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PATIENT OUTCOMES ARE INFLUENCED BY EXPECTATIONS.
UNJUSTIFIED NEGATIVE PRESS NOT ONLY DAMAGES THE NHS, IT CAUSES REAL HARM TO REAL PEOPLE.

 

Best of the blog

Extracts from the Big Up the NHS blog

Jeremy Hunt, Social Media and the Future of the NHS

Steve Smith

Jeremy Hunt leaves Downing Street

I honestly think that this is the most important piece that I have ever written. It is a little longer than most and will take you five or six minutes to read. It contains many links so may be a useful starting point if you are interested in further reading.If you don’t have time now please save it and come to it later, perhaps with a glass of your preferred tipple. You can then take time to read the most important links (in RED) and consider the implications more carefully.If you like it and agree with my conclusions then please share it with others.Above all – make sure that you take note of what you can do personally to help in the fight to save the NHS.

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Wow what a week. Jeremy Hunt offended hospital consultants with unfounded claims of laziness and greed leading to the deaths of 6,000 people. The doctors responded with a Twitter campaign (#ImInWorkJeremy) which trended all weekend in the UK and they started an e-petition for his dismissal.  This reached the 100,000 signatures required to trigger a parliamentary debate in less than 36 hours. The government response to the petition was dismissive and inflammatory and the docs started to realise a debate is not mandated. All of this was largely ignored by the national media except for a brilliantly funny piece on Channel 4s The Last Leg . Significantly this piece was triggered by social media using their #IsItOK tag. A second Twitter campaign (#WeNeedToTalkAboutJeremy – which was started by me) trended again with 45,000 tweets and a social reach of over 125,000,000. What a rollercoaster of a week - the power of social media at its best. At last politicians will sit up and take notice and the NHS will be saved. But actually the likelihood is that it will make no difference at all – or worse it could strengthen the government position.   The hugely successful #CameronMustGo campaign last year rumbled on for weeks but he and the majority of the press ignored it and eventually it went away. It did no long term harm to his reputation or ability to push through policy. It did not stop him increasing his majority in the last election. What does not kill us makes us stronger and I suspect the experience will have made him less susceptible to being influenced by current and future social media campaigns. When the #WeNeedToTalkAboutJeremy campaign fizzles out – as eventually it must – it will leave Mr Hunt tougher and more resilient, unless there are permanent and significant consequences for his career. We have started a battle that we cannot afford to lose. It is absolutely essential that Mr Hunt and indeed all politicians of all parties realise that they cannot ride roughshod over such strong public opinion and get away unscathed. He must be publicly taken down a peg or two as an example to the others. I am not by nature a vindictive person and I am a little uncomfortable about this approach but I have managed to rationalise it. He is not stupid so we assume his actions are deliberate. He used dodgy statistics to undermine the NHS and promote fear in our patients for political purposes. He used the same,by then discredited, statistics again in the response to the petition. He lied about doctors’ salaries, numbers of consultants using the contract to opt out and the consequences for the NHS. He is on record as wanting to dismantle the NHS and hand it over to the private sector. Even the timing of his attack on the NHS could be seen as cynical – just before the recess so he can keep his head down for 6 weeks until the dust settles. I really think his actions were deliberately intended to provoke a  strong reaction from clinical staff that can be spun by the press against us over the summer break. I have thought about it long and hard and have concluded that he has to go. Why is this issue suddenly so important? I described the inevitable decline and fall of the NHS if we do nothing in a series of three blogs published last year.  I have summarised each in a sentence below but I strongly recommend that you take the time to read them. They are important for your understanding the magnitude of the current threat.

