I wanted to take a moment to reflect on recent months. As if from nowhere, the health service has been thrust into the limelight. Neighbourhoods have been on their doorsteps clapping. The chief medical officer has fronted daily press briefings alongside the prime minister and other cabinet ministers. Never in my lifetime has there been so much attention given to the health service, and its workers.
So what, you might ask? We are in the midst of a global pandemic, it is only natural. But this is extraordinary, unheard of.
If you have read any of my previous writings, you will know that I am not a die-hard supporter of the NHS in its present guise. The national health service desperately needs transformation if it is going to provide an acceptable level of health care to the UK population over the coming decades.
Working within the service, having moved from hospital placements into general practice, it is easy to see myriad shortcomings. The staff shortages in primary and secondary care, long waiting times, an exhausted workforce, huge amounts of paperwork, excessive guidelines, and the ever-present threat of litigation.
There are many areas for improvement. Not all will require a great investment. A lighter touch in the management of GPs, greater autonomy, strategic investment in our workforce, and in systems to help reduce our workload. More investment in community care – moving the frail and elderly out of the acute trusts, into purpose-designed elderly care hospitals (remember the community hospitals?).
I can only hope his recent hospital admission was a wake-up call
And in secondary care, we need to have a long, hard look at which services the NHS can realistically provide. It is a painful conversation to have: but a system which provides fertility treatment, but leaves our elderly dying unattended in hospital corridors, is not fit for purpose. Our leading scientists and medics will always advocate for investment in their specialisms. But they will not always be right. Millions spent on reconstructive surgery, might be better invested in primary care, community hospitals, or outpatient geriatric services.
A citizen’s assembly should be commissioned to review the services provided by the NHS. Ordinary members of the public ought to be part of this decision-making. Pragmatic, but ethical, decisions would be more likely to result without political interference, and would help facilitate a cross-party consensus.
So, back to Boris. As doctors working in the health service – we see its importance. We see our patients with their unexpected cancer diagnoses, rushed into hospital, needing acute care. We see little old ladies, needing the emergency services, admitted with their strokes. But our politicians won’t always see this. Largely shielded from the NHS, a privileged group: they will, statistically speaking, have fewer emergency admissions and chronic health conditions.
When you don’t regularly need a service, it is easy to forget its importance. And it’s easy to become complacent, and underinvest in it over time. Like an insurance policy you have paid into for years, then allow to lapse; only to have your house burn down in a freak accident.
So when our Prime Minister comes face to face with his need for a health service, it matters. I can only hope his recent hospital admission was something of a wake-up call. Faced with an indiscriminate virus, such as Covid-19, right now any of us might need medical care. This is finally abundantly clear to all. And when we really need a GP, an emergency department, or an ITU bed: don’t we all want a decent service available? The demands on intensive care may be unprecedented, and impossible to maintain in normal times; but our acute hospitals, the availability of ambulances, the accessibility of GP care – our population needs these.
So, Boris, Matt Hancock et al.; don’t forget 2020. This was the year when you finally realised that we all need a health service which is fit for purpose. The NHS needs transformation, investment, and improvement. We all rely on it to be there to care for us in our hours of need.
And as you now know, any one of us might need it at any time.
Dr Katie Musgrave is a GP trainee in Plymouth and quality improvement fellow for the South West