Place your bets! Between now and the election we’ll see a raft of NHS flashpoints – maybe the scarcity of GP appointments, longer waits for treatment, or the ongoing saga of what constitutes fair pay for doctors. We can’t say what will grab the limelight, but without doubt something will.
These NHS squalls are nothing new. They rise up, lead the news, then are subsumed by the next item. Not that they don’t matter: such stories frame the debate and force politicians to reply, often steering the policy thrust of the sitting (or waiting) government.
But they focus on the latest thing to bob on the surface, not what’s going on underneath.
Let’s step back. Really step back, where not only the NHS’ recent birthday (75) seems small, but so do the Royal College of Physicians’ (500) and St Bartholomew’s Hospital (800). Because what we’re playing with when talking about healthcare is deeply rooted in our culture, and – without being too grandiose – what it means to be human.
Swirling under the surface are at least four themes which are as true in 2023 as they were a century past and will be a century forward.
The first is the most obvious: death comes to us all. The lengths we go to avoid even uttering the words is reflected in the euphemisms we find in its place: to pass, enter into sleep, be taken from us, snuff it. We will all die.
Second is how the need for healthcare affects us while we live. The emotional impact of being in pain and fear; the desire to find someone who can give us certainty, calm, and – hopefully – cure. This is the case even if it’s completely false: among medicine’s dirty little secrets is that prior to 1850 (when the understanding of germ theory started to take hold), going to see a doctor was more likely to harm than help you. Deep down, an inkling of this must have been known by those who appeared at the doctor’s door. But people knocked and went in anyway.
Third is how healthcare affects those who give it. The emotional impact of having to bear witness to parts of life and death that the rest of us would much rather not see. But not just the exposure to the fear and the dark, but also the inability to always provide the balm and the light. The pull towards helping others at their most vulnerable, followed by the recoil of realising that you have no superpower to overcome the inevitable. These are not ordinary jobs.
Fourth is how healthcare affects us as a society. We will always want more. There will never be enough to pay for everything which could postpone death or displace pain. On almost every objective measure, the healthcare we receive today is massively better than that we received even 20 years ago, let alone 50. We talk of gambling clinics being oversubscribed, but that we have such clinics at all is new. Take a thought experiment: if we cured cancer tomorrow, would health spending go up or down? Most likely it would barely change, with new ailments and causes of death simply shuffling up the pecking order. We’ve been here before: we used to have hospitals full of patients with Polio. And then we didn’t, but healthcare spending didn’t fall as a result. The idea that spending money on ‘prevention’ will reduce the amount we spend on the NHS is somewhat laughable in my view; it might reduce the need to treat some conditions, but others would soon take its place.
So what does this mean? We like to treat healthcare – and I very much mean healthcare not the generic ‘health’ – as a rational business, subject to the forces of good debate. But it’s far more a set of emotions without cure.
Healthcare isn’t a game which can be won. What these emotions require is acceptance. To see the long roots behind short-lived issues, and walk alongside these feelings without ignorance, nor a desire to fix. Not to paint the presence of budget shortfalls, or clinician suffering, as crises – but to welcome them in, give them a seat, and properly understand the nature of the industry healthcare is.
The upcoming election will be fought deep in the short term squall. Storms will brew, solutions will be demanded. But to properly effect change requires understanding that it isn’t the storm you’re sailing on, it’s the sea.
As they think of the next five, even fifty, years, politicians need to shape healthcare policy in the light of human experience of millennia. Without understanding the currents, the tides, the impact of hidden depths, you’re sunk.
This blog was also published on Medium on 4 August 2023.
Rich is an expert on policy, improvement and strategy engagement and development. Before founding Kaleidoscope in 2016, Rich was Director of the UK Improvement Alliance, Director of Policy at the Health Foundation and Head of Regulatory Change at the Care Quality Commission. Prior to that he was Deputy Director at the Department of Health, where his roles included advising Ministers on health strategy, and legislating for reorganisations ‘so big you can see them from space’. He also spent time at the Cabinet Office and HM Treasury. Rich is passionate about a lot of things but particularly improving how organisations work, understanding why people don’t talk to each other, and the Premier League season of 1995/96.
Declaration of interests
I have read and understood the BMJ Group policy on declaration of interests and declare the following interests:
Rich Taunt works at and owns shares in Kaleidoscope Health and Care, a Community Interest Company regulated by the Office of the Regulator of Community Interest Companies. He is also Chair of Here (hereweare.org.uk/), and Deputy Chair, the House of St Barnabas.