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1410052032-peoples-march-and-rally-for-the-nhs-ends-in-london_5688700

The Jeremy Hunt affair could be seen as the start of this public engagement process. So what should we do next? If we do nothing the dust will settle and this week’s activities will come to nothing. The government will continue their current policy and the NHS as we understand it will be dismantled and degraded. We need to increase the pressure on Mr Hunt and Mr Cameron, but without overreacting or doing anything that could damage the reputation of doctors and the rest of the NHS in the eyes of the public. We have to be professional and measured – but resolute and firm. Marches and demonstration are not very effective. The press has a record of ignoring even the biggest. They are transient and can easily be misreported to work against us. We need to focus on the use of social media to coordinate a prolonged campaign directed primarily at politicians but with the press and public firmly in mid. My suggestions:-

  • All the pro NHS pressure groups should combine forces to coordinate a campaign to “Save the NHS”.
  • The campaign should have a unique brand and an identity.
  • It should focus on the plight of the NHS rather than individuals and should target all politicians though we should not forget the Jeremy Hunt issue for the reasons outlined above.
  • We should seek high profile sponsors, raise money and invest in press and media advertising campaigns. The press may not cover the story as news but they certainly will for cash.
  • It is absolutely crucial that we achieve the debate in parliament. Failure to get this will be a major catastrophe with dire implications for the NHS.
  • We should continue the #WeNeedToTalkAboutJeremy campaign as long as possible - make sure that people look in every day, post their own tweets and share the best of the rest.
  • We should continue to encourage people to sign the petition. Size is everything with this sort of thing. Just think of the power of a million signatures.
  • We should promote other social media platforms. The Big Up the NHS Facebook group has 28,000 members and has real influence. Facebook is less ephemeral than Twitter. My blog calling for the resignation of Mr Hunt was read by 40,000 people and 80% of the referrals came from Facebook.
  • We should target all politicians in all parties directly using social media, email and postal campaigns.

I am sure there will be more suggestion and I welcome any comments or ideas. You can post them here or email me at admin@bigupthenhs.com. Please do not underestimate the seriousness of the situation and make sure that YOU do something to help. Spread the word, join the groups, and sign the petition. Make sure that when you are considering having to buy your first health insurance policy that you do not reflect on first reading this blog and wish you had done more. Steve Smith Big Up the NHS.

#ImInWorkJeremy – the new democracy in action or just old fashioned mob rule?

Steve Smith

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This piece has been co-published with Open Democracy


On Friday Jeremy Hunt made a significant error of judgement in releasing advance details of his upcoming speech to the Kings Fund to the media. Hunt implied that 6000 hospital deaths each year were unnecessary and related to consultants opting out of weekend work under the new contract.

But unfortunately for Hunt it turned out that there is no evidence to support these allegations. To many doctors, it appeared instead to be a politically motivated attempt to undermine the BMA in its negotiations about the new consultant contract - and one that misfired badly.

Hospital doctors were incensed. I wrote a blog pointing out that these sorts of political shenanigans are damaging the NHS, demoralising staff and frightening patients. I suggested he should apologise and maybe even consider resigning. Others set up a social media campaign with the tag #ImInWorkJeremy using Facebook and Twitter. On Saturday morning there was an explosion of activity. The hash tag trended on Twitter all day with thousands of hospital workers posting photos and comments from work. The story made the on line national newspapers and was mentioned on the Andrew Marr Show though it never made the national news bulletins.

My blog was read by over 30,000 people in the first 2 days.

The mood was predominantly pro NHS though there were a significant minority of posts calling for Mr Hunt to resign. An e-petition calling for a debate of no confidence in the Health Secretary was started on Monday morning and by midnight there were 50,000 signatures. I have no doubt that it will reach the 100,000 names needed to secure a parliamentary debate very quickly.

Jeremy Hunt probably had an uncomfortable weekend and kept his head down. A rather weak tweet, which looked far too “Twittery” to have been written by him personally, just added fuel to the fire, reading as if it was accusing doctors of being insufficiently professional.

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Hunt tweeted a picture posing in scrubs with a group of medical staff. Unfortunately this backfired further - the picture contained patient information on a board in the background and clearly breached hospital confidentiality rules. It was quickly taken down but gave people the opportunity to modify it and subject him to further ridicule.

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The #ImInWorkJeremy group released a press statement setting out how their aim was to ‘raise morale of NHS staff’ and ‘show the public not to be alarmed by the claims of Mr Hunt’.

