

What do I hope to achieve with Big Up the NHS?

I started Big Up the NHS as a twitter account in August 2013. The idea was to counter the negative press, raise the profile of the NHS, help improve morale, lobby for more funding and ultimately improve the experience of our patients. To reverse the downward spiral. This rather grandiose idea proved popular the account attracted more than 8000 followers in the first 6 months. This blog was started in January 1014 as was a Facebook group which attracted 350 members in the first week. There is a Linked in group which is just starting to get going.

The plan is to use these sites to disseminate good news. I hope to collaborate with others to promote the best of the NHS. The political debate is not off limits but it is not a primary purpose of the enterprise. Big Up the NHS has no political affiliations – just a commitment to supporting and promoting the best in the NHS.

What next?

I will be guided by others here. I have no current plans but it may be that we could look to developing a membership or at least recruit some like-minded collaborators. While I am really enjoying doing this stuff it is quite time consuming and I could do with some help (before I get sacked and/or divorced). Let me know if you are interested.

In the meantime please follow the various sites, spread the good news, feed me positive stories and BIG UP the NHS.

Steve Smith



  1. I fully agree with this article. I have had a couple of bad times with the NHS but I would not swap it for the world. The people of UK should shoulder some of the blame. They treat A&E as a walk in centre staff are often abused. There is a government motion next month to change the law to allow them to be able to close a hospital without the law stopping them. There should be more being said about this. No NHS is not perfect but it is one of if not the best services in the world


  2. Thanks for taking thine from your life to do this, it is so important. Have worked as a nurse in the NHS for 21 years. I do not recognise the stories in the press from what I personally witness in my working like but I do see the downward spiral due to increasingly untenable pressure put on the services and on staff. You don’t know what you’ve got ‘ til it’s gone…


  3. Reblogged this on 3 Decade Blog Scale and commented:
    One of the things that makes me most proud to be British is the NHS. If I need treatment, I can get it, for free. And the treatment is very good. As stated, like any complex system, there are weaknesses and failures, but the very fact of their newsworthiness is also a function of their low rate of occurrence. The NHS is an undeniably good thing in concept, and in delivery in the overwhelming majority of cases. If I have a serious, acute illness then the question is not “Should I go to hospital?” or worse, “Can I afford to go to hospital?”, but, “Where’s the nearest hospital?”. There are people who genuinely envy the UK for this, and it’s a service that is worth paying for.


  4. I understand where you’re coming from – the majority of NHS staff work very hard and do their best for patients – but I am afraid you’re missing the point in two ways. First, the vest majority of western countries provide universal access to healthcare – the NHS is not at all unique in this – and most achieve better outcomes and provide better patient experience, more consistently, than the NHS. Second, the problem is that the NHS (and most healthcare systems) are designed around a 1940s model of healthcare that is totally inappropriate for today’s medicine and today’s patients. We need to redesign healthcare around patients, rather than institutions, and most of the opponents of reform are, often unwittingly, blocking this by defending existing organisations and ways of doing things.

    To Andrew – the question is not ‘Where’s the nearest hospital?’, but where is the nearest hospital that is appropriate for my condition. If you go to the nearest hospital that does not provide the right specialist care for you, then you stand a far bigger risk of a poor outcome. See e.g. the changes to stroke care in London (opposed before they happened but now saving 100s of lives). This is a perfect illustration of the wrong-headed mindset of the opponents of NHS reform… 😦


    1. No I get both of these points. They are relevant and I have spent most of my working life trying to address them. They are however not the thrust of my thesis.
      My main point is that UNJUSTIFIED negative press is harmful. It damages the NHS and hurts patients. We will improve quicker in a positive environment.
      We will undoubtedly move toward a European or American style system. The latter is more profitable for industry and worse for patients. It is the way we will be more likely to go if driven through crisis and loss of confidence.


  5. Really interesting article, Steve – thank you so much for all the time and effort you into this wonderful endeavour. The NHS has saved my life 3 times in the last 3 years (and before that, too) – of course, there are always things that could be done better, but I’m alive and well and quite vocal about the GOOD of the NHS.

