Month: July 2014

Who will save the NHS?


I know the approach I have taken in this blog is a bit contrived but as a device to get the main message across it might work. Please bear with me and read to the end to find my answer. Share widely if you agree with the logic.

It takes the form of a conversation between me (@butNHS) and the average man (or woman) in the street (TMITS).

TMITS  – “What – save the NHS? Surely the NHS is one of the UK’s best loved institutions and is recognised to be the most efficient, effective and equitable health care system in the world. We all depend on it from cradle to grave. It is at the core of our society, truly a national treasure. How can it possibly need saving?”

@butNHS – “Yes, all these things are true, but the NHS as we know it – funded through central taxation and free at the point of need –  is under real threat at the moment.  Unless things change quickly we will see it systematically dismantled over the next decade.”

TMITS  – “How come? I have grown up with it.  I have always been certain that we will have it for ever.”

@butNHS – “There have been two significant changes in the law recently which are certain to force large chunks of the NHS into private ownership.

download (2)The Health and Social Care Act of 2012 obliges commissioners to buy in services through competitive tendering.
Private companies will be able to use their extensive business development know-how to out-manoeuvre NHS trusts and pick off the best and most profitable parts of the NHS.

The Transatlantic Trade and Investment Partnership is a piece of European legislation that when passed at the end of this year will oblige the NHS to offer its services for sale to the big American healthcare corporations.

The combined effect of these two bills will be a steady transfer of NHS services to the private sector – and as the new services are all badged as “NHS” the public will not see it happening.”

TMITS  – “But if it is still free at the point of need and funded from central taxation why should we worry?”

@butNHS – “ Mark my words – there is a lot to worry about!

Big business is mainly interested in the profitable, safe and predictable bits – routine surgery for instance. They have their shareholders to pay. Messy things like emergency services will be less attractive.

When the NHS acts as a unified whole the profitable and non-profitable, easy and difficult bits balance each other out, but take away the easy stuff and the rest is put under greater pressure.

And what’s more the move to private ownership is a one way street. When private companies take over a service the existing NHS provider loses the income and has to disinvest in staff and equipment. In a cash strapped health economy it is virtually impossible to upscale to take on the service again – even if the private company eventually decides to release it.

NHS staff will be torn. Should they work in the safe and sanitised private sector where they will most likely receive a variety of tempting inducements, or should they work in an increasingly underfunded and pressured NHS. Recruitment and retention is already an issue in many areas and this will make it much, much worse.

The final straw will come when private providers start to offer an “enhanced” service for those who can afford to pay a bit extra. It will fall outside the NHS umbrella at first bit we will see an inevitable drift towards those who can afford it taking out private health insurance.”


TMITS  – “I have heard a lot or press reports recently that the NHS is failing. Perhaps it is best to dismantle it anyway.”

@butNHS – “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 view has been widely circulated through social media. I am not a natural conspiracy theorist but I can see the logic of the argument.

There is little doubt that current press coverage of the NHS is skewed heavily towards the negative. The NHS bears comparison to any other health economy in the world and often comes out top in international league tables.  There is a lot of good work that never gets reported. The NHS is definitely NOT failing.

I don’t discount conspiracy but I think it 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.”

TMITS  – “OK – I get it. So what can we do about it? Surely there will be a public outcry.”

@butNHS – “Well no. Privatisation is already happening big time but there does not seem to be much noise about it at present. A bit of activity in social media and the odd article in the papers, but if you ask the average person what they know about this you will probably find it is very little.

I am really worried that there is no one with both the will and the means to save the NHS!”

GovplansTMITS  – “So how about the big political parties? They know the popularity of the NHS. Protecting it should be a big vote winner for them. But you said that they may be orchestrating its demise.”

@butNHS – “Yes I am afraid that may be true. All the mainstream parties were complicit in (if not directly responsible for) the legislative changes that have put it under such threat. The NHS poses a big problem as far as all the mainstream parties are concerned – regardless of what they say in their manifestos.  They know that it will require more funding in future but they do not have the courage to increase taxes to pay for it. Selling it gets them off the hook. They would rather you pay a lot more through private insurance policies than risk losing your votes by asking for a little more tax. It is political cowardice of the highest order.

