Let’s be frank about the NHS

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Part of The public and the NHS

In a guest blog for our NHS and the public project, Laura Fulcher explains how her poor experience as an NHS patient has prompted her to question whether our affection for the NHS as a national institution is blinding us to how it needs to change and improve.

What best represents the UK today?

Is it Britannia, with flowing mane, trident in hand, on a 50p coin? Or perhaps Lord Kitchener, his stubby finger pointing at you from World War 1 propaganda: ‘Your country needs you.’ No, such militaristic images don’t define us nowadays.

For a country devoid of a unifying religion, with nationalist pride used by some to justify racist thuggery, we must find our identity somewhere. And we find it in the NHS – that all-compassionate healer of the sick.

Yet NHS propaganda comes with the implicit threat of Kitchener’s finger. Without our zealous support, the health service could well be snatched away. ‘Save the NHS!’, the placards scream. For if we are deprived of our health service, who will cure the sick, who will deliver babies, who will save us in our hour of need?

And so we clutch the NHS to our bosom. We must protect it; ensure it doesn’t change; never a bad word must pass our lips.

I was born within the NHS for free – it’s the greatest treasure in the world!

No one could ever say anything bad about the NHS, because it’s made up of such caring, hardworking people.

With the NHS so entrenched in the nation’s psyche, it has become almost a treasonous act to call for improvements. We place the NHS on a pedestal as the envy of the western world. And as the system is now synonymous with hardworking clinicians, negative patient feedback is stifled further. We can’t possibly criticise overworked nurses, can we?

And so we don’t seek policy change or campaign for specific meaningful investment.

I too trusted the NHS once.

As a secondary school teacher, I was confident that the health service would be there for me in much the same way as I supported my students. But after the 15 months it took to fight for a cancer diagnosis at 29, that blind trust is long gone. Thousands of others are placed in a similar or worse situation every year, many of us waiting months or years to be diagnosed.

But there’s no use complaining about the delay. You’re told no mistake has been made; your treatment was timely; the only thing failing the NHS is ‘limited resources’ – something seemingly out of any one person’s hands.

As a secondary school teacher, I was confident that the health service would be there for me in much the same way as I supported my students. But after the 15 months it took to fight for a cancer diagnosis at 29, that blind trust is long gone.

‘Limited resources’ has become a catch-all of excuses; the ultimate shut-down of debate and improvement. This inertia now pervades the public, NHS workers and politicians too.

And to those whose eyes are open to the NHS’s issues, what options are there but disillusionment and disempowerment?

Certainly you can’t speak up. The formal complaints procedure is out of reach for anyone who values their mental health. Policy decisions are kept far away from patients. Not one person sits on the NHS England board in the sole capacity of a patient. Where is our People’s Champion? Who represents our views? Even NHS jargon, either purposefully esoteric or pointlessly truistic (‘person-centred care’ – I ask you!), seems set to complicate matters further.

With no opportunity to campaign for better, disillusionment breeds frustration. Harsh words are spoken. Commissioners begin to believe all patients just want to cause trouble; they batten down the hatches; they don’t want to engage. The public is perceived as too passionate, too uncontrollable.

Behind closed doors, financial decisions take priority over human life. Commissioners are told they can’t slide into further debt, so NICE guidance is overruled, services cut, waiting times lengthened… capacity never found. Propaganda states that private hospitals are the devil for putting profits first – but is this worse than an NHS at the mercy of an austerity-leaning government?

I paint a picture steeped in impossibility – everything seems just too difficult. With the menacing rhetoric, the ‘limited resources’, the jargon, the adversarial public relationships, the demonised government, the politicised system, the fact that policy decisions are all made so very far away… how can change ever be made?

The solution is brutal honesty.

The NHS in its current form is a system born of policy, targets and financial investment. Viewing it as such allows us to talk frankly about what we actually want from a health service without worrying about denigrating overworked staff or bruising our national pride.

The NHS in its current form is a system born of policy, targets and financial investment. Viewing it as such allows us to talk frankly about what we actually want from a health service without worrying about denigrating overworked staff or bruising our national pride.

