It’s Not Enough to ‘Save’ the NHS – We Must Transform It

Care, not competition, is the way forward.

by Joanna Sutton-Klein

25 January 2022

ambulance hospital worker nhs
Tejas Sandhu / SOPA Images/Sipa via Reuters Connect

Until now, it was considered political blasphemy for politicians to publicly call for the dismantling of the NHS. No Conservative government has ever felt able to openly admit that privatising the NHS was on its agenda, despite their actions demonstrating otherwise. 

For as long as the NHS has existed, it has been reported to be on the brink of collapse. However, a decade of brutal cuts to the insitution, along with a pandemic that has not only exposed their effects, but further exacerbated them, has shifted the narrative. Now, both politicians and the media are saying that our overstretched and underfunded national health service isn’t just on the verge of collapse; it already has.

This rhetoric is giving legitimacy to the argument that the NHS should be dismantled altogether, and emboldening the Tories in their mission to see it through. The Spectator recently reported that the cabinet is seriously questioning the viability of the NHS. Even Labour – the supposedly leftwing party that has always championed the NHS – is changing its tune, with shadow health secretary Wes Streeting announcing that the party would be prioritising the outsourcing of NHS clinics to the private sector. 

With the NHS’ failings so stark, and both sides of the political establishment united in their bid to dismantle it, we can no longer take for granted that the public believes it is worth saving. It is because of this, that reactionary campaigns to ‘save’ our NHS are no longer enough. Instead, progressives must offer a transformative and holistic vision, which puts care at its centre. 

The NHS has been decimated.

In order to make a compelling case for transforming the NHS, we first need to be real about its problems. This can only happen if we acknowledge the romanticised vision of the institution – from the Labour party website describing it as “the beating heart of Britain” to its fairy-tale depiction in the London 2012 Olympics opening ceremony – as a fallacy. 

Over a decade of Tory austerity has decimated the NHS, a reality best exemplified by its unacceptably long wait times. Almost six million people are on waiting lists to receive non-urgent treatment, over 30% of A&E patients have to wait over four hours for a hospital bed, and even the most urgent ambulance calls take an average of nine minutes and 20 seconds to respond to. These statistics are all the highest since records began.

When patients finally reach the top of the list, the picture is no better. They are met by a depleted, underpaid and exhausted workforce. Last week, the Guardian reported that a staggering one in four doctors are so sleep deprived that their ability to work safely is impaired. 

The coronavirus pandemic has made this so much worse. The NHS entered the pandemic with 100,000 vacancies and saw a record-breaking 27,000 resignations in just three months last year. 

Our caring culture has been lost. 

These staffing shortages and untenable waiting times are a symptom of the radical cultural change that has happened within the NHS over the last few decades.  

The NHS of 1948 was not perfect, but its aim was to be caring, more than efficient. Nye Bevan’s ambition for the health service to “universalise the best” is a far cry from its current mantra of  “improving value for the taxpayer”. 

Starting with Margaret Thatcher in the 1980s, neoliberalism has gradually seeped into the core of the NHS, transforming hospitals into factories, and patients into consumers, accruing itemised costs for each diagnostic test, treatment and consultation. Marie Flynn and Dave Mercer echo these concerns, highlighting the “assembly-line care” that the NHS has come to provide. 

Even in trying to reduce waiting lists and ambulance waiting times, that same market logic is replicated, manifesting itself in individualised performance metrics for doctors and hospital workers. Some hospitals give prizes to the ‘fastest’ doctors, while others publish weekly league tables to track performance. Enforced competition, rather than collaboration, between hospitals to reduce waiting time results in clinical staff feeling pressured to discharge patients as quickly as possible, leading to unsafe, and occasionally fatal discharges.

Under the Tories, the NHS has even adopted strategies straight out of the manufacturing industry, the most notable being ‘lean thinking’, which is used in the car manufacturing industry to “improve flow and eliminate waste”.  

While such strategies are not unsuccessful – over the past 30 years the NHS has managed to half the average number of days a patient stays in hospital, which has enabled a similar decrease in the number of hospital beds being used – they come at a cost. Any aspects of care that can’t be measured and monetised, are deprioritised. 

Indeed, the NHS routinely denies equitable access to healthcare to those deemed too overweight, too poor or to those with the ‘wrong’ immigration status. Doctors are unable to provide the care that they have been trained to provide, and at worst, they are turned into border guards. 

Occasionally, the lack of care necessitated by our increasingly marketised health service becomes too unpalatable for the public. The public inquiry into the infamous Mid Staffordshire hospital scandal condemned the poor care that patients received, which included being left unwashed for a month or in soiled bedsheets for hours without access to drinking water. However, the only solution proposed to address such a distressing lack of care was the introduction of yet more targets. 

We must transform the NHS. 

Given the core of the NHS is so rotten, it is not enough to merely patch it up by properly funding and renationalising it. Its deep problems require transformative solutions. We must demolish the industrialised healthcare systems that are central to today’s NHS, and rebuild a health service that is centred around care. Dismantling racism, ableism and poverty must be at its heart not merely tagged on as an afterthought. 

The pursuit of efficiency must be replaced with a vision of abundance. The NHS should have plentiful staff, with ample time, opportunities and resources to care deeply for their patients and for each other. Medical schools and all forms of healthcare worker training should be free, and open to the public and clinicians. Any epidemiological data generated from healthcare should be made publicly available, and all patients should have easy access to view and add to their own health records.

Healthcare is as much of an art as it is a science, and opportunities for creative and critical engagement with the philosophy and politics of healthcare should become a key tenet of how the NHS grows. 

Hospitals should be welcoming and luxurious, and they should provide the highest quality medical care for anyone who needs it. They should also be places of refuge and healing, which are rooted in the local community. Hospital canteens should provide delicious, nutritious, hearty meals to anyone who happens to be in the hospital.

Local clinics should take priority over large, centralised teaching hospitals, and they should have an expansive understanding of healthcare which could include the provision of art studios or community organising spaces. 

What’s more, progressives should focus on building our own healthcare centres before demanding centrally driven change. This is not a new idea. The Finsbury Health Centre, which opened in 1938, was a radical socialist proposition for how our healthcare system could look – and eventually became incorporated into the NHS. The futuristic building housed a wide range of clinics, unapologetic in the political underpinnings of its pursuit. These new community health centres could be run through mutualist principles, and experiment with different forms of democracy.

While the fear of undermining the NHS is understandable, given its status as both a national treasure and a beacon of socialist ambition, it is inhibiting our exploration of the countless forms that a genuinely socialist health service could take on. The state of the NHS today does not just offer an opportunity for the left to create new socialist health services for our communities; it demands it.

Jo Sutton-Klein is a junior doctor in Sheffield and has an MSc in social epidemiology.

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