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» Big Up the NHS

The future of our NHS – what can be done?

Steve Smith

The Big Up the NHS Challenge


Welcome to the final part of the trilogy on the Future of the NHS. If you have reached here from links in part 1 and part 2 then please read on. If not please have a look at them first. You need the background to take part in this.

Those of you that have come here looking for answers will have to wait a little while longer I am afraid. I know exactly what I will be suggesting we should do but, before I commit to print I think we need to pause and reflect. Also I really want to know what others think and hope several of you will offer your ideas. After all – why should I know all the answers?

I intend to link to my final blog from this page on Friday 16th January at 20.00 and I would dearly like to provide links to other blogs at the same time. I will see if I can commission articles from interested groups and high profile individuals.

What do you need to do to take part?

If you want to take part in this please write a blog with the title “The Future of our NHS – what can be done?”  Ideally it should be between 500 and 1000 words and should contain at least 5 significant actions which you think will make a difference.

You can post on your own web site or blogs and send me a link or just send the copy and I will put it on It is easier for me if it is a Word document with the pictures and links already embedded.

I will include links to the majority of submissions unless they are clearly inappropriate but I must retain some editorial rights. For instance blogs from high profile commentators may be given prominence.

I am slightly nervous about what might come out of this but there will at the very least my be my offering to read so it should be worth a look back here next Friday.

In the meantime please spread the word. Post links to the three blogs, think how you would like to go about saving the NHS and send something in.

All the Best

Steve Smith

A Tale of Two Christmases

Steve Smith

0d7cc19by Fiona Loud Policy Director of the British Kidney Patients Association



Ten years ago at Christmas the tsunami was about to strike and we were experiencing what seemed like a disaster in our family. After three years on dialysis I was about to have a kidney transplant, thanks to my husband Keith. However a final scan showed that the kidney cancer I'd experienced in 1998 had come back. So the transplant was cancelled and I went to a different hospital to have my one and a half remaining kidneys removed.

Being in hospital at Christmas feels very lonely as of course the wards empty as everyone who can goes home. Life is suspended as you know it; families and friends are reunited but you are in your hospital bubble. Nevertheless the care, sympathy and pain relief continue every day and every night; and nursing staff continued their work, although they must have been missing their families too, to care for me, at times the only patient in the bay.

The Salvation Army came in, and I was even given a present. I did try to go home to see my family for an hour, but had to ask to go back to the hospital. Lying in bed and listening to the radio, I heard the gasps at the news of the tsunami and the realisation that some of the nurses themselves had families in the areas being hit. That stopped me feeling sorry for myself.

We often don't think about the long hours and dedication our nurses and doctors have to put in, but that Christmas really brought it home to me. And so when almost exactly 2 years later I was back in hospital, this time for the living kidney transplant, and got home (just) in time for Christmas Eve, I had double the reason to be grateful to the NHS, which isn't just for Christmas, but for life.



Isn’t about time we shared some good news?

Steve Smith

First published by the Nursing Times but you need to be a subscriber to read it.


Wouldn’t it be great if at 12 noon on Christmas Day thousands of people across the UK simultaneously shared their good news stories about the NHS on Twitter and Facebook?

These could be personal experiences, pictures of Christmas celebrations or just a word of thanks for those who are working in the NHS during the festive season.

They could come from patients, NHS staff, carers or the general public. They could come from you.

Videos, photos, text or sound bites will all add to this movement. But the common theme is they all include the hashtag #MyNHSChristmas so everyone’s good news stories are easy to find and can be shared with as many people as possible.

This surge of activity would be picked up instantly by search engines and #MyNHSChristmas would appear as a “trend” - visible to everyone using social media and fighting back against negativity aimed at the health service.

More people would look in and contribute their own messages and stories. The best would be shared or retweeted, the whole movement fuelled by seasonal good will and a tsunami of support and affection for the NHS involving hundreds of thousands of people.

When it all dies down, there would be a subtle but real shift in the national mood. Morale of NHS workers may be a little better, patients may have a bit more confidence is the system and politicians would learn why they should value the NHS.

What’s not to like?


But could it really happen?

It could and it will!

Big up the NHS is a national campaign aimed at promoting good news about the NHS using social media. The #MyNHSChristmas campaign is in full swing and is picking up support rapidly.

Politicians and celebrities have been recruited to promote and take part. Newspapers and TV have picked it up and it will be getting national coverage on Christmas Eve.

downloadThe event will be opened with a tweet from Sir Bruce Keogh – Medical Director of the NHS – at 11.59.

It will definitely be big – the only question is how big?

If you have never been part of a live Twitter event of this type then I would strongly recommend that you give it a go. To see the positive messages flooding in is emotional and uplifting.

And if you have never used social media now may be a good time to start. It is easy and free to open account - and it will open up a whole new dimension to your life.

A sad NHS is a bad NHS so it is in all our interests to make this work. Please spread the message. Look for #MyNHSChristmas adverts and share them with your friends.

ChristmasPost some of your early thoughts or pictures using the tag, but make sure you keep some back for the day.

Please join #MyNHSCHristmas at 12.00 midday on the Christmas Day.

Have a very Happy NHS Christmas

Steve Smith, Consultant Physician and Nephrologist, Heartlands Hospital


Find out more:


My NHS Christmas

Steve Smith


Christmas is a very special time of year for the NHS.

imagesEJCSRXM1There are poignant juxtapositions of celebration and sadness, pleasure and pain, excitement and fear. The staff who work over the holiday period may miss out on a family Christmas but they try to bring a little of the party to work. The patients do the same if they can. There is a palpable sense of celebration tempered by professionalism and respectful care for those too ill to appreciate the season. In the NHS life goes on – 365 days a year - but Christmas day is different.