At times the Twitter storml felt a little uncomfortable – the enraged crowd out of control and baying for blood. At the end of the day all social media activity will inevitably fizzle out. Time will tell what will be the long-term consequences of this social media frenzy for the NHS or for Mr Hunt. Some will argue that this unregulated outpouring of emotion is the modern equivalent of the medieval lynch mob. People can hide in the crowd and let rip without fear of personal consequences. It is transient, ephemeral and ultimately no more than a minor irritation for a die-hardened politician.

But I disagree.

You do not get this sort of response without a real issue and strong majority public opinion. No clique or minority pressure group could orchestrate this response if the underlying passion was not there. People feel strongly about the NHS. They feel it is threatened and they are worried. Social media campaigns of this magnitude really do express the voice of the people.

The public response this weekend has clearly demonstrated to Mr Hunt and the government that a victory in an election is not a mandate to fly in the face of public opinion. It was overconfidence bordering on arrogance that led to his unfortunate lapse of judgement. The events of this weekend may be a learning experience for him, influencing his attitude towards NHS staff and patients.

It is for this reason that I want to see a parliamentary debate on his performance and have spent time pushing people to sign the petition, but I do not necessarily want to see him sacked. There is always the strong possibility that some one less clumsy, less chastened and more charismatic will take his place – which could be a problem if they are committed to following the present government approach to the NHS. Let him keep his job – but know that the public is on to him. He needs to consider very carefully how he approached the NHS in future. He needs to know that he only has a job because we allow it.

And so to answer my own question

Social media is here to stay. You cannot turn it off and it is growing in strength. The events of this weekend will seem relatively small beer compared with what is to come. Politicians mark my words - this IS the start of a new democracy.

Jeremy Hunt “declares war” on hospital consultants – and shows he cares more about politics than patients

Steve Smith

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Yes we do have a problem. There is no doubt that people admitted to a hospital as an emergency on a Saturday or a Sunday  are statistically more likely to die than people admitted during the working week. The difference varies according to the type of emergency and the individual hospital but on average it is large – up to 16% higher on a Sunday.

We know something about the cause. Patients admitted at the weekend are sicker on average so a difference could be anticipated. There are fewer emergency admissions at the weekend and one would expect that the missing emergencies are the less ill ones who can wait until Monday.

But even after accounting for this the differences remain. If you look at hip fractures, which happen in equal numbers every day of the week and always needs immediate admission to hospital the historical death rate in some trusts is 10% higher for patients admitted at the weekend and it is known that this difference can be eradicated by operating immediately to repair the fracture rather than leaving patients for the next working day list.

Nobody would argue that the quality of care for emergencies should not be the same every day of the week and few would claim that it is currently.

So what is the problem with Jeremy Hunt’s ultimatum to the medical profession this week?

Yes, it is his job to encourage consultants to work weekends in order to improve quality of care. What he should have done was engaged with clinicians of all disciplines in a discussion to decide the best approach and then made efforts to facilitate implementation of the plan and to mobilise the necessary resources.

What he actually did was launch a high profile attack on the whole consultant body, making best use of a scandal hungry media and with little regard to the facts. The assertion that 6000 patients die each year because consultants refuse to work weekends is disingenuous and wrong. I am a hospital consultant and have never come across a colleague who has used the terms of the new contract to avoid working weekends. All consultants in emergency specialties do weekend work as a routine.

He accused doctor of being overpaid and lazy – putting their best interests above that of their patients. Talk of a big pay rise in 2003 is a bit irrelevant when we have had a pay freeze for the last four years and the promise of the same for four more years to come (and a bit ironic when politicians have just awarded themselves 10%).

In my own organisation every ward is visited by a consultant every day of the week and this has been the case for the last 5 years.

We do this as an extra duty over and above our job plans but are paid very little for it. The on call supplement for consultants is between 2 and 8% of the basic salary depending on intensity so works out at an hourly rate not much above the minimum wage.

Mr Hunt’s plan – to force us to do shift work and have days off in the week rather than weekends - will add very little to patient care over and above what we do now, but will be hugely disruptive for our family lives. Most consultants are in middle age with partners and children who are at home only at the weekends. Taking consultants off the wards during the week when the rest of the multi-professional team are present makes no sense.

