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Is the NHS unfit for purpose?



Five years ago, it would have been unthinkable for me to write a blog with this headline. Growing up in poverty meant my views have always been comfortably left of centre, moderating a little as I’ve grown older. For nearly 15 years I have been working with marginalised groups within the inner city, where we are advocates for people who, for one reason or another, cannot speak for themselves. But it is this passion for reducing inequalities that has led me to reflect on the healthcare currently offered to my patients. 

The NHS had been starved of resources for years before the pandemic, and despite annual uplifts in funding, was unable to keep up with the demands of an ageing and increasingly comorbid population. The pandemic has now exposed this resource gap as a large gaping wound requiring major surgery, rather than the intermittent sticking plasters used to patch it up in the past. 

We have silently accepted ambulance waits of up to 10 hours, four-month waits for psychology services, six-month waits for physiotherapy and 12-month waits for elective surgery. Yet despite all of this, I have never questioned the fitness of the NHS until a recent conversation with a friend. 

This friend shared with me that their teenage granddaughter had not attended school since the start of the pandemic due to her anxiety. The factors leading up to this situation are obvious – a school overstretched by the demands of mental health problems among pupils, an eight-month waiting list for CAMHS and a parent who, understandably, is totally out of their depth. 

I reflected on my own experiences with my 13-year-old daughter, whose upbringing has been steeped in privilege and advantage. Who says money can’t buy happiness when it has bought private CBT leading to recovery? My knowledge about graded exposure also enabled me to work with her teachers to devise a back-to-school programme, and she is now attending full time. Six months down the line, though, my daughter remains on the CAMHS waiting list, and I dread to think what would have happened if I hadn’t been able to buy us out of this situation. I can’t help comparing the life chances of these two similarly aged girls and wondering how we could have come to accept this appalling service for the sake of maintaining a health service on a life-support machine.

By attempting to provide a universal service with inadequate funding, we are offering substandard healthcare and widening health inequalities. GPs are often the scapegoat for the resultant failings, including early cancer diagnoses. Yet, fast-track cancer appointments are designed to offer a yield of around 4% and the majority of cancers are still diagnosed outside of these pathways. This means it is crucial to have timely access to elective referrals, but this process has been obliterated by the pandemic. 

We are living in a country where those with a bit of cash are increasingly likely to buy their way out of an unfit NHS (as Pulse showed in its recent feature), but my marginalised patients will continue to endure pain and suffering, both mental and physical. The previously cherished mantra of the NHS levelling us all up is no longer applicable as we are all freefalling to the bottom. 

If we do not do something dramatic, the inequalities between social classes will widen even further.

Dr Shaba Nabi is a GP trainer in Bristol.

Read more Dr Nabi’s blogs here 

READERS' COMMENTS [21]

Patrufini Duffy 18 February, 2022 3:18 pm

You refer an atypical headache – you get rejected. You order blood tests – you get told off. You give a routine appointment in 2 weeks – you get slated. You don’t do an inappropriate face to face – you get monitored and shamed. They discharge the patient after one DNA – you can never do that. You offer people choices but you’re told to ration and delay the care. You wear a mask and keep people safe – they don’t need to do that. You promote equality – but you are treated as an unequal. You can’t do any private work – everyone else can. Duty of candour – but don’t you dare whistleblow. You open your doors – but they can close theirs. You must respect consent and autonomy – but you were threatened and stripped of yours. Sounds like a fair employer all around. The NHS is fit for one sole purpose – belittling, shaming, mistreating and scapegoating their workforce – silencing them into oblivion in an ugly, perverse and hypocritical orchestrated fashion. The coal face will only turn nuclear very soon. But, the workforce mostly has learnt hard lessons. Those that left, left in full awareness. The NHS missed out. Big time. Basic manoevres and gestures of good will and care for its own. An employer impervious to actually caring. But what is the NHS really beyond the carers and good-doers? An empty nothing. Who lurks in the shadows and what do they really want? Where is this all going? The carer is tired with the monotony and same old tricks – the party dressers, high heels, podiums and blue suits – all a fantastic show of well, hypocrisy. But the workers are sharper and clued up as to what this charade all is – all you are left with is fragmented, inert, corporate transaction and profiteering. Which is the plan. A juggernaut machine that lost its way, churning out illness not health. But. your time will come. In another form, or another employer. The NHS and primary care: transparent like mud.