Hard questions do not just need posing, they also need answering. And it is the public’s responsibility to do just that.

How long does Grandma really need wait for her hip replacement? A month, or two. Shouldn’t all cancer patients be diagnosed within two weeks? Yes! Do we really want our hardworking doctors and nurses run in to the ground? Definitely not. And fundamentally, don’t we all want a service that genuinely meets the needs of all?

The nation’s answers to these blunt questions must replace the current moveable targets that are so easily manipulated. Instead, they will form a transparent contract outlining what the public can expect from the NHS, with no place for blind trust in vague promises. Solid expectations would empower us all to champion ourselves.

But to reach this open and honest world, culture needs to change. The NHS should never feel faceless or corporate but should be ‘people powered’ and wholly entwined with the local community. Red pens should be wielded to cut the jargon that makes strategy so inaccessible. Communication channels should open – through social media, email, by providing open-office hours, and launching Westminster ‘fly-ins’ to engage the public in debate.

Complaints should be treated as opportunities to improve rather than pesky letters to be dismissed and ignored by departments that are so distanced from the front line. Leaders must stop seeing policy as a set of divine commandments inscribed in stone, but guidance to be challenged and upgraded.

And in all this, the public should be reimagined, not as the ‘great unwashed’ fixated on problems, but as energetic folk with the capacity to lead on improvements with innovation, passion, and resolve.


mark woodhead

retired community development and health worker,
Comment date
26 March 2018

Yes, the NHS needs to change and improve. The two main changes that are needed, it seems to me, neither of which might be easy to achieve, are these -
1. Reverse Lansley's decision to move public health out of the NHSinto local authorities.
2. curb the frightening power of huge pharmaceutical companies. In the early seventies I was studying economics, and, as an example of a monopoly, we looked at Hoffman la Roche. Very little seems to have changed since then. Big Pharma is still bleeding the NHS dry.

Alan Wright

GP in New Zealand,
Self employed
Comment date
26 March 2018

Well written piece. The images of Lord Kitchener made me think of a paraphrased old saying “ The NHS is dead. Long live the NHS”. Having quit the UK NHS 25 years ago I have come to a country that has made some of those difficult decisions and allowed patients to financially contribute to their own primary health care through reasonable fees and it works. Time for significant change and less flag waving I think.

pamela ellis

Comment date
28 March 2018

Now in my 7th year I still do not know the truth regarding why my mother was "neglected from the outset." Her admission reason changed in secret by A+E. ECG showing abnormal binned. Vital troponin refused. 2nd ECG misdiagnosed, doctor unknown to hospital, patient id missing, no doctor's notes, suspicious death as found from Freedom of Information a nurse stayed on after her shift and I believe watched my mother die and I was told unknown and unseen. I involved the police and he has lied to me and the Coroner and misled the Coroner calling dementia a SIMPLE DISEASE. I believe Scarborough Hospital and the Police in a conspiracy to avoid the truth being told.


The King's Fund
Comment date
29 March 2018

Thank you for your offer, Mr Carlisle. I'll pass it on to the relevant colleague who will be in touch if they want to take this forward.

Lee Taylor

Orthopaedic Consultant,
Part time NHS
Comment date
09 April 2018

It is a sad reflection that so many comments come from retired nhs staff or those who maintain anonymity. The bullying culture of nhs management makes people fear for their job and stifles healthy debate and suppresses clinical engagement. These people behave like this because the incestuous system makes them untouchable and unaccountable.


