Is it Our NHS or Their NHS?

I'll start with a little celebration. A senior finance officer from our local NHS presented to Bradford's Health and Wellbeing Board. Now if you'd made a habit of reading Twitter or The Guardian you'd be very worried at the content of this presentation - the pain, the stress, the cuts....AUSTERITY!

The officer opened with this (I paraphrase from my notes but it's close enough):

"The NHS has £800 million to spend across the three CCGs. This number is not going down but is rising. However, it's not growing at the pace we think we need to meet demand."

This, dear reader, is the truth about the NHS. When you see parades of nurses waving banners about 'saving the NHS', you're led to believe - it's implicit in the protest - that the health service is suffering draconian cuts when the truth is that the rate of growth for the NHS simply doesn't keep up with the growing pressures. And every report, each presentation we see from the officials of the NHS repeats the need for system change - words like co-production, self-care and prevention dominate the pages of PowerPoint flashing up on the screens. And this is great.

There is, however, another theme and it is this that explains the 'Save Our NHS' campaigns and the heartrending tales of cuts and awful austerity. It cropped up in today's presentation - the first three lines in the list of economies to be made were all about workforce efficiency, pay restraint and savings in administrative staff. It's not 'Our NHS' we're saving, it's 'Their NHS' - the anger about cuts and austerity is mostly a response to the NHS applying the same cost management practices that private business and, latterly, local government have used.

This isn't to say that all is rosy in the NHS or even that it is grossly overmanned but rather that a system predicated on annual increases in costs significantly above inflation is simply unsustainable. It's not a solution - as some seem to think - to create a hypothecated tax unless you plan on making the rate of that tax increase by 5% each and every year. The solution lies in stabilising the cost base and this, whatever those banner-waving NHS employees may say, means cost controls. And the NHS's biggest cost is wages.

What we're seeing with the NHS Action Party, with the doctors' strikes and with the sanctifying of all NHS employees, is an endeavour aimed at drawing the public into defending the interests of the health service's employees. For many this is right - these are deeply caring, highly skilled people - but it covers up the truth. The reality is that, without different ways of working including those involving fewer staff, the NHS is not sustainable. None of this is about privatisation, market forces or some sort of dark and evil Tory conspiracy to destroy 'Our NHS' - it's simply a necessary process aimed at ensuring that, so far is practical and possible, we retain that central idea of a health service free to all without favour at the time they need that service.

Here in Bradford the forward look at NHS finances tell us that, without changes to the way we work, there will be a deficit of over £200m by 2022/23 - this scales up to a national deficit of £20 billion. It doesn't require much analysis to conclude that this simply can't be met. So the result is that we have to make these cost savings and since over 75% of NHS costs are wage related, the biggest chunk of those savings has to come from staffing. The impact of strikes, protests and campaigns won't be that these reductions don't take place but rather - as with almost every campaign of this sort in recent history - with the resultant cuts being more extensive, more painful and more damaging.

If you want it to really be Our NHS then you need to start by rejecting the militant 'Save the NHS' campaigns and instead support a considered, rational and planned approach to reforming the NHS. This means better use of technology, it means partnership with the private, charitable and voluntary sector, it mean promoting the idea of healthy ageing and it means working with local councils to improve case - at home and in the community - for the elderly and disabled. It cannot mean supporting current structures, systems and staffing levels - if we do that we will be the losers as the NHS fails to meet our needs and the needs of our neighbours.

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Whose NHS is it really?

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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.

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