A consultant alone can add little without the support of the rest of his team. We need physiotherapists, OT, pharmacists, juniors doctors, radiographers, pathologists and the rest. If you look in a hospital staff car park at the weekend you will see 75% of the spaces empty – but many of the cars that are there there will belong to consultants. Proper 7 day working with a full team of people, not just a consultant, will need a massive investment of cash and a huge recruitment drive. This will not happen quickly and probably never under the current government.

Why would Jeremy Hunt take on the BMA in such a high profile way?

So the ultimatum to the BMA this week was bound to be rejected because it completely unworkable and pointless. Mr Hunt is not stupid - he must have known this.

I can only conclude that this attack on senior doctors had the PRIMARY purpose of trying to discredit them and reduce their status in the eyes of the public. He needs to do this because he knows what the government has got planned for the NHS – commercialisation and gradual progression to an insurance based system - and he also knows the consultant body will be amongst the strongest opponents of this. He is getting in his retaliation first. This is all about politics and nothing about patients.

So what if this is a political act – he is a politician after all? Consultants are grown-ups and they should be able to take it. Maybe so, but there are consequences to these high profile spats. Patients hearing the scare stories will be frightened and their experience of care will be damaged. Staff will be further demoralised and care quality could actually be worsened.

Political games of this sort can cause real harm to real people.  By picking a public fight to score political points he has demonstrated cynicism, callousness and a lack of respect for the NHS and the British public.

He should apologise for the pain and suffering his actions will cause NHS patients and staff and if he had an ounce of conscience he would resign.

The Future of the NHS – What can we do?

Steve Smith

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Professionals_700.jpg700x235

 Thank you to everyone who responded to my challenge to write a blog about how they would safeguard the future of the NHS. You can see all the posts on the Big Up the NHS web site. Please visit - there is some brilliant stuff there. 

www.bigupthenhs.com/the-future-of-the-nhs

 Here is my answer

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NHS constitution1

The primary purpose of the NHS is to deliver high quality healthcare in a reasonable time-frame to every UK citizen. The fact that it is free at the point of need regardless of financial means and that it does not require subscription, substantial cash top ups or insurance claims is a huge bonus which is sometimes not fully appreciated by the British public.  It removes most of the financial worries which are an inevitable accompaniment to serious illness in every other country in the world.

I hope that I have convinced you in part 1 and part 2 of this blog that there is a real threat to these underpinning principles and that inactivity is not an option.

What needs to be done to protect the NHS?

I do not believe that fiddling at the edges of the problem will do the trick. We need big and brave decisions which will lead to a radical overhaul of the way the NHS is managed at both national and local levels. I suspect that many of you will be more than a tad sceptical about achievability as you read through my suggestions but please keep going to the end – there is a plan.

My top 10 suggestions are:

  • There should be a large scale, open and very public debate, led by the government, to determine what sort of NHS the public wants and how much they are prepared to pay for it. This should consider how demand can be managed and to what level it should be funded.
  • The internal market should be abolished. Financial competition between non -profit making organisation is inefficient, divisive and illogical. It has not led to improvement in quality or safety and administering it is wasteful.
  • Social and health care should be integrated with a single budget. Much of our current inefficiencies are generated by standoffs between social and health care with patients trapped in the middle.
  • Each region should have a Director of Health and Social Care , appointed by the government and sufficiently empowered to ensure effective cooperation between the various health and social care providers.
  • Healthcare should be exempted from the Transatlantic Trade and Investment Partnership and the Health and Social Care act should be repealed. These both increase the threat of commercialisation which will erode the core principles of the service.
  • Central regulation of the service should be radically reduced and reformed. It is expensive and demoralising yet it does not seem to lead to improvement. There should be less focus on targets and inspection and more on patient and staff satisfaction. All healthcare organisations should measure and publish satisfaction figures in real time.
  • Money freed up by reduction management wasted on internal markets and inspections should be reinvested initially in front line services. Better function of these services will lead to further efficiencies throughout the health economy.
  • There should be a stronger focus on research and innovation at a local level but with mechanisms established to endure that learning is disseminated quickly and effectively at a national level.
  • New standards need to be developed to ensure that complaints are heard, acted upon and resolved. Success should be measured in terms of complainant satisfaction and not just timeliness.
  • There should be a national media campaign to improve the reputation of the NHS. Good news should be shared and the benefits of the NHS promoted. It is difficult to do without it looking like cynical spin but it is really important. Patient experience of treatment is strongly influenced by expectations. Positive messages are not just good for staff morale, they actually improve outcomes.

