I seldom write about the NHS and its future. Too hot, too polarised, and frankly, I don’t know enough about national funding models to be clear on my views.
But when Partha Kar, a consultant diabetologist I like and trust asked me to give NHS Survival some advice and support, I thought it would be good to pen some thoughts.
NHS Survival is a new campaign group that wants to ‘save the NHS’, through “patients, the public and professionals working together”. Indeed, it has been bold enough to proclaim that it is already working in partnership with patients.
A quick skim through its original website (it is a bit better now) triggered my disdain. No patients included. But more of this below…
Here are five reasons why I will not yet support the campaign.
1. Too strident
For many years, I have been trying to shift my work towards a sense of true partnerships - a struggle for a born and bred activist. I firmly believe that patients can be partners in finding solutions and should be equal partners. That means modelling partnerships and moving beyond an ‘us and them’ mentality.
The NHS Survival clarion call seems to me to be akin to many other calls to save the NHS – from evil government plans, from mafiosi-like corporate ventures – from ‘the other’. It frames the NHS as victim to perilous forces. The (dare I say it, ‘childish’) tone is set, the attitude strident. I do not want to join sides in a battle. I want dialogue.
2. No survival without change
As some may have read on twitter, my view is that I will not support the status quo. All campaigns to save the NHS thus far have been built around the notion that we should defend ‘what is’ – that is, to all extents and purposes the power base of the current elite.
The NHS has, for 70 years, been led, controlled and largely influenced by clinical, managerial and political leaders – patients have no power (see my previous blog on the lack of patient involvement in policy). Claims of 'public accountability' seem vacuous when each 'side' claims to speak 'on behalf' of patients.
I will not support a campaign that puts survival first and patients second. Change comes first. Indeed, my view is that only by patients having true influence at all levels (nationally, locally and individually) can the NHS be sustained. If and when the campaign shifts tack, I may take it more seriously.
3. Patients included?
Patients on social media have questioned the ‘patients, public and professionals together’ tagline. Rightly so. All founding members of the campaign are health professionals. It is they that have decided the vision and purpose.
Now, many of them are saying it is their ‘intention’ to involve patients. And I am sure they mean it. But, as with many efforts to involve patients, the question has to be asked: Is it too late? And, how dare they lay claim to patient support without having done the legwork first. This makes me cross.
Only by engaging with patients, carers and the public from the beginning, can true co-design take place. For me to be involved, I would want to go back to first base, and question the very purpose of the campaign. I am not prepared to tick the box (again). This is a real question – if patients were to be involved, can we move the goalposts? For me to be involved then, how would I want them moved?........
4. It's about the money
When Partha and I have talked in the past, it has often been about how patients and professionals can work together and have serious conversations about what the NHS can and cannot afford. That’s where my interest lies.
I would have wanted a campaign like this to spearhead an honest debate about what is, and what is not, affordable; how patients can be partners in decisions at national and local level about funding. I had thought that to be the purpose of the movement. If that is (or was to have been) the intention, this seems to have been lost in the blood-lust for a fight about survival.
5. What to do?
The campaign makes great play about the need for an ‘independent’ Royal Commission. That sounds intriguing, I must say. It is probably where the campaign is on its surest footing – a tangible process and product.
In my experience, such processes require the involvement of patients. I have run several patient or citizen-led inquiries into prioritisation using ‘deliberative methodologies’ such as citizens juries. They are very useful tools for tackling complex and controversial issues, such as decommissioning and rationing.
In order to run such a process, the question needs to be clear. For me, a deliberative process that looked at key specific tricky issues, such as ‘whether and how can the NHS run a seven day service’ or ‘what can be done about A&E demand’ lend themselves to focus on pinch-points in the NHS.
Inevitably, such a specific focus would also lead to wider discussions that reveal ideological assumptions about the very nature of the service we want in the future. They might also be useful at a local level and help busy staff.
More useful I suspect than a vague and politically loaded question built around the assumptions of the current NHS Survivalists.
In summary, I am not joining NHS Survival yet. I am not persuaded that it can truly involve people like me. I am not willing to call for NHS survival, unless the NHS (and the campaign) changes tack significantly. If it were to work with patients to reframe its purpose, tone and processes… maybe.
Until then, it is interesting more broadly to note that the NHS Survival campaign seems to be yearning for patient-side credibility. For once, patients may have some leverage over a visible national policy initiative. How could we use that?