Comment date
31 August 2018

Excellent article! After 7 years in the UK, I am still shocked by the huge waiting times, the general inefficiency and the lack of proactivity in the NHS. Sometimes I feel like I am interviewing with the GP to convince them to let me see a specialist. Coming from France where healthcare is cheap, you have direct access to specialists (and you can choose which one you want to see!), there is no concept of waiting lists (and therefore no bottlenecks delaying care) and outcomes are much better for patients I know for a fact that British people deserve MUCH better.
My favourite story was when I had a breast lump, went to see the GP. He couldn't get a hold of the Breats clinic so asked me to come back the following Monday to monitor. Came back except it was another GP who asked me again to come back 2 weeks later to monitor. Eventually 3 GP appointments later I was referred to the Breast clinic (with an additional 3 weeks wait of course)... So I used 3 GP slots and it took 6 weeks for me to be diagnosed for no reason except general inefficiency when in France I could have gone straight to the Breast surgeon to get everything checked all in one appointment. Mind-blowing and not in a good way for any European living here.

Michael Lingard

Orthopath: Holistic Therapist,
Comment date
15 October 2018

A refreshing article, thank you! I do not believe the NHS main problems lie in inadequate funding but at a far deeper level. The entire system is an excellent sickness service but a poor health service. The key workers within the system , the doctors are not responsible for this, as with a few exceptions, they never had any significant health promotion training and hence the public are left to discover for themselves what lifestyle changes they need to make to improve their health and avoid serious chronic diseases. The key foundations of health are diet, exercise, body alignment, breathing, mind and community. The Kings Fund was given the remit in 2004 by the Government to find ways of changing the NHS from a "Sickness service" to a "Health service". Perhaps this monster organization is just too big to change (the second largest employer besides the China Red Army) and the front line staff will have to continue their impossible task of trying to make it work. The long term solution will need radically improved management , breaking it up into manageable operating organizations, the re-educating the public and the medical profession in health education through lifestyle changes and reducing the power of the pharmaceutical industry on the NHS. Finally the evidence is loud and clear that most of our serious diseases are preventable and even reversible primarily with diet, shifting to a plant based diet; the WHO has identified processed meats as a carcinogen and we also know that meat & dairy are linked to heart disease and diabetes.

Chris T

Comment date
03 April 2019

I agree with this. For anyone coming from most of the Western European countries, the NHS and how it works is baffling... I have wso far tried three times to get an appointment for abdominal pain over the past months and it's always been 'no slots available, try again later on...' IMO it's a service you won't even find in many developing countries. I've had some very good experiences with NHS nurses and many work really hard, but I feel sorry for them for having to put up with a service that's so badly run and managed (or even conceptualised).


DIY Patient,
Comment date
16 October 2019

Excellent article – For the first 40 years of my life I was lucky enough to be very healthy and so had almost no interaction with my GP surgery or any other part of the NHS, and so like almost everyone else in the UK I believed the superb NHS propaganda engine, believing that ‘our’ NHS was the best in the world, all doctors and nurses are saints, and they are always broke and under-funded, etc, etc.

However, 10 years ago I started developing a number of strange symptoms, and tried engaging with the NHS, and over this period I have come to the realisation that effective healthcare for most citizens in the UK is a myth – and its rather like the story of the ‘Emperors new clothes’ story, where no one is permitted to challenge the cult of NHS excellence and to do so is heresy.

Over these past 10 years, I have been fortunate enough to have the resources to be able to manage my own diagnosis process, sometimes requiring me to go to other European countries that are claimed to have much poorer healthcare services and pay as a visitor for access to their national healthcare services that have actually completed the diagnostic activity, confirming several serious and life-threatening illnesses. Its notable that over these years I have been actively blocked by GPs, and NHS specialists and Hospitals at every turn, only to have them eventually agree with my diagnosis from leading consultants in other European countries, when ultimately presented with the incontrovertible evidence. If I had relied on the UK NHS alone, I have been advised it is very likely I would be dead now, or as a minimum completely paralysed, and assuming I survived, the ongoing cost of my care to the NHS would have been vast.