You will notice that I have not suggested massive injections of cash, at least in the first instance. There are big savings to be made from these reforms and pouring in money the NHS as it is currently structured will be wasteful and possibly counterproductive. There will be of course be a need for some targeted investment but most should be met through reallocation of resources.

You will also notice that I have also not mentioned public health promotion. Not because I don’t believe it is important in principle. Just that it has a track record of not working and cannot be relied on to deliver benefit at present. Its time will come.

OK, fine but these changes will never happen!

Well possibly not, but it is clear to me that the NHS cannot continue in its current form. Even if you don’t agree with my suggested actions there is no doubt that unless there is some sort of intervention on a massive scale the NHS will be degraded and gradually replaced by commercial providers. We have to try!

So what to do?

Consider the logic of this sequence of statements and see if you agree.

  • Only the government in power can make the changes necessary to safeguard the NHS.
  • We don’t know who will be in power after the next election so pinning your hopes on one party is risky.
  • Politicians are driven by a mixture of idealism and self-interest. It is not likely we can change their beliefs; self-interest is the Achilles heel.
  • So we must make sure that ALL politicians believe that that the success of their career is inextricably linked to the success of the NHS.

If you agree there is only one conclusion. We have to make A LOT of noise, take this discussion out of social media and get it into the public domain. We need marches, petitions, events and demonstrations. We need the media to take up the challenge and support the NHS instead of knocking it. We need celebrity endorsement.

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All the pro NHS pressure groups must work together and pull in the same direction. This is a political campaign but should not be constrained by party politics. It is not just about the election. The campaign will continue long after that dust settles.

This is a call to arms. We can all do something.  Together we can make a real difference.

Steve Smith

The Future of our NHS – if we do nothing

Steve Smith

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nhs_cartoon_graham_syringe_help_patricia_hewitt

In part one of this series I described some of the threats to our NHS in its present form. While nobody can predict the future with accuracy it is worth taking a moment to consider where we are heading if nothing is done to protect the service.

You will find this hard reading. No doubt some will accuse me of scaremongering. I concede that the picture I will paint is grim but I truly believe it to be a real possibility. I will not suggest a precise timescale these events – that would really be stretching it too far – but suffice to say we are talking months to  a couple of years rather than decades.

To follow the logic of my argument you need to have read part 1 of the series.

Where are we now?

Let’s start from the current situation. Emergency departments in hospital trusts are under extreme pressure. Ambulances cannot offload at hospitals so there are not enough vehicles on the road for new emergencies. Hospital bed occupancy is near 100%. Mental health bed occupancy is over 100% with patients sitting for days in emergency departments waiting for places.  Primary care is struggling to cope with increasing demand. GP workloads have rocketed and we cannot recruit enough GPs to replace those taking early retirement.  Social care is near breaking point with limited community places and no cash for care packages.

We have already started to see a deterioration of performance against government operational and financial targets affecting all sectors of the health economy. Emergency department 4 hour waits, ambulance pick up times and cancer treatment targets have all deteriorated. Two thirds of acute  trusts are in financial difficulties and some may go bankrupt.

So what will happen next?

Senior managers will be put under enormous pressure by Monitor, NHS England and the CQC to improve both financial and operational performance AT THE SAME TIME. There will be some extra cash from a government slush fund which will be trumpeted but will be manifestly inadequate.

CEOs will find their jobs are on the line so they will respond in the only way they know. By putting more pressure on their front line staff, cutting non-essential services to the bone, cancelling elective work (while being careful to shuffle the patients around so elective targets are not compromised), freezing vacancies and putting a ban on procuring paper clips.