The NHS has taken a bit of a battering lately. Unjustified negative press, swinging financial cutbacks and the threat of privatisation have all conspired to undermine and destabalise the NHS. The pressure on the staff has never been greater and morale has suffered.

A sad NHS is a bad NHS, so it is everybody’s interest to Big it Up. There can be no better way to do this than to share stories of what the NHS means to us at Christmas time. We can use social media to channel, amplify and direct the seasonal good will.

How does it work?

All you need to do is share your positive NHS stories and pictures on Twitter and Facebook using the hash tag #MyNHSChristmas.

IMG-20141202-00023This is not just for NHS staff who are working at Christmas. If you are a patient, carer or just have good memories of the NHS at Christmas time please join in. You may simply want to thank those at work while you enjoy the festivities.

There is no limit to the number of posts you can make.

You may also want to search for #MyNHSChristmas from time to time and see what others have posted. You can retweet or share the ones you like the best.

You can start using the tag straight away but if you use Twitter please try to save at least one killer Tweet for Christmas Day at or just after noon. The idea of a mass coordinated tweet is that it will trend on Twitter. Trending means that everyone will see the tag and it is likely that more and more people will join in. A twitter storm of positive feeling. Don’t worry if you cannot make the exact time anything close will do. Make a mental note now or better still put it in your diary.

Please advertise #MyNHSChristmas

I will be sending out reminders at intervals. Please share these with your friends and followers whenever you see them. Try not to be irritated if you see it more than once. Not everyone sees each post every time it goes out so the message needs to be sent more than once.

You can advertise too. There is a graphic below which you can copy and share – or better still make your own to add a bit of variety. You can also use a link to this blog when you send out your messages.

ChristmasIt works well to direct message your most influential friends and see if they will take an active part in the publicity drive.

You may also want to make some posters to put up around your organisations. If you do please let me have a copy and I will make them available for everyone to share on the web site.

A word of caution

It is great if you can include pictures but if these are taken on NHS premises be very careful to observe your local social media guidelines and do not include pictures of patients without their permission.

Please have a Merry NHS Christmas and lets all look forward to a Happy NHS New Year.

Steve Smith

It could have been worse........

Steve Smith

End of a busy day, about to drive home then out of the blue – my car broke down. Just refused to start. Nothing too dramatic but a bit inconvenient.images (1)

I was not concerned. I have a Gold Membership with the AA. They cover the cost of repairs and a hire car if they cannot get you going. It would be fine.

The AA man arrived quickly but after 30 minutes with no joy my confidence started to diminish. “Had I used the right petrol?” I was starting to feel it might be my fault even though I was (fairly) sure I had done nothing wrong. The AA man looked worried – no compression – it would have to be towed.

I know enough about cars to understand the implication of “no compression”. It could be serious, possibly fatal. The first question – which garage do you want it towed to? Main dealers are expensive but it was a reasonably new car and I wanted someone who would do it properly. I chose the main dealer. download (3)The next day I got the call from the garage. Probably a slipped timing chain which may have wrecked the engine. The next question – did I want to authorise the work to find out what was wrong? Best part of £1000 for just the diagnostic work. Much, much more if their fears were realised. The sums they were talking about seemed mind boggling. Ludicrous labour charges. Could I trust them? Were they ripping me off? Getting the car anywhere else for the work to be done would mean towing and more expense and I didn’t know any other garages anyway. Without the work the car was worthless so I said yes – but felt vulnerable and unsettled.

Then I learned about the limitations of my AA Gold Membership. Only 3 days car hire and a maximum cover for repairs of £500 with an excess of £35 – and I needed proof of regular servicing and had a whole load of other criteria to satisfy. I was pretty much on my own.

To cut a long story short I needed new engine – over £5000 and 2 weeks work. All outside warranty and so my responsibility to pay. I spent a fortune in taxis and I worried a lot about whether I was being fleeced. For me it was not exactly a life changing amount of money but it was an unexpected loss, and I felt alone and vulnerable. Nobody seemed to be on my side. It was a genuinely distressing week. All sorted now thankfully though but I am still in correspondence with the AA who are asking more questions which are clearly designed to find ways to wriggle out of paying their rather small contribution. The experience set me thinking though. It could have been worse. It was only a car. What if it had been a heart attack on the way to work? And then I realised why we have to be so thankful for the NHS. article-2058424-0EB2A17C00000578-464_468x311

If you suffer a major unexpected health “breakdown” you get immediate emergency attention from the best available - on the NHS. You know that the clinicians’ primary objective is YOUR wellbeing and not THEIR profit. You don’t have to worry about money or making insurance claims. Just about everything you need is available where and when you need it and if not you will be “towed” by ambulance to the most appropriate centre. People take on your problem as their own. They advise and support and try to make it right – for you - with the minimum of fuss. You can trust their motives.

Our NHS is under threat right now and we may lose the “free at the point of demand” principle unless there is a significant change of heart from all political parties. We may also find ourselves being treated by people who are in it for the money.

Please, please don’t underestimate the value of the NHS just because you have not used it recently. We will be all the poorer if it is gone.

Somebody else’s story could start like this - End of a busy day, about to drive home,  then out of the blue - I got this crushing pain in the chest...... 


It turns out it was a bit worse than I thought. The AA have refused my claim on the basis that a slipped timing chain is wear and tear and thus excluded from the policy. If anything that might be worn is excluded what is the point? I am fighting.  Would like to hear if others have had similar experience with the AA. I feel a non NHS campaign coming on.


I have now had the letter from the AA confirming they will not to pay up because they presume the timing chain must have been worn. They could not inspect the part because the garage quite rightly refused to strip down the engine. This would have cost more than the value of the claim.