Some" Bloke 18 February, 2022 5:38 pm

am very surprised that BBC have aired “It’s going to hurt” as realistic as it’s meant to be. Was expecting some smoothed version more acceptable for the public.
have relieved some unpleasant experiences/memories of working for nhs trusts before going GP. of cause nhs is not fit for purpose and hasn’t been for long long time. bullying staff into obedience is the only HR approach they know.

Stephen Aras 19 February, 2022 10:20 am

Wow – playiinto the hands of the Tories why don’t you?! The NHS is not fit for purpose is exactly what they want to hear so they can tear it down and start again with a private insurance based system that some can afford and the rest will have to accept a second rate service designed only to ‘do what we can’ (not much) – Instead ask is the NHS perfect – let’s move on quickly, of course not – no health system is. However is is good enough or maybe more pertinent is it the least worst system? YES it is. Could it be better? Of course! How so? Vote for tax increases for one and party willing to invest in people – patients and staff. There will always be a shortfall of cash when we strive for better but accepting and even celebrating that what we have, despite all its faults is ‘good enough’ whilst driving for better is key to avoiding the disaster of giving up and starting again.

Giles Elrlngton 19 February, 2022 10:24 am

Is the NHS unfit for purpose? Depends upon the purpose of the NHS:

If purpose is optimal health for the nation, then yes.

If purpose is political gaming, then no.

Recommend dramatic action: remove the politicians from the NHS. Who can trust today’s politicians? As doctors we are no more than pawns in their game.

Nick Mann 19 February, 2022 12:39 pm

The NHS is very fit for purpose. The mistake is to presume that NHSE represents the NHS in its destructive, dilatory, disengaged corporate management of our national health services.
NHSE/DHSC is not fit for the purpose of managing the NHS.
Please ask the right question. Otherwise the answer will always be more harmful ‘transformation’.

Wendy Domleo 19 February, 2022 6:26 pm

https://www.commonwealthfund.org/publications/fund-reports/2021/aug/mirror-mirror-2021-reflecting-poorly

Can we change systems to the best in the world? …Yes Australia..

There is a great health system that the UK could adopt but we all have to be brave enough to say that the current system is neither fair nor functional.
Thank you Dr Nabi

Dave Haddock 19 February, 2022 11:01 pm

Western Europe levels of funding, Eastern Europe outcomes.

David jenkins 21 February, 2022 11:07 am

“Eastern Europe outcomes” ??

i had a patient who went to india to get his mri scan !! admittedly he coupled this with a holiday, but the main reason was to get an mri.

how can the politicians possibly pretend this is an acceptable level of service !!

Finola ONeill 22 February, 2022 10:33 am

Government not fit for purpose. Political system not fit for purpose (we need PR). NHS England not fit for purpose.
The only thing pushing this government to give the NHS the funding it already gets , is that the rich can’t buy their way out. DR Nabi may have bought her daughter’s way out for CAMS, but anything acute, you’ve got the NHS or death.
There is not private acute care.
They can buy their way out or a hip; but ICU; Johnson went to Tommies.
They pretend they love the NHS, but at the moment they just need it because they can’t buy their way out for the most serious illness.
Once you give them that, we get America.
The rich get their care. The poor can’t even get asthma inhalers or their kids.
Is Dr Nabi living on the same Planet as me.
You have realised that there is a difference between acute and chronic conditions and that the fact that you can’t get acute care outside the NHS is why any of this government and their selfish voters still give a rats arse.
If they could buy their way out or all their care at this moment the NHS would be getting nada.
There would be lots tea and sympathy for the terrible services. But not the cash.
But at present we are all stuck with the terrible acute services; so solutions will be sought.