This will not work. Performance will deteriorate. Staff morale will fall and recruitment will suffer. General practice and front line emergency services will be the first to really struggle with recruitment. The private sector will look appealing to exhausted staff and some will jump ship.

The regulators will up the ante piling on the pressure from the centre. Ministers will screech that something must be done. A couple of high profile CEOs will be sacked, and several more will walk while they have the chance. Unsurprisingly their vacated posts will not attract any suitable candidates and other non-executive board members will “act up” on a temporary basis (which eventually will become permanent).

The twice daily local health economy teleconferences between commissioners, acute and ambulance trusts, primary care and social services will become increasingly acrimonious and ineffective as the combatants try to shift the blame away from their service. Participation will be delegated down to more junior managers until they fizzle out completely.

Eventually Monitor and the CQC will realise that trusts cannot reasonably expect to meet the targets and will back off. Watch out for this happening because THIS IS WHEN IT ALL FALLS APART. Services which have only been kept going by fear and Draconian management will take their collective feet off the gas. Burnt out staff will accept patients waiting on trolley for 12 hours as the norm. Quality and patient experience will plummet. Waiting lists will increase, routine surgery will be reduced and “non-essential” services such as infertility will be discontinued altogether.

While all this is happening private healthcare providers will tender for the profitable parts of the NHS. They will usually win these bids, partly because they have more resource to put into the preparation and partly because they can afford to offer loss leading prices. Current NHS providers of these services will disinvest in staff and equipment. Some may even be slightly grateful as it gives them an opportunity to meet cost improvement targets – but they will be deceiving themselves.

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B6xowL9CYAAYsJO

The private providers will attempt to make any money out of their new services. These will still be branded as NHS so the public will be largely unaware of what is happening. They will cut costs, downgrade staffing, avoid complex cases and stoke up demand for the profitable parts of the service. They will try to maximise profit by offering “enhanced” services for cash top ups.

If it turns out to betoo hard to make money they will walk away, leaving a hole for the NHS provider to fill. But remember – the NHS provider has given up the staff and equipment for CIP and they have no cash to reinvest. Some private providers will take advantage of this and renegotiate a better contract price.

As the core NHS business shrinks, quality nose dives and waiting times rise there will be a big increase in the number of people with the spare cash taking out private health insurance. This will lead to a steady growth in the non NHS private sector (as opposed the private sector still branded as NHS). Many of the most powerful and influential of the population will become less reliant on the NHS. Pressure to keep it going will diminish – by that stage it will be pretty rubbish anyway - and it will become an organisation providing second rate health care for those without insurance. It will be staffed by a combination of skilled altruists and no-hopers who cannot make it in the private sector.

Patients who genuinely need to access healthcare will stay at home because they don’t want to impose on a pressured system – and nobody will have the energy to try to persuade them otherwise.

At the end of the day we will have a fragmented healthcare system. It will be much more expensive but we will pay for the increased costs through insurance schemes rather than tax. It will be inefficient, inequitable and socially decisive. Illness will be a financial as well as a physical catastrophy – even for the very rich.

So what do we have to do?

I warned you it would be grim. I scenario I have described may be towards the "worst case" end of the spectrum but there are other potential issues that I have not included which could make it even grimmer – a flu pandemic for instance.

Whether or not you believe all of this analysis to be correct there has to be a great deal of cause for concern. Much, if not all, is avoidable but it will take early and decisive action from a strong government to fix things.

In the final blog of this series I will describe what I think could be done to save the NHS, and you will have an opportunity to have your say too.

Who will save the NHS?

Steve Smith


I know the approach I have taken in this blog is a bit contrived and potentially irritating 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, and 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 UKs best loved institutions and 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 this very moment and unless things change quickly we will see it systematically dismantled over the next decade.”

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

@butNHS - “There have been two significant changes in the law which will effectively 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.”

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

@butNHS - “Many believe that the bad press about the NHS 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 however 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 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 tolerant of, 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 NHS England?”

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

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 tired 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.”

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 never win seats in an election. 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 none of the 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 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.

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

 

Footnote

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? 

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