I started to experience crisis in the NHS when I qualified as a doctor in 1981, and it would only get worse and worse over the next decade. The main indicators of failure were, and still are, delays in planned surgery and in emergency care.
I got used to patients coming to see me doped up on morphine and in a wheelchair because of excruciating pain from an arthritic hip, after waiting two years or more for surgery. I would write letters to orthopaedic surgeons pleading the case, knowing they would simply join a pile of similar letters. There was, by the way, no point trying to get on to the waiting list two years before you needed your new hip; only those who needed surgery urgently earned the ticket to start waiting.
Dialysis treatment for kidney failure was rationed, with our take-on rate per million population for new patients the laughing stock (if it wasn’t so tragic) of Europe and of the world. If you were a bit old or had a few other health problems, the kidney specialist would tell you, often rather unconvincingly, that dialysis wasn’t suitable and you would soon die of kidney failure.
While I was angry about delivering third-rate care, I was also optimistic. It didn’t feel like the end of the NHS, it just needed a sympathetic government. Under Tony Blair and Gordon Brown, the Labour government almost doubled healthcare spending as a share of GDP – lo and behold, it was affordable for the nation and transformed clinical outcomes. People could get elective surgery in a reasonable time, they could choose which type of dialysis suited them best and, of course, a full range of treatment across all specialities was deliverable. The keystones of the NHS were broadly preserved, namely national standardised terms of service for all staff, reasonably fair pay (certainly looking back from a 2023 perspective) and a requirement to deliver care equitably across the nation.
Innovation led by staff blossomed. I didn’t start a telephone clinic service in 2006 because managers wanted me to; it was because there was a demand for the service from my patients and I wasn’t too overwhelmed by other work. A new programme of kidney transplants started in Coventry saved the NHS money and transformed lives. There are many, many more examples from my experience and even more from around the NHS as a whole.
So I don’t accept the premise, touted so often by some politicians and media that it has almost become gospel, that the NHS cannot deliver great healthcare. In my experience, an adequately resourced service will deliver top-rate healthcare at a price point other providers cannot equal. For every fault in the NHS, I can point to just as many, if not more, examples of private delivery being either more expensive or lower quality (or both). Remember that the NHS is publicly accountable for its failings, in a way that other providers can dodge, if they are so minded.
In the early 2000s I was hopeful that these qualities of the NHS would be recognised and valued – but it turned out I was naive. Yes, some threats were seen off, or so I thought. Tax relief on healthcare insurance was a failure, delivering only subsidies to those already paying insurance. The private finance initiative (PFI) policy, using private funding to pay for infrastructure projects, was an expensive way of building hospitals. Employment of ancillary staff by PFI providers did nothing obvious to improve quality and reduce costs, even after getting staff off national terms of conditions of service and cutting their pay. I saw companies that thought they could see a way of making money in NHS clinical services mostly fail, usually through being unable to deliver a safe service of acceptable quality.
In 2023, elective surgery and emergency departments are again in crisis, even though people are (so far) getting far better care than in the late 1980s and early 1990s. Yet 2023 still feels far worse. A word cloud from those working in 2023 would feature “burnt out”, “let down”, “despair”, “crisis”. Thirty five years ago I would have said “angry”, “avoidable”, “we can do better”.
The big difference between then and now is that the NHS crisis of the 1980s and 1990s had an obvious solution – more resources. When these were delivered, the service was transformed. In 2023 the solution isn’t so easy. Yes resources are important, but where would any extra funding go? Would it be channelled towards helping the NHS in the medium to long term?
Adding to the uncertainty, what is the current government plan for the NHS? In a recruitment and retention crisis, what employer in their right mind would be hellbent on forcing a substantial and humiliating real-terms pay cut on its employees? When he was health secretary, Jeremy Hunt gave, in sporting parlance, a jolly good beating to junior doctors in 2016 when he saw off their industrial action and imposed a new contract. It seems now, as chancellor, he is determined to deliver the same treatment to nurses and others. But to what end?
Do we want a service based broadly on the NHS that we know works, or do we want a fragmented service dependent on private providers? Some individual providers may be competent, but would be working among many others of varying quality. Who wants to risk their wellbeing against the real possibility that healthcare could collapse into the same kind of chaos we are witnessing in the energy industry and railways? Failure of healthcare will cost you a lot more than money or travel delays.
I would back the service that has a proven track record of being clinically effective and cost effective when adequately resourced, with national terms and conditions of service, and services commissioned equitably and working for the greater good. We needed it 30 years ago, and we need it now.
Rob Higgins qualified as a doctor in 1981 and was consultant in general and renal medicine at the University Hospitals Coventry and Warwickshire from 1995 to 2015. He returned to work during the 2020 Covid crisis
