Good old anonymous senior sources in the NHS. You can always rely on them to tell you the truth, the whole truth and nothing but the truth, can’t you? In their latest act of radical candour on behalf of patients and frontline staff, these cloak-and-dagger freelancers briefed the BBC about their growing unease at Wes Streeting’s insistence that the NHS is broken.
Speaking to the corporation ahead of the health secretary’s Labour party conference speech, the sources worried that Streeting’s unflinching descriptions of current NHS failings might “spook patients” and “make it really difficult to raise staff morale”, with one brave yet unnamed hospital leader muttering darkly: “If the government isn’t careful, it will cause lasting damage.”
Now, I am no apologist for Streeting, but honestly? This is exactly the kind of vapid doublespeak that rots the NHS from the inside out. There are two ways to confront a bleak reality. One – and we’ve had 14 years of this approach – is to pretend it doesn’t exist. At best, this is a form of benign paternalism, such as when patrician doctors of old chose to keep the C-word from their patients in case being honest about a diagnosis of cancer might do more harm than good. At worst, it’s nothing more than political snake oil.
Even as waiting lists ballooned to nearly 8m cases – with one in seven people in England now waiting for NHS treatment – still successive Conservative spokespeople fobbed off journalists with fatuous quotes about how the NHS was thriving. For every member of the public in pain and indignity, for every member of staff who has been forced to treat patients dying on trolleys in corridors, these glib denials were soul-destroying. Because how can you ever hope to fix what you refuse even to name? How can staff or patients feel optimistic when infinitely louder voices than theirs try to erase what they actually experience?
Streeting has a different approach – and he’s not holding back in the slightest. The fundamental promise of the NHS, he told conference today – that it will be there for us when we need it – has been well and truly broken. He cited the 100,000 toddlers and babies left waiting for six hours in A&E last year and the fact that cancer is more likely to be a death sentence in Britain than in other comparable countries.
This last phrase drew particular ire from the anonymous sources, with one of them objecting that it strikes “completely the wrong tone” – as though tone is what really counts with cancer. Perhaps it’s just me, but when, as a hospital palliative care doctor, I meet a young, formerly thriving patient for the first time and I have to tell them their new, and delayed, diagnosis of cancer is also terminal, these facts seem to matter more than tone. They matter even more when it’s the third time that week I’ve had that conversation.
The truth – and we all know it – is that the NHS is failing. This is not to blame staff, who inhabit a service that has been deliberately savaged by 14 years of neglect and underinvestment. In that time, staff morale has plummeted. Burnout and early retirement are rife. I’ve lost count of the number of gimmicks NHS apparatchiks have deployed in order to try to address this. Free zumba classes you never have time to attend, a pandemic era George Cross shared out between 1.3 million people and once – in a truly revelatory moment – the gifting to staff at one trust of a single NHS-branded teabag.
Meanwhile, the sincerity of NHS England’s commitment to staff morale was revealed earlier this year when it snuck out, late one Friday afternoon, the news that it was cancelling the funding of the NHS practitioner health service. This little-known but precious resource supports doctors with mental health issues. More than 17,000 NHS staff members signed a public letter expressing their disgust at the cost-cutting exercise. Formerly suicidal doctors spoke in heart-rending detail on social media about how the service had saved their lives. Eventually, when the public furore grew too loud, NHS England made a hasty U-turn.
The fact is, the NHS has a long and ignominious record of prioritising reputation management above protecting patients and (genuinely) supporting staff wellbeing. The culture of secrecy and cover-up is endemic. We’ve seen it with the Mid Staffs scandal, the infected blood scandal and with the many recent maternity scandals that Streeting has rightly termed a “national shame”. But it is never acceptable to hide the truth from the public, whether you are a health secretary, an NHS senior manager or an ordinary nurse or doctor.
I felt nothing but relief, then, when Streeting chose to spell out – in all their ugly detail – the crisis conditions in the NHS. Hope genuinely flickered. What was singularly lacking in his speech, of course, was any mention of how, without a vast injection of new resources, he can possibly take the NHS from “the worst crisis in its history to build an NHS fit for the future”. Staff are long jaded by health secretaries who peddle in magical realism. This has to be the real thing – or the NHS could die on Labour’s watch.
Rachel Clarke is a palliative care doctor and the author of Breathtaking: Inside the NHS in a Time of Pandemic
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