    I have precious little time to be more of an advocate than I already am (I sit on the NHS London PLCUP & other Commissioning groups as a patient representative, whilst running my own business and trying to recuperate from cancer treatment) but I DO strongly feel that people need to shape up and take responsibility – for their health, for their treatment, for voicing their praises and their concerns. Medical practitioners and staff are not mind-readers : we need to help them. We fail to speak up (in the main) during our treatment, and fail to speak up when the NHS and it’s staff are under attack – either through government bullying, media bullying or idiots who kick off and endanger NHS staff’s safety and wellbeing.

    I feel so frustrated by the continual attacks by the media – it’s appalling and puts patients at dreadful risk (too scared to seek help because of scaremongering, for one).

    Membership would be a wonderful idea but not really sure how we could go about this – we need to somehow build a solid tribe who appreciate that (as Toonpig so wonderfully put it) the NHS is (one of) the best service(s) in the world and wish to ensure it continues in the same vein spirit as to which it was created. And to help save your job and marriage, Steve!!

    Gosh – I still have to pinch myself that the NHS is a FREE service (‘ish – National Insurance contributions are a small price to pay for the excellence of care and treatment) – how blessed are we as a society?


  6. Reblogged this on Jane Crofts in person and commented:
    This is a really great idea and I hope it will inspire others… The NHS is by no means perfect but it is much better than what we could be faced with through privatisation by stealth – you only have to look at adult social care for the evidence of how damaging it could be. Read on, join in and save our wonderful public services…


  7. I very much enjoyed reading your article and fully support your views. As a nurse of almost 20 years I feel proud of the service the NHS delivers with the insufficient resources it has. If you had to feed a family of 4 with £1 you would not be able to offer much more than beans on toast. May not be fine dining but it does the job and satisfies hunger.

    Praise is crucial, just like in parenting. Children respond to praise and flourish from it. Put a child down and you take away their self confidence and watch them lose their desire to develop. Staff within the NHS need positive feedback.

    I also feel that people should take more responsibility for their own health. People abuse their bodies with smoking, alcohol, obesity, lack of exercise and when their bodies start to fail them they expect tge NHS to put it right and complain if the service is not 5 star. Wake up people. This is the people’s health service. Look after it. Don’t clog up A&E depts & GPs with minor ailments. There is so much advice out there for looking after yourself.


    1. Jane, hi there i was thinking ( which is not normally a good idea ) when i remember when i was fit and athletic in my younger days the way I remember it the amount of injuries i had through sports,smashed my elbow broke an ankle fractured the other one split my head open on a number occasions, gashes on arms and legs needing stitches broken fingers muscle tear ligaments damaged. i dare say i was very competitive. I gave sports up for the last 10 years. now i’m a stone and a half over weight which say’s i’m obese. I’ve never been to the hospital once for anything hope that may long continue maybe lose a stone in the process. i just walk most places now or cycle. so basically for me so far being competitive sportsman has cost the NHS more problems. just another point of view. 🙂


  8. Well said! For the last couple of years it seems like barely a day passes without the BBC featuring a bad headline relating to the NHS. I think the inundation of negative press is also partly due to a reduction in standards of journalism with simple rehashing of PR notices put out by companies and the government without any efforts to research stories and check facts.
    Does the NHS even have a PR officer or department to counter the negative press? Because it doesn’t feel like it?