As a result I am in a difficult position. The car had done only 23,000 miles and was fully serviced by a main dealer. To me it was a sudden mechanical failure but they disagree. I will appeal but it feels unfair and one sided and I don't want to throw more money into this mess by involving solicitors.

This story illustrates why we must NEVER give up the NHS for an insurance based system.

It is also a reason to never use the AA. I may not succeed in getting what they owe but if I can stop just a handful of people joining their dodgy scheme they will be the ultimate losers. Spread the word..........



Schwartz Rounds – a key to unlock culture change in the NHS?

Steve Smith

I was a medical director in a large acute NHS trust until recently and one of my jobs was to read through all letters of complaint. It was heart-breaking. Some described simple mistakes or misunderstandings but many told stories of cruelty, neglect and callous indifference. So I began to wonder – how could this happen? The staff seemed to me to be reasonable, caring human beings. Indeed most clinical staff members are rigorously selected for their caring natures.

cruel-doctor-225x300Then it happened to me. I was having a bad day, too much work and not enough time to do it, worries about a health issue at home and a major presentation later that day that was not properly rehearsed. I was in clinic and an elderly lady was banging on about something (apparently) trivial. I cut the consultation short and bundled her out as quickly as I could but just caught the briefest glimpse of disappointment in her eyes as she left. It wasn’t awful, not worthy of a complaint letter, but it was definitely not good.

I can still remember pang of guilt as I recognised what had just happened. I had appeared (been?) uncaring and unsympathetic, I had not given my patient what she needed and the encounter had been unsatisfactory for both of us. I did not set out to do that. On most days I am pretty good and my patients are usually happy. I had just let my internal turmoil get in the way of delivering compassionate care. It could happen to anyone.

In fact it could and it does happen to almost everyone. Working in health care can be stressful to a degree rarely seen in other professions. We make decisions that have life and death implications and have to learn to live with ourselves on the rare occasions we get things wrong. We each have to develop our own strategies to deal with this – blocking, denial, distraction, overcompensation - and sadly these may affect the way we interact with patients.

1729007NHS workers are not good at talking to each other about how they are feeling. The culture is “don’t moan” and “don’t hesitate to cope”. People who externalise their feelings are often considered to be a bit flaky. You certainly would not want one of those on your team. Believe it or not there is no forum in the NHS where team members can say what they feel about their work, share their stress and anxieties and help to support each other. Or at least there wasn’t until Schwartz Rounds were introduced.

Schwartz Rounds were developed in the United States about 20 years ago by the Schwartz Centre for Compassionate Healthcare. The founder, Ken Schwartz, was a healthcare attorney who at the age of 40 developed terminal lung cancer. During the 10 months up to his death he wrote movingly about his experience in an article for the Boston Globe Magazine entitled A Patient’s Story. In it, he reminds caregivers to stay in the moment with patients and how “the smallest acts of kindness” make “the unbearable bearable.” He founded the Schwartz Centre in 1995 – just days before his death – to ensure that all patients receive compassionate and humane care.

Schwartz Rounds are structured meetings for all members of the clinical and non-clinical staff, but not for patients. The one hour meetings consist of brief presentations form three or four staff members about a particular case or experience followed by a facilitated discussion. Two trained moderators make sure that the discussion is kept to the emotional aspects of caring and does not drift into problem solving or personal confrontation.

Everything that is said during the meeting is regarded as confidential. Participants can talk about the process in general outside the meeting but must not attribute anything that is said to individuals.

The Schwartz Centre web site sums up the principle nicely with this quote from a participant - "Schwartz Center Rounds are a place where people who don’t usually talk about the heart of the work are willing to share their vulnerability, to question themselves. The program provides an opportunity for dialogue that doesn't happen anywhere else in the hospital."

schwartzbhhI have just completed training as a facilitator and we have conducted a couple of rounds in my organisation and I can tell you first hand that they are wonderful. The participants all came out of the meeting feeling reenergised and supported. I am sure it will help them care more compassionately for their patients – at least for a while.

My main concern is that there were only 50 people in the audience from a staff base of over 10,000. I can’t yet see how the benefit will roll out to the rest of the organisation.

Nevertheless these meetings have started to address a serious and intractable problem. We will not make real progress in delivering more compassionate care for our patients until we understand and tackle the root cause of poor care directly and assertively.

Schwartz rounds are being rolled out in the UK by The Point of Care Foundation. They are a charitable foundation dedicated to improving patient experience. If you would like to know more about Schwartz rounds their web site is a good place to start.

Steve Smith

Is this deliberate NHS bashing from the chairman of the CQC or just political ineptness.

Steve Smith

By Roy Lilley The Original title was "What does he do for and encore" and you can read it here. I have reblogged as it illustrates the problems of press and government coverage of the NHS perfectly.



If you read this in the morning the NHS will have killed about thirteen people. If you read this in the afternoon the NHS will have killed another 13 people. If you read this, this evening just over 26 people will have, deliberately, inadvertently, neglectfully or somehow been slaughtered by the NHS.

It is unlikely the police will have been involved, no record made. The identity of the dead will be known only to the families who will be unaware of how their loved one might have met their end. Death certificates will offer little clarification.

By the end of the week 190-ish people will, by accident or design, be slayed by the NHS. In the course of the year... ten thousand.

How do I know? The Daily Telegraph tells me. They offer no evidence, only the word of the Chairman of the CQC, chief flat-earther and high Tory, David Prior. The Guardian makes the same claims based on the same vapour.

In  response the CNO at the Carbuncle, Jane Cummings said; "The NHS treats millions of people every year and the overwhelming majority of our patients receive great care from staff who are pulling out all the stops. We do need to do more, but the quality of care is better now than at any point in the history of the NHS."