Sadly though, it is only the party in power that can really make the legislative changes that will safeguard the NHS. If we are to save the NHS we have to convince current and future governments that it is in their best interest to preserve it. We need to exert sustained, forceful and unambiguous pressure. All parties need to understand that saving the NHS is the Great British public’s top priority when we come to vote in the next election.”

TMITS  –  “Yes that makes sense. So we need a big campaign. Let’s get the press behind this.”

@butNHS – “Oh dear – I don’t think you have been listening. The press seem intent on undermining the NHS. So far they have not taken this on. They may even be part of the problem.”

TMITS  – “Then we must make them change their minds. Who else can exert an influence on press and politicians? What about the big bosses at NHS England? They must know what is going on.”

@butNHS – “They are far too embroiled in politics and worried about their own jobs. They dare not speak out.”

TIMTS – ” Or the Care Quality Commission?”

@butNHS – “Not likely – it is a political quango which looks to be operating at present as though it wants to undermine the service  too.”

TMITS  – “Well there are the professional bodies, the General Medical Council, The British Medical Association, the Royal College of nursing etc.”

@butNHS – “Maybe one day but they seem more concerned with protecting their individual members and keeping out of the spotlight than looking at the full picture. To be fair it would be a bit intimidating to take on a hostile press. They would be massacred. You must have seen what Channel 4 News can do to a society president.”

TMITS  – “The Trade Unions? Surely they must understand the importance of socialised health care.”

@butNHS – “Possibly but they have not made a lot of noise so far. I hope they may get more involved in future but we need to get them engaged somehow.”

TMITS  – “There are 1.3 million people working in the NHS. Surely they can exert some influence.”

@butNHS – “Eventually maybe but many NHS staff are not in good place at present. Overworked, underappreciated – at least by the media – and too beaten down to lead this. Some are worried about their jobs. We know that whistle blowers can be very badly treated. There is huge potential for NHS staff to get involved though given, the right guidance and support.”

TMITS  – “Why don’t we just vote in the NHS Action Party? They seem to care about this stuff.”

@butNHS – “Undeniably true but single issue parties will rarely win seats in an election. Even if they do they don’t get to make law. They can only lobby the government like the rest of us. They can help in spreading the message but they will never hold real power.”

TMITS  – “A-ha, I have got it. You are a big fan of social media. That must be the answer.”

@butNHS – “Well no, not really. Social media has quite a lot of reach and works quickly but it is ephemeral. The vast majority of the UK population do not use any form of social media. This campaign needs to be firmly in the real world. There are lots of little social media groups working separately but nothing seems to join up. Committed people can tweet at each other as much as they like but it will not change the world.”

TMITS  – “OK – I give up. Who do you think will save the NHS?”

@butNHS – “Think about this logically. The only people who have the power to make the legislative and organisational changes needed to save the NHS are members of the government who you, the man in the street,  put in charge of the country next year. The problem is neither of the mainstream parties seem to have the political balls to take it on.

They will only do it if they think their political lives (as opposed to their real lives, ironically) depend upon it.

We have the make saving the NHS the top priority for every party in the coming election.”

protect the nhsTMITS  – “But how can we do that? You have just spent 10 minutes telling me that everyone is impotent or disengaged and nobody can make a difference!”

@butNHS – “Well yes , and also no. The truth is that no single organisation can do it but if everyone joins in we can make a difference. Social media can be a big driving force to spread the message. We need to coordinate the various pressure groups and get them all working together. We each individually need to encourage our unions and professional organisations to get involved and give them the confidence to speak out. We need to big up the NHS and empower its staff to speak out.

Any person can canvass an MP or a healthcare correspondent and these are the people who will make all the difference. They all need to be bombarded with thousands of messages from concerned men and women in the street.

We need petitions, demonstrations, marches, celebrations, and lobbying. We must celebrate the NHS and counter the negative press stories.

We need the nation to be proud of it greatest institution.”

TMITS  – “So you are saying that the only thing that will save the NHS is the combined will of the British people, and that it is everyone’s responsibility to do something about it.”

@butNHS – “You have got it in one. If we all sit back and wait for someone else to fix it we will have no NHS in 10 years’ time and we will all be much the poorer, and many will be dead.

So, man in the street, what are you going to do now?”



I am thinking about converting the dialogue into an animated video using one of the free on-line services. What do you think? Would any of my dear readers have experience and be able to help with this?