  9. I also agree with the points you have made. The work carried out every day by caring professionals that saves lives, and makes lives more bearable through treatment and good management, is vastly undervalued. When care is going well it is far too often taken for granted. It is only when something goes wrong that people find a voice- leading to a very negative bias against the NHS. An unfair bias that reflects on staff and the NHS in general. It must be very demoralising. Furthermore people do not do enough to protect the NHS. I would not be alive had it not been for the NHS and I dread to think how I might survive within, for instance, the American system of healthcare given how many doctors I see and the number of prescribed drugs I take. I would need to be very wealthy or have decent insurance; and to be honest I would not wish to begin trying to understand health insurance in America- Americans often seem to have many problems understanding it. The problems you mention in the first paragraph are however also greatly damaging the image of the NHS. A complaints system that does not work effectively potentially places patients at risk- it is currently a cruel system of resolving problems regarding healthcare for anyone who is ill, has caring responsibilities or who has been bereaved. I also believe that a defensive culture is the NHS’s number one enemy. It permits problems to escalate, can lead to hostility, and results in the high profile cases highlighted by the media. One case can be reported by the press for months, even years, and some are horrific. These are the reports that cause the most harmful impact and remain in people’s memories for a very long time. Additionally the high profile whistleblowing cases are the tip of the iceberg- staff are attacked for raising concerns rather than rewarded. Can you imagine the type of impact these kind of attacks can have on patients when they raise concerns? A health care system where patients are attacked when they raise concerns should not be tolerated. At the end of the day it is cases that come to light in the media as a result of a defensive culture that cause the most damage to the NHS. A defensive culture harms patients, families, staff and ultimately the NHS. A defensive culture will increasingly pave the way to a ‘them and us culture’. High profile cases will encourage people and the media to take a pot at the NHS whenever they can; even over minor incidents. It sets it up as a target. It will ruin the NHS if individuals or groups have no means of stopping it other than going public. I think that a massive effort needs to be made to stop it. It is overshadowing the great work carried out by staff and the qualities of the NHS; it is not fair that it does so much damage to a great institution. There will always be mistakes made but the picture presented should be (as pointed out in the Berwick Report) one of a continuing battle for safety that is never won. There cannot be an expectation of perfection; and there needs to be transparency to prevent information being leaked later to the press. Finding resolutions to the existing defensive culture which clearly exists must also be part of the shift if the reputation of the NHS is to be saved. I do not want the NHS lost so please keep up the work that you are doing in promoting it in whatever way you can. I wonder if there is anything that the Personal and Public Involvement groups might be able to do to help; they should be unbiased but encouraging sharing of positive experience is beneficial- it shows what works well.


  10. Thank you Steve from George and
    Me for bringing to light the true
    Importance of praise and encouragement for all the hard working achievers in the NHS – many must
    have become increasingly discouraged
    by the over-emphasis of the media on
    Unsatisfactory aspects of what is
    In the majority of cases a
    Magnificent service in all its many
    facets – a Service which should not
    Be frozen out of existstence by
    multiple criticisms but warmed improved and fostered with
    positive and encouraging action.
    Three cheers for the NHS!
    Where would we be without it??
    25 May 2014


  11. I absolutely agree. Sadly we seem to have lost our way . Let’s support each other and provide a united front which says we can be the best!
    My biggest issue is with the way the public react to us.We do our absolute best to provide a professional service whilst maintaining compassion and understanding in an increasingly difficult line of work but we are exposed to relentless attacks upon our services which are completely unwarranted
    Come on Public help us to give you a service you can depend upon !


  12. I feel the NHS is imperative to the UK population the amount of bad press is totally wrong human error is a flaw in most of us.
    I feel that there trying to get some kind of system in the pipeline pushed forward ( probably cash related business or another set of clever laws put in place that will close the NHS down ) just thinking out loud on my own part.
    I feel people nowadays have An American mentally to sue. I’ve heard it constantly “Sue them!! I wouldn’t let them get away with it” “get a lawyer and take them for everything “. common phrases nowadays.
    Now I’m not saying that nothing ever happened there are cases of neglect, sadly causes of fatalities which must be devastating to people that have suffered these situations, there will be cases of lesser concern but also scary to people affected.
    I mean it would be great to hear someone sticking up for the NHS ( Taking one for the team ) We all can’t go through life with no mishaps how would we learn? I for one, sure remember saying “I won’t be doing that ever again” in my lifetime. ( I’m not saying how many times though 🙂 )
    The staff need our support, give them our backing. We have to realize the staff have to deal with difficult patients and pressures than most jobs ( Imagine trying to get work done in an office. bricklaying or any job dealing with people fueled with alcohol, imagine the chaos and health and safety laws broken ) reporting an abusive boss would be nothing.
    I’m sure they will get things better in the future.
    NHS are doing a lot of good after all, we never hear much from other media based across the country headlining NHS successes.
    Most of us did think going to war with Iraq wasn’t a great idea, We sure celebrated and supported our troops in Iraq and coming back from the war.
    Why the hell can’t we celebrate one of our greatest assets to our country the NHS


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