In other words *&%%$£-off.

The NHS deals with over 1 million patients every day and a half. In that time, Prior tells us, 39 of that million will have been killed. One death is too many, let's get that straight, right from the off, but do his sensationalist allegations hang together? What exactly does he mean? Does he know?

It appears Prior is basing his comments on this old Telegraph story which is a complete over-reporting of a not very good academic study. 

Mortality amenable to healthcare is an international measurement. Research requirements in diverse countries, different ways of recording death, often poor data and so-on means the information is not last week's. This is from the OECD; out of 31 countries the NHS is rated in the middle, 19.

Preventable mortality is a different matter and probably what Prior is talking about. The most recent and authoritative study (2012) the source of the Telegraph story, was funded by the National Institute of Health Research conducted by researchers from the London School of Hygiene&Tropical Medicine, the National Patient Safety Agency, Imperial College and the Uni of Newcastle.

 It's a review of the patient records of just 1,000 adults who died in 10 hospitals across England, five years ago, in 2009.  It concluded that one death in 20 had a 'greater than 50% chance of being preventable'... poor diagnosis or inappropriate treatment; mostly occurring in the frail elderly with multiple other medical problems. This raises debate over whether these deaths were actually "preventable".

The researchers extrapolated their results, multiplied them up and made an educated prediction on the national picture.  Guestimate, conjecture, supposition.  When academics guess we are supposed to genuflect... I used to... not any more.

The study reviewed medical records, which may not be accurate. Previous, similar studies have produce estimates ranging from 840 to 40,000 deaths a year. They highlight adverse events but cannot say if they contributed to death and are, in any event a subjective view. They excluded paediatric, obstetric and psychiatric hospital admissions.

Here's the cracker that Prior ignored; the researchers concluded '... the incidence of preventable hospital deaths in England is lower than previous estimates'. In truth - we still have no idea.  There is more interesting stuff here that concludes death is probably not the best measure of quality care.

If you are with me so far you will be far better informed than the Chairman of the Flat-Earthers and better able to talk intelligently on the matter.

Prior has form for saying unevidenced things. Here and here. It looks to me, from the CNO's comments that the Carbuncle is fed up with him. I know for a fact a lot of his staff and some of his Board think he's an embarrassment. Monitor just ignore him.  As the election comes nearer I expect the Tories will be sick of him, too.

On Prior's watch the CQC struggles: to recruit; to justify sending 79 people to inspect a hospital; cannot defend inspection as a technique to improve quality; has trophy-senior-inspectors with no management qualifications; has a Board that lacks grip and has had to row back on its strategic objectives; recruited inappropriate staff it can't sack; has an eye-watering budget; mired in legal cases; has no evidence that it is improving Trust performance; publishes no meaningful peer reviewed data and has a hot-head for a chairman who can't control his organisation any more than he can control himself when faced with a journalist.

 What does he do for an encore?

Socialised or commercialised healthcare for the UK – which would you prefer?

Steve Smith

This blog is a little longer than my usual offerings but I hope you will take a few minutes to read it and then to share it widely. I think the message is important and helps to clarify the current arguments about privatisation of the NHS. Those with short attention spans may wish to cut to the take home message by going to the last paragraph (but you will miss a couple of brilliant video clips). BulCCYiIUAA5d1eThe privatisation debate

There has been much debate in the media recently about “privatisation” of the NHS. Should we allow parts of the service to be subcontracted to private companies or do we believe that our future health care needs will be better provided by not for profit, publically owned organisations?

Clearly this is a crucial issue but in some senses the “p” word is unhelpful and can be misleading.

Much of the current service is already in private hands. All GPs are independent (private) practitioners and are not employed directly by the NHS and many existing services are already provided by the private healthcare industry under the NHS banner.

The law has been changed so that further privatisation is pretty much inevitable and effectively irreversible, so the argument about privatisation is not about “if” but about “how much” and “how fast”.

The main weakness of the term “privatisation” is that it allows the argument that that as long as the NHS remains free at the point of need the financial basis of its providers is irrelevant. I don’t believe this argument to be true but will park it for the moment and come back to it at the end of this piece.

To complicate matters further the term privatisation has acquired political connotations and has a tendency to divide people on party political grounds – not a great help when trying to engage the general public in this critical debate.

A much more important debate

A much more important question is what are the underlying principles that govern healthcare strategy in the UK? To my mind there are two broad approaches - socialised or commercialised medicine.

  • Socialised medicine is characterised by central control with the PRIMARY intent of achieving the maximum amount of health gain from the available cash.
  • Commercialised medicine is characterised by relinquishing control to market forces with the PRIMARY intent of extracting the maximum amount of profit from any available cash.

Socialised Medicine

Ironically the term socialised medicine was first used in the USA in the early 1900s. It describes a healthcare system that provides medical and hospital care for all at a nominal cost by means of government regulation and subsidies derived from taxation. The NHS is often held up as the archetypal example of socialised medicine.

While initially a positive term in the USA, by the 1940s it had become a brickbat used to discredit Truman’s proposed national healthcare system. The implication was anyone advocating universal healthcare access must be a communist.

Socialised medicine is strong in terms of cost, equity of access, efficiency in procurement, preventative medicine and economies of scale. On the other hand it tends to be bureaucratic and unwieldy, slow to innovate and struggles to control demand.

Commercialised medicine

Commercialised medicine runs according to the rules of the market place. The primary purpose is to generate profit from delivering health care. There is no central control or planning so it tends to be agile and innovative. Access to care is determined by access to cash so it is intrinsically inequitable. Companies are keen to increase demand and they can do this most effectively by promoting health anxiety. The United States health service is often held up as the archetypal example of commercialised medicine.