Finola ONeill 22 February, 2022 10:37 am

And Wendy. I worked in Australia or 3 years. It is not better than the UK health system. Their public health is way better but it is properly govt funded. Primary care is massively pared down in Australia, they have a much younger population and so less challenged, very remote populations that in rural Australia often have a rural GP doing their surgery, Obs and Gyne and anaesthetics. Yep 6 months of anaesthetic training and your G anaesthetises you. I trained alongside them. And hospital care was way inferior. Better nursing ratios. But standards o care way lower. Apart from city centre teaching hospitals. Some of it due to rurality and distance but not all. And they pay for loads of their outpatient stuff like scans, etc.
Have you lived and worked there Wendy? If so where?

Dave Haddock 22 February, 2022 12:08 pm

My GP has repeatedly sent out texts saying that they are very busy and we should not contact them unless essential.
Meanwhile “our” NHS spends about £3000 per head per year. How do I get a refund, as I must be owed at least £150,000 by now? How do I opt out, I could certainly make a better job of spending that £3,000 per year?

Martin Williams 22 February, 2022 2:10 pm

It would appear that the Conservative government of the last 12 years are unfit for purpose.
A car won’t go without enough petrol. But that’s what they want.

David Church 22 February, 2022 3:00 pm

Dear Shaba, whilst you have enviably short waits for CAMHS and surgery in your area, I feel you also may hold the key to more urgent action : all those deprived social groups you work with or have contacts with :- could they not be utilised to mobilise a vote for a change of government to one more supportive of the basic needs of a civilised society : viz : to be caring and considerate of the health and needs of others, because only by raising general health can we effectievly raise our own health and reduce the risk of infections and adverse effects.

Leonard Mirvis 22 February, 2022 5:06 pm

it is a great system with countries all over the world rushing to UK to see how it works then rushing home to copy it? I think not!

Hello My name is 23 February, 2022 9:33 am

You are right Shaba. We need better and to open our eyes to how inadequate the present system is. It has been failing our patients for too long.

Monica Stevens 23 February, 2022 10:51 am

David Haddock,

Of the £3000 spent on the NHS, your GP only gets about £130/ year for you, to do everything. I don’t think you will get far with £130 refund to pay for your GP care. The rest is for secondary care.

Paul Evans 23 February, 2022 7:32 pm

David Church: Shaba works in inner-city Bristol. Her patients don’t vote Tory. Staying within the democratic process, it is unclear how inner-city poor people in a Labour seat are going to mobilise to bring about a change of government.

Jamal Hussain 24 February, 2022 1:42 pm

I’d be very happy to see everyone getting their 130 pounds on 1st Jan. And having to pay for all of their interactions with their GP.
For every blood test requested. For every set of results reviewed and file. For every piece of patient related correspondence read/ filed or actioned. Etc etc.
I don’t think your 130 pounds is going to do it Dave. You might be looking at 3000+ per year Dave for a large cohort. Vet check up 60 pounds just for the consult and the cat or dog doesn’t have a massive list of co-morbid conditions and current medications. So let’s say 60 for an easy consult and 100 for a complex one. You might run out of your GP budget in January and have to make do until the following year. Might not go down too well in inner city Bristol.

Dave Haddock 24 February, 2022 2:45 pm

£3,000 per head every year.
Please can I have my share, and in return I’m happy to never use NHS primary or secondary care ever again. It’s not as if it can be relied on to deliver when you need it.
Thank you.

Monica Stevens 25 February, 2022 9:12 am

All acute, emergency care, worth having is through the NHS. Private hospitals transfer their patients when things go wrong and the patient needs ITU. Your three thousand pounds will not go far.

None of us can predict the future, so you may well need secondary NHS care. Better to keep it goingand well funded for yourself and your loved ones.

Dave Haddock 27 February, 2022 9:14 pm

Hopefully the widespread disappearance of GP services during Covid as experienced by many of the Public might help promote a re-examination of attitudes to the holy relic that is the NHS.