My very personal experience of the NHS over the last 10 years has given me some clarity over a few of the issues I believe exist in the NHS, and from what I see it is not simply about lack of funding and resources which is the standard ‘NHS cult’ mantra that everyone is expected to chant when describing NHS failings that surface regularly.
It seems that the NHS has a combination of features creating a 'perfect storm', including;

(1) GP Practices that are purely profit driven legal partnerships, operating exactly like law firms or limited companies, These organisations can only drive profits for their partners or shareholders by maximising revenue and this can only be achieved by maximising their patient list, and minimising their fixed cost base = minimising staff costs = not employing sufficient doctors and nurses and basic training for admin staff so they can be 'authorised' to carry out medical procedures - e.g. you probably had your last GP phlebotomy procedure done by a receptionist whose training amounted to a two-day course! This 'ripple down' of de-skilling is just part of numerous strategies GP practices are implementing to minimise operating cost, in order to drive up the annual profits / dividends for the 'Partner GPs' averaging well over £100,000. Essentially in the UK we are relying on private, profit-focussed ‘Law firm’ like, corporate organisations for our front-line healthcare services – It’s just the superb NHS propaganda machine that prevents the UK public from realising that a significant segment of the NHS has been fully privatised and purely profit focussed for many years.

It seems bizarre to have GP practices operating a 'Stealth, Law firm' profit model, even more so given the effective monopoly GP practices and it seems like a simple solution to genuinely 'nationalise' these profit driven partnerships and limited companies, making all GP doctors and associated practice staff NHS salaried employees. Most importantly it would remove the primary profit motive from GP practices, and replace it with patient care. It would allow many more GP doctors to be employed, whist still ensuring they are well paid rather than Partner GPs being obscenely well paid. This would drive a dramatic improvement in front-line heath care, because simply put, with the current model, the GP partners’ drive for profits can only happen by signing up as many patients as possible, and then ensuring that they minimise access to their front-line services for these patients. This stealthy minimising of front-line healthcare by GP practices has forced their ill patients in desperation to seek much needed medical support from anywhere they can, which results in the significant increase in workload at A&E, and also increased hospitalisation and social care loading. However, the GP lobby is very well funded and powerful so sadly I don’t expect this to change any time soon.

(2) The next element of the ‘perfect storm’ is what I can best describe as the ‘British Rail’ effect. I know we moan about current rail franchises, but if you can remember how things were when we had a single nationalised Rail service with a complete monopoly, the effect was trains that almost always never ran on time, or just never even showed up, and really bad food, really bad service, and we were just expected to be grateful for whatever service we received. There was no motivation to deliver a decent service. Unfortunately, with a few notable exceptions, my personal experience of the specialist / hospital services in the NHS is exactly like trying to catch an old British Rail train – the only difference is the worst risk we used to face on BR trains was travel inconvenience and reasonably frequent food poisoning from the terrible curled up sandwiches on trains. The problem with the NHS analogue, is that the service was so bad, I now know with certainty that they would have killed me (mis-prescribing, ignoring serious illnesses, etc.), and it’s likely that they are causing significant numbers of patients unnecessary suffering, and possibly death.

(3) The last issue is the strange contracting mechanism that permits our NHS consultants to be paid by the NHS what equates to very generous full-time salaries, but allows them to work part time and then take on private clients at very high rates, which is even more profitable that the NHS work. I had personal experience of an NHS consultant who I ended up having to consult privately, telling ne he had been signed off on (paid) long-term sick leave for several months from his NHS work, but saying that it was not a problem to continue seeing me as a private patient while he was ‘off sick’ and being paid his NHS consultant salary! Another example is when I did actually manage to have a diagnostic procedure completed at a London NHS hospital, after waiting 12 months. It was an Adrenal Vein Sampling procedure which was a little tricky, with successful application being dependant on experience. Unfortunately, the interventional radiographer was too busy doing emails, so he left the procedure to a trainee interventional radiographer, who subsequently messed up the procedure. However, it seemed the team in the operating theatre had forgotten that I was only under local anaesthetic, rather than knocked out with a general anaesthetic,, and I heard them all discussing that I was the second 1-hour procedure that they were doing that morning, and that they were literally told by the trainee radiographer at 11am that they had done enough work for the day and to go home, and if anyone asked to say that they had spent the rest of the day ‘tidying’ the operating theatre! The point here that it seems to me that the hospital in question, which is the country’s leading hospital for these investigations, could double or treble their throughput of these test procedures, thereby reducing the waiting list by half at least, with absolutely no increase in costs – they just need to stop what appeared to be an endemic culture of skiving. An obvious part of this would be not allowing consultants to work for the NHS and privately at the same time – it is hard to think of any other professions where this is permitted in fact.