A key principle of commercialised medicine is that profit comes from delivering the maximum amount of healthcare for the smallest cost while charging the highest price. Health improvement for individuals is not so important and in some instances becomes irrelevant.

0One good way to increase profit is to drive up demand by stoking up public health scares. Genital herpes was turned from a minor, inconvenient, untreatable disease into a hugely scary and stigmatising untreatable disease by a drug industry intent on selling treatments which are largely ineffective. A whole generation grew up fearing that they had halitosis which could stop them finding a partner, which they could not detect themselves and which their friends would not tell them about. It was all so the manufacturers of Listerine could make millions from the gullible spitting gallons of their product down the sink.

Why can’t we have both?

Well of course we can and do. Every health economy consists of a mixture of socialised and commercialised services. Proportions vary between countries with the UK being at one extreme and the USA at the other. Most European countries sit towards the socialised end of the spectrum. Where we sit on the spectrum is not set in stone and there is a real danger that we in the UK will move towards the US model.

So which is best?

While both socialised and commercialised medical systems have their faults you only need to look at the comparison between US and UK health systems to see which is best. International studies have demonstrated time after time that the UK system is cheaper, more effective and fairer.


It is sad that the US paranoia about “reds under the bed” in the McCarthy era and throughout the cold war led them to develop a health care system that is second rate, inequitable and overpriced. Thousands of their citizens die for want of healthcare or are financially ruined by chronic illness. In this respect you could argue that the US lost the cold war, and is still taking casualties to this day.

In that case who on earth would support a commercialised health service?

There can be no doubt that a socialised medical system is better for the nation as a whole but there are some groups of society who benefit from a commercialised system – and among these you will find individuals who are happy to put their own self-interest above the greater good. These individuals are likely to come from the following groups:-

  • Investors in healthcare companies.
  • Employees of healthcare companies. This may include clinical staff – especially doctors.
  • Politicians. Commercialised healthcare reduces the central tax burden on health, generates tax revenue and increased economic output.
  • The wealthy. Progressive taxation means that the very wealthy pay more towards healthcare in a socialised system than they take out in healthcare.
  • The healthy. If you don’t need healthcare why pay for it?
  • Some political hardliners who have philosophical objections to socialised systems on principle.

Combined these various groups are powerful but remain a minority. The problem is that the majority who stand to gain most from socialised healthcare come from the least empowered sections of our society.

What is the difference between commercialised and privatised healthcare?

I am very aware that this treatise may generate some confusion. The terms commercialised and privatised are not synonymous though there is an overlap.

I agree that it is possible for private healthcare companies to take part in a fully socialised healthcare system as long as their activities are strictly regulated. This means that the care they provide should be controlled; the cost and quality of treatment is determined and paid for by government rather than market forces and they should not be able to manipulate demand (for instance by advertising).

Much healthcare in the UK is currently provided by private companies on that basis. Further privatisation does not necessarily mean that we will move to a commercialised US style healthcare system, but it does of course increase the danger that we could move in that direction.

While “privatisation” is a relatively new and trendy term, worries about commercialisation have been around since the birth of the NHS 66 years ago. Nye Bevan himself said “The field in which the claims of individual commercialism come into most immediate conflict with reputable notions of social values is that of health”.


So what are the chances that the UK will move towards a more commercialised model?

Privatisation is already with us and is likely to increase. The way we prevent privatisation turning into commercialisation is to have strong central commissioning, tight controls on quality and clear rules about the interface between commercial and NHS services.

Unfortunately these controls have already been eroded by changes in legislation such as the Health and Social Care Act which removed the responsibility for the health of citizens from the Secretary of State for Health. This, and the proposed Transatlantic Trade and Investment Partnership (TTIP) has opened up the NHS to future privatisation.

Existing controls on private healthcare providers such as NICE and the NHS commissioning board have been undermined in the press and the continuous barrage of anti NHS media has (to a degree) weakened the will of the British people to fight for it.

All it will need is a relaxation on the rules about advertising and commercialised medicine will be unstoppable. There is real danger here.

So what do we need to do next?

Doing nothing and we lose the NHS in its present form and risk drifting into a commercialised US style of health care.

While privatisation alone does not necessarily lead to commercialisation it makes it much more likely. If you choose to swim with sharks you are much more likely to be bitten. We must continue the campaign against privatisation and try to reverse the changes in the Health and Social Care act and stop the introduction of TTIP.

This alone is not enough though. We have to ensure that the NHS is strong enough to manage effectively the big International healthcare providers and stop them being able to exploit our sick and vulnerable. We must support the NHS regulators and make sure they know what we expect of them.

We must remain solid on the rules about advertising and stop companies creating unnecessary fear to drive up demand.

This will take a strong government driven by a strong public voice.  I don’t know which party will succeed in the next election so it is imperative that politicians of all parties know that we value our NHS and want to preserve it from exploitation. This has to be the top priority as we approach the next election.

So, to preserve the NHS we ALL have to do SOMETHING. Lobby your politicians. Join in the #March4NHS. Share your views on social media. Write to the press. And most important please, please, please Big Up the NHS!

