Wednesday, 30 December 2015

Whose NHS is it really?


We hear it time and time again. Repeated almost ad nauseum.

"Save Our NHS"

"It's Our NHS"

"Protect Our NHS"

All this, in the ultimate marrying of popular culture and political sloganising results in a bunch of NHS employees forming a choir (helped by the chap off the BBC), releasing a sinlge and getting the Christmas Number One. Helped along the way by Justin Bieber and every second tearful person on social media.

On Christmas Day, five minutes before the Queen’s speech, a video displaying the best of our NHS was played on BBC1’s Top of the Pops. For better, for worse, for richer, for poorer, in sickness and in health, ran the messages on the screen as scenes of the NHS in action played out. It was a poignant moment for all who were involved in running the campaign - our song had got to No 1.

I'm really pleased for the people who were involved in this 'campaign'. It's always fantastic to see a project succeed, a message crack through the shell of public resistance, make a difference. But it got me thinking about 'Our NHS' and whether it sends out the right message. For sure we can show thousands of examples of how the brilliance of doctors, nurses and other medical folk, the smiling faces of families as their loved one pulls through, of mums delighted as their child's eyes open again, and of seemingly miraculous applications of medical technology to saves lives.

But is this really what "Our NHS" is about? Surely those same live saving, uplifting scenes are commonplace in every hospital everywhere? Aren't medical miracles performed by doctors and nurses in France, in Germany, in Spain - even in India? Places where "Our NHS" doesn't exist? And all these places - all these systems - are less than perfect, filled with error and mistake, lacking in resources and subject to failure? Just like the NHS.

The word 'our' implies possession - collective possession for sure but still possession. I wonder whether I - as a mere customer - can truly call the NHS mine. I do not control or influence its actions or activities beyond that moment when I put a cross in a box on a ballot paper every five years. I have no choice - there is only one NHS, that's it, like it or lump it. Decisions about when it's open or closed, about where it's located, about what services are available - these decisions are political decisions made (in theory if not in fact or reality) by those MPs we elect. We no more possess the NHS than possess the police force or the army. It is a huge, unaccountable bureaucracy directed by ministers and the officials they (sort of) employ. It really isn't ours yet the lie that this is the case is central to sustaining the NHS as Britain's sacred organisation.

Instead of talking about 'our' NHS, those doctors, nurses and so forth should be speaking of 'your' NHS. Where 'your' means the patient, the customers, the 'service user', the ordinary member of the public. If the NHS is to mean what these people claim it means then that is where the ownership should lie. But it doesn't and we are conned into believing that 'Our NHS' somehow means something - our heartstrings are tugged, the emotional buttons are pressed and, lo, the interests of those who really control this organisational behemoth are duly served. All those people who, sparkly-eyed, extol the virtues of 'Our NHS' are patsies for the nearly millionaire consultants, the trust bosses with their jaguars and barn conversions, and the 'system leaders' whose every act is to resist any change to an organisation that, for all the efforts of front line staff, fails far too many people.

It's 'Their NHS' and we shouldn't forget it. The 'Our NHS' campaigns do not serve our interests.



Anonymous said...

But 'our' NHS does not understand the concept of customer service because there's no 'live' exchange of money involved. An example:-

On Sunday 27th December, I ordered an item on-line from a national company - despite the Monday being a Bank Holiday, the item arrived by free-delivery courier at lunchtime on Tuesday 29th December (that's a mere 4 'working hours').

On Saturday 26th December, a lady ordered a repeat prescription on-line from her local NHS GP - when she called at the surgery to collect it around lunchtime on Tuesday 29th, she was told it would not be avalilable until Thursday 31st because "it takes 48 hours". That is, 48 hours plus the three non-days, merely to print-off and sign a pre-completed piece of paper, not even deliver it !

It was certainly not HER 'NHS', but it was MY 'House of Fraser' - that's the service quality difference you get when there's a 'live' exchange of money involved.

Kit Byatt said...

It's 'our' NHS insofar as all we taxpayers fund it, and also insofar as it's available to all of us as needed (admittedly rather clunkily for some non-urgent things) without paying at point of delivery.
It's thus 'ours' in the sense of being a national accord in which we contribute as able so that all have access when needed, without risking bankruptcy from treatment costs (the cause of >50% of US bankruptcies). As a result we have, although not perfect, the most cost effective health system in the world [as assessed by the independent Commonwealth Fund].
No private system works more efficiently - US health admin costs are approximately twice those of the NHS.
It's just as much 'ours' as the UK is - none of us owns or controls it personally, but we buy into the concept of agreeing to delegate control to the (equally imperfect) systems in place.
So, for all those reasons, it's 'ours'!

RES said...

By the same argument it's not our country, our government, our anything in the public sphere.

As a customer, I accept goods and services offered with terms and conditions all dictated to me by the supplier. I can only ever ask change and hope it is offered, if it suits them. I can complain if they do not meet their own targets. This is a situation where I am fundamentally weak. I am nothing but the strength of my wallet, which means effectively powerless, like most of the population.

But the issue of systems being "ours" matters because it does influence how we think about it. It's an affinity to it - a belief in rights and responsibilities, and to demand some say in its operation at a core level. This is more empowered than being a mere customer. And whatever else you can say, if NHS "change" means privatisation, it becomes less ours.