- Jennifer Darlow, consultant paediatric haematologist
On his first day in office as the new Labour health minister, Wes Streeting declared that the NHS was “broken.”1 It’s a message that has been repeated and doubled down on by the prime minister, Keir Starmer, and throughout the Labour party conference.2 Spiralling costs, increasingly missed targets, and maternal mortality rates fill our daily news reels. No one can deny that the NHS faces an increasing number of challenges, but it still provides world leading and life saving care.3 These recent labels have received a backlash from senior health officials,3 leading to the question of whether continuously calling the NHS “broken” is unhelpful. Indeed, it may risk worsening an already difficult situation as patients lose confidence and staff morale falters.
Many patients will have experienced firsthand the troubles currently facing the NHS. News articles often largely focus on cancer waiting times because it’s a target that’s easy to measure and has a high emotional impact, but this only accounts for a fraction of the frustrations that many patients experience. A reduction in services that were previously provided can have sometimes devastating consequences for patients. Getting a GP appointment can be a struggle, and you only need to spend a day with our specialist nursing team to see the number of patients ringing with problems brought about because of delays in outpatient care.
For those of us who work in the NHS, many of the problems run far deeper and are not always visible to the general public. For the past year I have worked a one in three on-call rota, covering a tertiary service for a large geographical region, with job vacancies left unfilled and little sign of imminent relief. Work related stress has contributed to staff sickness and worsened morale, and we frequently have to advocate for patients to get what we consider to be a basic standard of care. We have more patients under our care than appointments for their treatment, and our clinics usually run between one and a half to two times over capacity.
Yet what recent news reports fail to convey is the absolutely incredible work going on in the NHS. On a daily basis I see highly driven and dedicated staff members working hard to bring about life changing outcomes for patients, with great compassion and humanity.
I can recall several occasions when I have gone into the hospital in the middle of the night to see an unwell patient transferred to the intensive care unit, and been met by consultant colleagues of different specialties all there for the same reason: the care of the patient. The collaboration and communication among healthcare staff can be inspiring, and the feeling when you see a child who has been critically unwell return home to their families is second to none. Even in a non-acute setting, there are many examples of excellent care, and the relationships I have built with many of my patients with chronic diseases can bring great joy to any clinic.
A relationship built on trust
Professionals—both medical and governmental—have to be incredibly careful in how they communicate with patients and their families about problems in the NHS. The doctor-patient relationship is largely built on trust, and if that trust is shattered, patient care fails. A patient admitted to hospital may be in pain, exhausted, confused, or scared of what could be to come. They need to know that doctors know how to look after them and will deliver the care they need. If these patients believe we can’t attend to their needs, their fear may be heightened, their presentation delayed, or their recovery prolonged.
This truth has been emphasised to me from personal experience. It’s not an exaggeration to say that the NHS has saved my life more than once. On two separate occasions when I was in a high dependency unit, I can pinpoint the moments when a health professional attended to me with such calm and confidence that I completely trusted them with my life. At these moments of extreme fear and vulnerability, knowing there were adequate resources and knowledgeable staff to get me through had an immeasurable effect on my perseverance and recovery. Had this faith wavered, my experiences would have been devastating and traumatic.
Most people agree that the NHS needs to change, but to call it broken conjures up images of abandonment and forsakenness. This is not a true reflection of the NHS that I see. How exactly the NHS should be reformed is under constant debate, but we all know that what it fundamentally needs is improved staffing, finances, and planning. It’s important to be transparent about service provision and to moderate patient expectations, but we must work to maintain public trust in our services. In times of illness and fear, we all need hope. It’s possible to be honest about the difficulties that the NHS needs to overcome and to get the public behind this, while still promoting messaging that highlights the incredible service NHS staff continue to deliver on a daily basis.
The fundamental NHS backbone of knowledge, drive, and compassion is still there. Writing the service off as “broken” risks negating this good work, and could sound like defeat in political leaders whose job is now to sort out the well documented problems that have beset our healthcare system. NHS staff haven’t given up on the health service and all it stands for. It’s important that our politicians don’t either.