Back to the top (for those who cut to the chase and now want to read more)

Steve Smith


NHS in action

Steve Smith

securedownload Yesterday afternoon I was out on my bike and was hit by a car.  The driver of the car happened to be an ex nurse and she very quickly assessed the situation and stopped anyone else from moving me, although I was lying in the middle of the road.  Other people who stopped helped to direct the traffic until the police arrived.  The driver had also called the emergency services.  I had an obvious injury to my left cheek but at that time it was not possible to see if I had been injured elsewhere.  My bike was a wreck!  Within minutes a paramedic arrived and it also started to rain, he tried very hard to shelter me and to assess my injuries at the same time, well done him!  The ambulance arrived and the paramedics continued the assessment before moving me, they decided to immobilise my neck because I had some pain there.  I heard a helicopter arrive as well, perhaps because the traffic was heavy and possible concern about head injuries, I obviously don't know, but the doctor on the helicopter also assessed me. We arrived at the hospital in Worthing and every care possible was given to both me and my family.  I was scanned by all manner of machines etc.  the staff in A&E could not have been better.

securedownload (1)I cannot imagine what this experience would have been like for us all if we were also having to worry about the potential cost.

Please keep up your wonderful campaign for the sake of us, our families and descendants.

Thank you NHS


The ambulance crew had tried to stand down the helicopter but I think they were too late.


Steve Smith

By Roy Lilley Re-blogged with permission. Click here to see the original version


I'm guessing you won't be able to tell me, who is Arthur B. Sleigh? He was a colonel in the British Army and his big claim to fame, in 1855, he started publishing the Daily Telegraph. He couldn't pay the printing bill so he was forced to sell the banner to his publisher Joseph Levy.

Levy re-launched the Telegraph, at one penny, the cheapest newspaper in London. By January 1856 the Telegraph circulation was the biggest; 27,000. Today, the Telegraph's circulation is 544, 000 and is 5th on the ABC list.   The paper was dubbed, by Private Eye, the Torygraph.

The Torygraph NHS coverage is at the tender mercy of the energetic Laura Donnelly who writes, relentlessly, of NHS failures, foibles and misfortunes. I hope she will forgive me but I'm afraid I've stopped reading her as the incessant diet of failure is too much for my delicate constitution. :-) 

However, I happened across a non-Donnelly, Telegraph story that probably, inadvertently takes the lid off one of the most crucial policy failings the NHS is facing; how cack-handed policy can create a fault-line across the fortunes and futures of hospitals. The story, by Steven Swinford and Olivia Rudgard is about staff shortages:

"(A Telegraph survey has found) ... Hospitals at the centre of patient-care scandals are facing significant shortages of senior doctors and nurses... up to a fifth of posts for senior doctors and one in 10 positions for nurses is going unfilled at three NHS trusts that have been investigated over high death rates."

The report continues; FoI requests ... across 63 NHS trusts... found that average vacancy rates for doctors are 4.5 per cent and for nurses 6.3 per cent. Taken across the NHS, the figures suggest it is facing a shortage of 15,000 nurses and 4,000 doctors.

Significantly the Torygraph singles out a number of familiar, 'troubled' Trusts: Mid Staffs, a shortage of 66 nurses - equivalent to around one in 10 posts... it also has the highest levels of vacancies among consultants, with nearly a fifth of posts unfilled by permanent staff; Basildon and Thurrock is facing a shortage of 162 nurses, equivalent to a vacancy rate of 11 per cent... the trust was put into special measures last year after being investigated over high death rates; United Lincolnshire, which was also investigated by the Keogh review over high death rates, had 10 per cent of its consultant positions left vacant; Havering and Redbridge... 13% vacancies among consultants.

What does this tell us? Give a dog a bad name and hang him... so the saying goes. The sticking power of labels.

We could label people as heroic and organisations as busting a gut. We could call hospitals successful or we could say challenged, faced with difficulties, working through problems, confronted, risk managing, taking on challenges, withstanding pressures, suffering from a melting local health economy, defying overwhelming demographic pressure, dealing with history, managing a legacy... or we could just label them 'failing'.

Swinford and Rudgard have put 2 and 2 together, done the maths and realised, if a hospital is in trouble and gets the wrong label, given the option, the evidence is; talent won't want to work there.

With ease, the ham-handed, careless use of language reduces Trusts in the maelstrom of financial woes (not of their making), demographic pressures (not of their making) from difficult to recover to well-nigh impossible.

Clod-hopping inspection regimes, designed to find fault, will create fault lines as the pressure of employing people (who can transport their talent to pretty well anywhere else in the UK and the English speaking world) crushes an organisation, reduces efficiency and threatens quality. The whole process sucks troubled organisations from difficult to run into a vicious vortex of decline, ending in dysfunctional.

Dr Shirt-Off, health minister said; "... if poor staffing levels compromise the care of patients, the chief inspector of hospitals will step in."

'Step in' and do what, exactly? More reputational damage; 'step in' with another label; 'step in' and make it even more difficult to employ career grade staff. 'Step in', put the boot in and trample all hopes of a recovery?

If studying the work of the great management gurus, who tell us inspection and criticising struggling organisations and exhausted people doesn't work, then ignore Deming, Porter, Peters, Kano, Chowdrey, Haque, Christiensen, Moss-Kanter, Amabile and the like.

Let's make it Bozo simple; just read Swinford and Rudgard in the Torygraph.


  Contact Roy - please use this e-address

Who will save the NHS?

Steve Smith


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? 

Big Up the NHS needs YOUR help!

Steve Smith

briton needs youOn the 31st July Big Up the NHS will be 1 year old. It is hard to believe how quickly it has grown. It all started with a simple concept and a new twitter account. It now has 25,000 followers on twitter and over 2000 members in the Facebook group. There are also LinkedIn, Google+ and Flickr groups, an active blog and (although I say it myself) a pretty zippy web site. I am just about to start publishing a regular newsletter for the growing mailing list. People often assume Big Up the NHS is an organisation with a membership but they are wrong. It is just me, working alone, burning the midnight oil and missing lots of sleep.

