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At the heart of general practice since 1960

If the NHS ain't broke, don't fix it

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I’m not one for banning things – least of all words.

But if I could put my libertarian principles aside for one moment and strike a word from the OED, then it would be ‘unsustainable’. Because never again do I want to hear the hackneyed phrase, ‘The NHS is unsustainable.’

I’m bored by it, I don’t believe it and I don’t trust it. We hear about how unsustainable the NHS is every other week – remarks from a Chief of the NHS here, quotes from an acute care director there.
It’s not even a new concept: this report from 1999 questions ‘the sustainability of the NHS in its present form’. And yet the organisation has staggered on for another 15 years.

Interestingly, the current narrative would have us believe that we must accept the demise of the NHS because the UK is broke and can’t afford it any longer, while the 1999 report blames - among other things – ‘public expectations’, which are ‘rising partly because of increased wealth’. So we’re damned if we’re rich, and we’re damned if we’re poor.

There is a strong political agenda behind the use of the word ‘unsustainable’, of course. If something is unsustainable then something must be done about it. And there’s no need to worry about whether it really is unsustainable – in our modern, fast-paced, read-the-headlines-no-time-to-think-about-what-it-actually-means-world if you just say something often enough then people start to believe it. And once we start to believe it.

However, all is not lost. This detailed report, with recent data from 2013, is not an ideological statements, but a summary of hard data on things that matter – like patient safety, effective care and access to care. Comparing 11 of the most developed healthcare systems in the world, the NHS came first, and not just first overall – the UK was ranked first in nine out of the 12 categories, and in the top three in all bar one.

Think the NHS is unsustainable because it’s staffed by doctors and nurses who are always making cock-ups in patient care? Actually we ranked first with the lowest rating for medical mistakes.
Claim the NHS is broken because no-one ever has a regular doctor co-ordinating their care anymore? We came top in that too.

Think the NHS needs an overhaul because British doctors are hopeless at explaining things? We topped the charts there as well.

And there’s more: want to complain that you can never see a doctor the same day when you need to? Try living in one of the other 10 countries that ranked below us.

Find it difficult to see a doctor out of hours without going to A&E? It’s worse everywhere else. Had to visit A&E for a condition that could have been treated by a GP? You’re less likely to have to do that in the UK than any of the other countries.

Most of all, whenever we hear the lie that the NHS is unsustainable because we can’t afford it, we need to ask just how all the other countries afford their (inferior) health service, given that ours is the second cheapest of the lot.

The report is such an endorsement of the UK system that you would think the UK press would want to celebrate it, but oh, the silence when there is something good to say about the NHS! The Guardian and The Independent did pick the story up but not a squeak emerged from the rightwing press, and the BBC drew a blank too.

Like any big organisation, the NHS is not perfect, and we should always be ready to learn from mistakes, but it is absolutely sustainable if we want it to be. It is the best healthcare system in the world, and we are very lucky to have it.

Dr Martin Brunet is a GP in Guildford and programme director of the Guildford GPVTS. You can tweet him @DocMartin68.

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Readers' comments (12)

  • Vinci Ho

    It is sustainable only on one condition: politicians stop interfering with the everyday running of NHS at all levels, including finances.

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  • problem is that the story has been decided and the headlines written..... no amount of actual fact can be allowed to interfere with that.

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  • Whilst I agree that the NHS has much to commend it and receives far to much criticism but an agenda driven press, the Commonwealth Fund is not a completely unbiased organisation and the one item that the NHS did badly on was early medically avodable deaths. The system does need change - probably considerably more GPs so that access can be made better and I believe this is what the RCGP etc are arguing for. A positive report is however always welcome amidst the usual doom and gloom.

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  • Isn't the data two years old as well...I think the acceleration has been remarkable in that time.

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  • Vinci Ho - you are my hero. Stop using the NHS as a political football.

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  • Ivan Benett

    Well said Peter Mcevedy. I agree with all of that. Martin Brunet might be bored, put he obviously hasn't seen the figures. Perhaps he's not aware of the economic stagnation we're in and have been though since 2008, perhaps he doesn't read the headlines or listen to econmic up dates. They're just too boring. I wonder what he teaches his registrars. Perhaps the concept of modernising General Practice is just too boring.
    The fact that we have a good news story about the NHS is welcome, of course it is, but we still have high levels of premature and avoidable death, wide degrees of inequality and huge variation in service provision. Modernising general practice is about confronting those old enermies - the Inverse Care Law and the Rule of Halves. It also means modernising GP career paths to offer flexibility, career progression and freedom frm the burden of administration. Finally it means offering the public a more accessible service to meet the needs of modern society, including gainful employment, child and parent care, and the increasing burden of disease . The RCGP themselves acknowledge this in their (our) plan for General Practice 2022.
    It's a shame that educators of the next generation are so bored and complacent. I'm afraid those attitudes just wont do.

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  • I think Ivan Benett has missed the point completely. What world is he living in that he hasn't noticed that health inequalities are widening under the modernisation that he supports.

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  • Ivan - you've obviously decided to get out of bed today and decided to have it in for GP Trainers and Educators.
    But you are forgiven as you amuse me!

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  • Ivan is often angry at GPs

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  • Ivan Benett

    Never angry at GPs (anon 9.12) but I think those who are given the responsibility to train the next generation should be more careful in the attitudes they portray. It's no wonder students are put off going into General Practice when all they get is Cynicism from their teachers. No, I'm not at all angry with GPs and can't think were you would have got that from...anon
    As for Steven Martin, you clearly are unaware that I was against the whole direction of the reforms set in train by Labour and pursued by this government.
    However, we have the policies we have, and better to work with them than spend a lot of energy in these columns get angry at the system - like it or not they are democratically elected. Check out Pulse sponsored candidates for the 2005 election if you want my political stance. I believe General Practice is the only way forward. Don't confuse me with GP bashers, I'm for GPs despite some of the contributers to these comments pages. And it doesn't mean I will pander to some of the mindless drivel i hear from some commentators. It's a bit to easy to be populist. It all too easy say what people want to hear, and get a big cheer from the crowd. It's a bit harder to speak the truth as you see it and accept that you might be wrong. At least Steven names himself but it would be good to hear his views, rather than what he's against. How would you modernise the NHS Steven?

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