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.



Self employed,
Comment date
17 December 2019

There’s so much wrong with the nhs that it would need a complete overhaul to be any sort of use for any one again..its not just about all the things we know we can fix or change it’s about all the things we don’t know about that need to change as well.the people up top in no 10 know exactly what’s happening and controlling it.its like a controlled disaster that is on the edge of a knife.what sort of person with the power to make change and prioritise a place for treatment would’t?things like your high care babies unit ,cancer diagnosis/treatment ,death,child birth,ICU to name just a small few.how for a start has it been let to get like it have.and still slipping.how have it not been a priority.a government of action but only when they decide. it only takes some one willing and some one who cares to make a change for people to feel like they understand and they are trying so let’s hang on in there change takes time.but that’s not the case in any way what so ever.or it wouldn't be like it is .don't fix it until it’s broke rather then don’t let it break in the first place would be better. why is no one held accountable if you neglected a child you would face consequences for example.if you neglected your job you would be reprimanded.the point I’m trying to make is the government are quick to serve against you when you do wrong, they send people into our lives to control every thing from health visitors to police to make sure we do our moral duties but they neglect people in the worse way possible with our health.they have had many conversations over our nhs behind closed doors it’s better to build a statement piece of architecture for them selfs to prove to the world our government are great but if a person prioritised a new phone to buy over taking a child to A&E in a life threatening emergency for example we would be morally wrong and held accountable.people to them are like a pest and only the strong will survive which I hope is not true but how I feel .i know this all sounds strong minded and far fetched but just think for a moment imagine you was in power with all you seen an know and all the people ether dying needlessly or mistakes resulting in infant death and you had the ability to be a hero and make a change to do the morally right thing which ever way you could ,would you or not.the list goes on poorly trained staff that speak to you how ever they damp well please whilst you dare to ask how long will it be ?weather it’s holding a broken arm or cradling a sick baby with flue or what ever else it is .life is precious and we seem to be indispensable.people have power n they’re own hands down drink don’t smoke and eat healthy and educate your self mentally ,physically and about what’s truly healthy not just what your told to eat by a system so out dated use your instinct and help others when and where you can.not had hardly any good experiences I’m afraid to grow old in a system like this.it won’t change until people make it clear and others are made accountable for wrong doings not with many or apologies but with some thing that shows they care by fixing it.and taking care of our self.knowledge is power

Susan Donnelly

Unemployed due to Covid event,
Comment date
03 April 2020

Reading these comments has shocked me to the core, I though that due to the complete lack of negative press against the NHS that my feelings were unreasonable and misplaced: However I see that the truth is being hidden under a mountain of misinformation and sugar coted sentiment.
My own experiences are particularly negative and because I am waiting for surgery I am afraid to comment really because of what may occur as a result. I have been waiting now for over 6 years for a decision to be made, I have been transfered from 4 different hospitals over that time, each time I have had an appointment I was asked to give feedback via a telephone text link, these have reflected my experience and I gave a low score. The messages suddenly stopped coming after appoinatments, but I did complete a written paper complaint for which I have never ever received any feedback other than to be transferred to another hospital much further away from the ones that I ahd previously attended.
I read the articles after the comments section and noted that they all seemed to reflect that the general concensus was that customer/patient satisfaction had now increased to an all time high, but I sincerely beleive that the hospital trusts have simply disregarded any negative ones and only included the positives. It would be interesting to see the numbers rather than percentages, also could ait be that patients are to afraid to speak openly for fear of reprisals?
I have been going to the same GP practice for over 35 years and I do not have a bad word to say about anyone within that service which is outstanding, it is only when I reach the consultation stage that I experience total ineptitude, it is like hitting an insurmountable object and I am pushed right back to stage one. This has affected me phusically and psychologicaly but reading the information on this site has made me feel that my misgivings about the NHS are not based on irrational emotions but are quite tangible. Thank you so much.

louise white

written off,
Comment date
23 May 2020

Nothing said here shocks me at all. My experiences of the NHS have affected me so badly, as a patient I fear for my safety. They've taken my freedom.


Comment date
15 February 2021

Hi Laura,

Nice article. I think you’re dead right that affection blinds us, but I don’t think it’s affection for the NHS per se that is the problem. Rather, it is the acceptance of the moral code of altruism that blinds us. Socialised healthcare (& religiosity towards it) is merely a natural consequence of an altruistic moral code (& by altruistic I don’t mean benevolence, I mean the sacrifice of human values as articulated by Auguste Comte).

Throughout the history of mankind, all socialist institutions have ultimately failed for reasons well understood. It should come as no surprise to see the socialist components of our mixed economy fail as well. Unfortunately, I don’t think enough people can overcome their emotional attachment to altruism to even begin a discussion about the virtue of privatisation, let alone the practical benefits of free market competition, innovation & specialisation in healthcare.

In a true free market for healthcare, there would actually be incentives to create better products for less & prices would actually fall.

‘Why isn’t existing private healthcare cheaper?’ some might ask. Because competing against subsidised industries for the same market is economic suicide; why expect people to pay for something twice they have already been coerced into paying for once already? In the current climate, there is no incentive for private healthcare centres to even come into being. Ultimately it is the government monopoly of healthcare that keeps prices high & quality low.

‘What about those that cannot afford it?’ Personally I think forcing people to pay for their own ‘noble causes’ via government is hypocritical & immoral. On the other hand, voluntary charity is a much healthier foundation for a benevolent society.

In summary, I suspect that deep down the aversion to privatisation is not on practical grounds (everyone knows that free markets create the best & cheapest products and they would in healthcare too), but rather on moral grounds. However, until we actually challenge the morality of altruism, we cannot expect anything close to world class healthcare.

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