I discovered another example of how effective the NHS propaganda engine is when a number of years ago, I was one of those over-priced consultants invited to look at the NHS National Blood Service. I was staggered to find out that they actually sold much of the blood products that they collected from UK donor volunteers to many other countries for very significant amounts of money - they explained that other countries were willing to pay a price premium for UK blood products because they perceived the NHS had a high quality source of completely unpaid volunteer blood donors in the UK. As far as I'm aware, this sale of freely donated blood is still a big revenue stream for the NHS, but I'm guessing that almost everyone in the UK is unaware that the NHS is making a lot of money from selling blood products from their donations.

In essence it seems we are suffering from a third-rate NHS service that will not improve just by throwing more money at it. From my limited experience it’s clear that there is a ‘perfect storm’ of the worst aspects of privatised profit focussed elements combining with the worst aspects of ‘old school’, protectionist internationalised industries in a monopoly situation and a superb NHS propaganda department, who have success developed the cult of ‘The NHS is the Best in the world’ and no one is ever allowed to challenge it. We need to be brave enough to ‘tell the emperor that he is not wearing any clothes.’. If we don’t, more and more people will suffer and die unnecessarily, and the collateral effect will eventually be a crippling cost to the UK economy.
After all, there is a reason why the UK already has one of the lowest life expectancies in the developed world, and despite what the NHS press office says about it being the fault of the citizens, we are not significantly different to any other country’s citizens. By way of example next time you hear a ‘bad news’ NHS story on the BBC, try counting how many days it takes for a ‘good news’ NHS story to be announced, typically with a single (understandably) very gratify patient or family saying how wonderful their experience was, carefully stage managed with lots of smiling nurses and consultants – It is purely an amazing PR engine – I cant help but admire that part of the NHS at least.

stephanie lowdon

Comment date
10 November 2019

Thank you so much for this article. Just out of interest I googled 'NHS not always perfect and wonderful' just to see if I could find anything other than the usual propaganda and after some difficulty by changing words here and there I found this. As someone who has over the years been at the hands of the NHS , both mental and physical services, I have zero faith in doctors now. I just don't trust anything they say any more. After having an accident which has left me chronically disabled and because of the refusal to do basic investigations when someone is in chronic pain, the only option in th complaints process, to get even an appt to see a specialist. Both specialists I saw in one area were rude and arrogant . THE continual BBC nonsense about all we have to do is throw more money at the problem just insults the intelligence of most people. Also the nonsense about every single member of staff is an angel. Some are good at their job and lovely to patients, some are not and have a nasty attitude. It's called human nature. As long as there is no honest discussion about how things can change, what needs to be done, better management, what can and cannot be treated on an NHS that was set up for less than half the amount of people it deals with now, then all we will get is a bottomless pit to throw more money into. The culture seems to be about 'keeping people alive' rather than healthy, so we end up with lots of very sick but breathing people, but that's okay coz they're breathing. If they are in pain just chuck more and more toxic painkillers at the problem. Don't bother finding out what might be causing the pain. I think doctors think that only idiot patients would not want to suffer from the added pains of withdrawal every time they want to come of these damaging drugs. The things that are beneficial for chronic pain like yoga, osteopathy, etc . are not available on NHS. Surely that should be addressed publicly. Why are poisons available on the NHS that only work short term, but long term effective treatments not suggested or provided? I have also seen comments by doctors online talking about patients who complain in very insulting terms like 'time wasting trash'. ONe claimed that because she is has been a doctor for a number of years, she couldn't possibly ever make a mistake. Perhaps she was a narcissist, really believing she is the angel from heaven (upaid of course)

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