Despite this I think the campaign has made a difference. #NHS66 and #thankyounhs campaigns have been hugely successful. Politicians and media people are following the campaign and taking note. We still have a long way to go but I believe this approach has ENORMOUS potential for good.

The problem is the rate limiting step is now my time and energy. I cannot fit in any more without getting sacked, divorced or both. I need YOUR help!

How can you help?

There are four ways you can help – listed here in order from least (almost none) to most time commitment. You can of course do more than one.

1)      Become a Big Up the NHS Supporter

Basically you just register your support by completing this form. No commitment to do anything. You will receive an occasional newsletter and get a slight warm glow for being involved.

2)      Become a Big Up the NHS Tweeter/Re-tweeter

Make a commitment to scan for good news NHS stories and tweet them to me. I will then re-tweet to 25,000 people. You should also follow my tweets and re-tweet them. The commitment is as little or as much as you want. Email me at if you want to do this. I will add your details to a page on the web site. It will show you care and will help you pick up more followers.

3)        Become an Big Up the NHS Group Administrator/Moderator

This is a bit more of a commitment and carries a responsibility to behave well and keep to the positive, non-party political message. It is possible for me to delegate administration rights to members of the Facebook, Linkedin, Flockr and Google+ groups. You will have the power to approve and delete posts, add and delete members and promote the groups. I am looking for people who will be prepared to commit time and energy to promoting and growing these groups.

If you are interested let me know by email which platform you would like to take on. We will need to discuss things with you on the telephone before getting going with this.

4)      Start a Big Up the NHS local Group

Set up a new Big Up the NHS account to serve your local health economy. Make connections with your local NHS organisations. I will help support your efforts and list your details on the web site. This is potentially a lot of work but there will be a huge sense of achievement for those who take this on. Once again I would need to talk to prospective local group owners on the telephone before getting started.


If you care about the NHS and want to take an active part in making a difference one or more of these options may be of interest to you. Please give it some thought and get in touch if you want to help.

Steve Smith

Big Up the NHS.

The Big Up the NHS in a verse e-book now published

Steve Smith

It was all Sandie's She approached me as I started to develop the concept of #NHS66 - a celebration of 66 years of the NHS - with the concept that we should Big Up the NHS through verse.

We asked people through Twitter and a Wordpress blog to submit poems of 100 words or less about the best of the NHS. All the entries were excellent so we were able to include everything that was submitted in this e-book.

You can access the book by clicking on the image of the front cover to the right or by following this link. Please share the book with anyone who you feel will appreciate it.

Steve Smith


Steve Smith

Dear Big Up The NHS, I live in Northamptonshire and am currently an outpatient of the Urology Dept at Kettering General Hospital being treated for bladder cancer.  I also suffer from a primary lymphedema on my right side that can be quite debilitating and is always a consideration when I have to go into hospital.  The primary lymphedema took several years to diagnose so I have quite some experience of the GP to hospital experience over many years.

The NHS improved massively under the Labour Party and I know it was at some substantial cost but in recent years and especially during my treatment for cancer it has hit harder times.  There are higher risks for patients due to the immense pressure on all departments and I am increasingly concerned about what that may mean for outcomes for patients for the future.  Both from the GP perspective and the direct care to patient frontline areas.

The Urology team are great and work their butts off for the NHS as do the theatre staff and the nurses at the treatment centre.  They are always under massive pressure and go above and beyond the call of duty to ensure I get my treatment.  Having been diagnosed with bladder cancer in 2012 I have met most of the Consultants and Registrars at one time or another and several anaesthetists.  Thorough and competent they have got me, so far, to my first clear result and although I know it is more likely than not that it will recur I am comfortable with that as I know they will help me get through it again.  Despite the 'appointments' pressures!

I have to make a special mention of Mr Freeman, Anesthetist , who I believe hit 70/71 last year, and on my very first contact with him he asked how my husband was getting on.  He remembered him from an operation some several months before.  He took excellent care of me and due to his natural manner of overt 'inclusion in your care' made me look more carefully at the way staff deal with patients.  I really cannot fault the wonderful people who have treated me at Kettering Hospital.  Always respectful, always talk to me as if I am part of 'their' community not just a customer.  It really has been a joint venture over the past 2 years defending me against attack.

It has been a bit of a love hate relationship though at times.  I love the staff with their calm and friendly manner but hate how they have to work with constant shortages of staffing, beds and theatre time.  I hate having to complain to people who don't deserve my ire.  I have had to chase quite a bit for appointments but thanks to my wonderful specialist nurses Rachel and Janine we have developed a great relationship regardless.  I said to Janine one day that I was sorry I had to complain about the issue and she replied 'No you must do that it is your right' and put a hand on my arm.  She meant it.

The NHS isn't perfect and I could tell you lots of positive and negative anecdotes about my travels through the NHS during the past 10 years but instead I wrote a poem about the NHS as seen through my eyes.  I couldn't send it to be included in your 'NHS verse' section as it is just far too long and I apologise for my tendency to waffle a bit when writing about this subject.

However, here is my view with some passion, perhaps some naivety #but overwhelmingly my heartfelt thanks



Your aren't the perfect partner and you sometimes let me down

You often are too busy, no time to play the clown

#But just like all relationships we try to muddle through

You do your best and still slip me a little smile or two

Your timing for some promised dates has sometimes made me mad

You have so many partners one could think you're quite the cad

#But in truth you are pure of heart just smothered by the muddle

So many demands upon your time we need to clone you double!


Your fashion sense needs some work you know it makes me frown

You are just so damn practical with that bare back, weird, tied gown

#But the worst part of your dress sense really gets some flack

Those stockings that you make me wear?  So NOT the new black

Of course I have to mention the lingerie you always buy

And those 'Cinderella' slippers that almost make me cry

#But not with tears of upset no that is just my humour

I hear they arn't just for us girls or is that a nasty rumour?


