Nick Hopkinson: Saving the NHS—a lesson from Carthage

nick_hopkinsonCato the Elder is said to have concluded every speech he made in the Roman Senate, regardless of the topic, with “Delenda est Carthago”—Carthage must be destroyed. In answering the Editor of The BMJ’s call for ideas on how the medical profession can protest against the destruction of the NHS, a similar clarity and consistency of message is essential.

The simple proposal is that in every discussion on every topic of medical interest, the management of long term conditions, novel therapies, the causes and the cures of cancer, avoidable deaths, whatever thing awareness is being raised about this week, good news or bad, doctors need to include a clear statement that it is government policy to underfund the NHS by £20 billion pounds by 2020.

A new cytokine target for asthma—great, but the audience needs to know that right now asthma care is constrained by staff shortages, child poverty, cuts that are being made to smoking cessation services and poor air quality.

A breakthrough in Alzheimer’s research—great, hope for the future, but patients and families need staff with time to care now, not rota gaps and overstretched nurses.

Every announcement (and re-announcement) of supposed “extra money” for today’s policy priority needs to be met with a clear reminder of the overall funding picture.

A statement from the Department of Health of a government “commitment” to ensure that older people can get “dignified care”—you get the idea.

The recent joint report from the Kings Fund and Nuffield Trust finds that social care spend has also collapsed with an 11% reduction in local authority funding for social care of older people and a 26% fall in the number receiving it. This, despite the supposed demographic time bomb of our ageing population. We must not allow this to disappear from the news cycle.

An audience encouraged to take an interest in health, while the fact that the services patients need to help them cope in the community are not there, as councils are forced to implement the consequences of the government’s choice to pursue austerity policies, is an audience misled.

People do not want to believe that the NHS is in danger—the least we can do is to place the consequences of political choices about health and social care, the causes of much of the inequality in life expectancy that our Prime Minister has promised to address, at the forefront of their minds.

Nicholas Hopkinson @COPDdoc, reader in respiratory medicine, Imperial College, London.

Competing interests: None declared.