Ten common misconceptions about “Big Up the NHS”

I receive a handful of tweets every day from people who have either misunderstood my purpose or think I have ulterior motives for running the Big Up the NHS campaign. Most are polite but some can be surprisingly unpleasant. I don’t usually respond because entering a public debate in bursts of 140 characters is unlikely to lead to a resolution and I don’t want to spread a bad vibe.

This blog is primarily for people who have questioned my raison d’etre. I hope it provides a reasonable rebuttal of the common misconceptions and gives some insight into my motives for starting Big Up the NHS.

If I have referred you here after a tweet please take a couple of minutes to read the points below, and then get back to me by all means if you still want to.  If you have arrived here under you own steam I hope you will find it interesting.

Ten misconceptions

1)      I am in denial about the problems in the NHS

Trust me I understand the problems. As part of my job I see all the complaints that come into my trust. I know that things go wrong, that people can suffer horrendous harm and that some staff can be cruel. I believe in openness, listening and learning. I want to encourage and support whistle-blowers.

To improve an organisation needs to embrace its mistakes and learn from them. This will happen more easily in organisations that are confident, valued and unpressured. Bigging up the NHS will ultimately help it to improve.

2)      I have exaggerated the risks to the NHS

I don’t think so. The fall of the NHS will be a quiet affair that will go unnoticed unless we shout about it. Large chunks are already being run under the NHS logo by private companies. The public can’t tell who owns what at present.

So why does this matter if the service is still free at the point of demand? The problem is it won’t stay that way. Companies will soon start to offer an ‘enhanced’ service for a small cash top up and the rot will then have truly set in.

Ultimately you will have to make your own mid up on this but look at the stuff that is now out there on the net about the way things are going. Much of this is pretty compelling.

3)      I am a front for NHS England…

…or a whole range of other organisations. Honestly – this has been suggested but it is not true. Big Up the NHS is all my own work.

4)      I am politically motivated

I am not aligned with or affiliated to any political party. My primary purpose is to improve the NHS and save its fundamental principles for future generations. This may mean that I take the odd swipe at the current government but it seems to me that all parties are actively or passively complicit in the current crisis.

5)      Big Up the NHS is an organisation with a membership

No – at the time of writing it is just me. That is not to say I would not like to enlist some help, perhaps by setting up local groups. Things may change in future. Watch this space.

6)      I don’t really understand the complexity of the NHS

Consultant Physician for 20+ years, Clinical Director for Renal Services for 15 years,  medical director of a large trust for 5 years, past president of the British Renal Society……

7)      I am in it for personal gain

I can’t deny feeling a slight sense of satisfaction as I watch this enterprise grow but there is no ulterior motive. I make no money from it. It is, as it always was, about the NHS and not about me. You can read how it all started here.

8)      I have no mandate to represent NHS staff

I don’t pretend to represent anyone. The views expressed are all my own.

9)      It is too late to do anything, the NHS is already a lost cause

While sadly there may be some truth in this I do not believe that all is lost. Unfortunately the legal framework for privatising the NHS is now in place and it will take an enormous public outcry to reverse this. Unless it is reversed privatisation will progress relentlessly.

It is for others to mobilise the public. My mission is to help convince the public that the NHS is worth saving by countering the relentless barrage of negative press which sometimes seems deliberately designed to undermine it.


10)   Big Up the NHS is only on Twitter

Twitter is effective, immediate but also transient. Apart from this blog there is also a Big Up the NHS group on Facebook and two groups on Linked in – ‘Big Up the NHS’ and ‘NHS  – Putting Patients First’. Here you can enjoy a more in depth debate. Please have a look and join in.

And one truth

I am often accused of being partisan, filtering out the good news and ignoring the bad. I hold my hands up to this. The whole premise of Big Up the NHS is that positive feedback loops will help staff and patients and improve outcomes. It is based on positive discrimination – indeed this is how it works – and I am not ashamed of taking this approach.

Steve Smith




  1. – Am seriously worried about new and imminent legislation that will allow me Hunt to close down hospitals with only 40 Days notice


  2. If we stay in the eu the we have various legal obligations which are especially expensive for the nhs and other uk social care systems…. A more pronounced two tier nhs system, even if unfair, makes this more affordable.


  3. I’m particularly struck by the accusation that you have a “political agenda”. The NHS is a political issue, I fully endorse your political agenda. Keep up this great and important work.


  4. Many support your cause as we all owe something to NHS, unfortunately the public are sleepwalking through the current situation, the Govt stands back and blames individual cash strapped Trusts


  5. The NHS is already largely private. Pharma, GPs, Mental Health and best surgeons subsidising income through private practice. Some of the best systems in the world use private providers to deliver healthcare (Singapore etc.). And you can’t have an honest debate about cost until you discuss value. BigUp was started as a forum to celebrate NHS success. Now you are using it as a forum to debate it’s operating model, and being very selective in your facts while promoting political attacks on Government policy. This is now a propoganda tool for your opinion, and no longer a vehicle to celebrate what is great about the NHS. Shame on you. PS.


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