{"id":47872,"date":"2020-06-26T13:50:44","date_gmt":"2020-06-26T12:50:44","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=47872"},"modified":"2020-07-01T15:19:56","modified_gmt":"2020-07-01T14:19:56","slug":"charles-ebikeme-to-save-the-nhs-we-must-rewrite-the-rules-on-health","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2020\/06\/26\/charles-ebikeme-to-save-the-nhs-we-must-rewrite-the-rules-on-health\/","title":{"rendered":"Charles Ebikeme: To save the NHS, we must rewrite the rules on health"},"content":{"rendered":"<p class=\"standfirst\">The social contract between society and the NHS needs rewriting after this pandemic is over, writes Charles Ebikeme<\/p>\n<p><!--more--><span style=\"font-weight: 400\">The covid-19 pandemic has shown, once again, the deeply sentimental place that the NHS holds in the collective hearts of the nation, and how inherently political health and its provision have become. The policies that governments put in place ultimately decide\u2014in broad yet definite strokes\u2014who lives, who dies, who lives well, and who carries with them the burden of ill health. This is why in order to save the NHS, we must be willing to destroy it\u2014or, at least, destroy the way our health is framed in society.<\/span><\/p>\n<p><span style=\"font-weight: 400\">England\u2019s previous chief medical officer, Dame Sally Davies, on more than one occasion, <\/span><a href=\"https:\/\/assets.publishing.service.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/767549\/Annual_report_of_the_Chief_Medical_Officer_2018_-_health_2040_-_better_health_within_reach.pdf\"><span style=\"font-weight: 400\">said that <\/span><\/a><span style=\"font-weight: 400\">we<\/span><span style=\"font-weight: 400\"> focus too much on the NHS as an \u201cillness service.\u201d When we understand health in the UK solely through the familiar infrastructure of hospitals and GP practices, we neglect those elements that lay outside the traditional delivery of health services. We talk about health systems rather than systems for health.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Amid the #ClapForNHS, #TreatOurNHS, and general outpouring of support for the healthcare service lies something unspoken and perhaps uncomfortable in the way that we as a nation have put our vision of the NHS on a pedestal. Of course, during this pandemic, this is not something completely unique to the UK. Many other countries have been following similar rituals of tribute for their healthcare staff (although the distinction between staff and system is the key difference), but perhaps no other nation has made an idol of their healthcare system in the same way. During this covid-19 pandemic, government messaging has urged us to stay at home to protect the NHS, begging the question who is in service of whom?\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">This deification of the NHS has come with some unfortunate side effects. We now <\/span><a href=\"https:\/\/www.theguardian.com\/society\/2020\/apr\/16\/capt-tom-moore-is-a-hero-but-the-nhs-shouldnt-have-to-rely-on-charity\"><span style=\"font-weight: 400\">raise money<\/span><\/a><span style=\"font-weight: 400\"> for our health service, <\/span><a href=\"https:\/\/www.cam.ac.uk\/business-and-enterprise\/donating-personal-protective-equipment-ppe-faqs\"><span style=\"font-weight: 400\">donate<\/span><\/a><span style=\"font-weight: 400\"> goods to it, and <\/span><a href=\"https:\/\/www.bbc.co.uk\/news\/health-52242856\"><span style=\"font-weight: 400\">even die<\/span><\/a><span style=\"font-weight: 400\"> for it. All this is taking place at a time when we\u2019re truly starting to realise the impact of a decade\u2019s worth of austerity measures and shrinking budgets, which forced the government to <\/span><a href=\"https:\/\/www.gov.uk\/government\/news\/nhs-to-benefit-from-13-4-billion-debt-write-off\"><span style=\"font-weight: 400\">write off<\/span><\/a><span style=\"font-weight: 400\"> \u00a313 billion of the NHS\u2019s debt in early April. Let\u2019s be clear that this was a write-off to essentially plug earlier funding gaps.<\/span><\/p>\n<p><span style=\"font-weight: 400\">We cannot continue to pin the health of our nation entirely upon the NHS. With health ultimately affected by obesogenic environments, welfare safety nets, economic outlooks, and other inherent political decisions, governments wield a much wider influence on the health of their populations than they often take responsibility for. Where you decide to put a public space, a school, or a bus stop within communities are as much a part of our health systems as where you put hospitals and GP offices. Arguably, the best thing for the health of the nation would be to undo our deification of the NHS\u2014or at least expand our understanding to include all those other things that also determine our health.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">The NHS isn\u2019t a cure all or superhuman entity, even if many within it have worked under unimaginable conditions during the pandemic. It is staffed by our mothers, our sisters, our friends, our brothers, and our fathers. It is staffed by normal people who took an oath to do no harm and who every day make sacrifices for it. The social contract between society and the NHS needs rewriting after this pandemic is over. We need a rewrite that places the burden of health on the government, corporations, and citizens, and not just at the feet of our frontline workers.<\/span><\/p>\n<p><em><strong><span class=\"il\">Charles<\/span> Ebikeme<\/strong> is a policy officer in the Department of Health Policy at the London School of Economics and Political Sciences. Twitter <a href=\"https:\/\/twitter.com\/CEbikeme\">@CEbikeme<\/a><\/em><\/p>\n<p><strong>Competing interests:<\/strong> None declared.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The social contract between society and the NHS needs rewriting after this pandemic is over, writes Charles Ebikeme [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2020\/06\/26\/charles-ebikeme-to-save-the-nhs-we-must-rewrite-the-rules-on-health\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":47873,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[236],"tags":[],"class_list":["post-47872","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-nhs"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Charles Ebikeme: To save the NHS, we must rewrite the rules on health - 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