The last few years I've needed you to give me much more time

I've even done some pouting and reminded you you're mine

#But you didn't get impatient you were careful not to ire

You do your best to keep me calm even under fire

At present we are on a break you said 'You're clear now go!'

You gave me a hug and I skipped off out, the wrong way don't you know!

#But it is not a separation of that I can be sure

I know 'we'll meet again' when I need a date once more.


You will have me back with open arms (once I've chased your butt)

You will give me your attention and again you'll make the cut

#But as usual I'll be worried and you will put me at my ease

You're such a smoothie face to face aiming so to please

With all that said I have to raise a TINY little matter

I've heard some things about you in amongst the chatter

It seems someone is making you break our sacred pledge

I've heard you're being shackled with some partners in some hedge?


I've been told you have no choice you have to sell your wares

To some pirates roving round the world trading in some shares

I'm no brains of Britain but I know it isn't right

To let them sell your soul away without putting up a fight

I have to raise this question for others and for me

Is it really moral profiteering from misery?


They didn't ask my opinion!  No contract have I signed!

I've twittered and I've tweeted, the interweb I've mined!

There is no signed agreement from any of your babes!

Yes I mean me and millions more, sixty plus decades!!!

#BUT it seems we were cuckolded, mislead and lies were told

#BUT I won't shut up about it this really is too bold!

Our only common ground built with blood and sweat and tears

Going to gamblers' immoral earnings? No way! No sir! No fear!


Big Up The NHS!!!!  It's yours too!

#butNHS #saveourNHS #NHS66

Sincerely and faithfully yours,

Mrs Linda Schmidt

Grateful Patient


Waiting room

Steve Smith

I love this piece written by Steve Biddle. He originally submitted it as a comment on the blog. This is what he said when I asked if I could publish as a full article. "I'm elated you like what I have written and wish to publish Waiting Room. It is as written on my mobile phone as I waited so the gaps are as they were. I'm happy if to fit on a page with in margins it needs altering.  If once published you would be kind enough to send the link so I can share that would be much appreciated.   I have read Waiting Room at poetry readings and people always come and chat to me about their experience. I'm very grateful to give something back to the great work the NHS does."

It is published below exactly as it was typed on his phone.


Waiting Room © 2013 Steve Biddle.

Waiting room, we’ve all been there.

Are all these people ill?

Thank god for Doctors and the people in care.

Facing forwards looking back, glasses, papers, magazines, some old folk looking red faced, veins running blue, map of England heart attack.

The amount of people just like me occupied with phones, one is making the occasional bubble noise.

38 people to go before me.


Just heard, 65 minute wait for a needle to puncture my skin.

Steady hand, watch my blood, biology, I’m human, tick box, my name date of birth, pleasantry grateful that’s just me.

The little round plaster must have been brave.

Shuffling down the line ultimate illness dig a hole, yes I’d like a grave.

Not there yet, nothing's  wrong, is what one said by mistake.

I like mistakes surprisingly, we make them all, or there would never be a mistake.

Define a mistake, negative outcome.

No! Some mistakes are positive, so there you have it.

Back to the process, 65 minutes what shall I do?

28 to go just like sheep.


Ok the people, the noise, the young are few.

Middle, that’s me, waiting room 65 minutes of getting old.

I’m safe here, this is the safest place, no accidents, even if I do have some kind of freak illness, where better to be?

I look up “Wow” to the Art on the walls; I’ve been here 20 minutes consumed with the slowdown of the power of this waiting room.

No Artists name to be seen, the gravity of Art the vision of the mighty wall filler.

I wonder where these pictures are from? Skies, mist, the sea, and this incredible planet we’re on.

Right got to turn round now and check out the rest of the Art.


I’m surrounded by accents from around the world, I can’t even work out what nationality some are.

Ok look.... I’ll be back in a moment. Right that was a quick.

Scarf count, winter is cracking on, umbrellas, tissues, coats on chairs.

20 people to go.

The number counter is electronic and to my listening pleasure is Welsh, the people next to me discussing life are Welsh.

The old couple who probably go everywhere together, remind me of how we should all be, looking out for each other.

During life’s bad bits, the ones to forget, we always remember the people who helped us through.

The bad bits become like a ball of mushy peas, but the people they demonstrate love and compassion just like the old couple, we never forget.

16 to go.

There is a window facing a wall, neat brick work.

Builders use string to get their lines straight then along come the other trades, putting their vents, pipes, clips, grey boxes where ever they like.

Hospitals have the largest selection of cacti’s I’ve ever seen, they grow so well in this humid carbon monoxide, well watered, public blood, rich street.

13 to go.


Why with so many people in one room is hardly any one talking?

Everyone I think has deep thoughts here about life, outside this room and in the world we are free.

Here we are controlled by complicated words, we could be told anything and we would just believe.

“Mr. Biddle you have an itinoplumupietred condition and will live to 110”… yep I’ll go with that.

“Mr. Biddle I’m sorry but we have run out of number tags and can’t see you for a year!" Ok.

The TV screen now has a who’s who of hospital staff, now it’s a drink campaign.

The fluffy adverts for the hospital use models, the bad stuff it’s us, real people.

I really love the NHS.. again, read this really slowly ……I LOVE the NHS, I have been here with chopped off fingers, broken bones, kids being born, metal removed from my eye, acute appendicitis . Now, this kidney problem I can't even spell. My folks are horsey people and the NHS has saved all of my families lives.

2 to go.

If I win I’ll be back.


© Nvember 2013 Steve Biddle Bournemouth Pathology

Copyright © 2014 Big Up The NHS. All rights reserved.