Perspectives from a ‘broken’ system: why language matters

The Prime Minister and Health Secretary have sparked debate by repeatedly stating that the NHS is broken. One poll by YouGov found that nearly two thirds of the public agree with this description, but what do NHS staff think? We have explored the views of staff that we work with as well as those who have spoken publicly on the issue to consider what impact this language might have on the system and its workers. 

Take Malcolm. He had been experiencing dizzy spells for four weeks. After calling 111, he was referred to an out-of-hours GP service. This is where he met Sam, a GP registrar. When asked why he hadn’t seen his regular GP, Malcolm’s response was resigned: “Regular GP? I don’t have a regular GP, and I couldn’t see them even if I did. You know, the NHS being what it is.” While the potential causes of Malcolm’s dizziness were varied, his diagnosis of the NHS was clear. By bypassing his GP, the conventional first contact point for his chronic issue, and turning to 111, Malcolm’s actions underscored a belief he shares with the government: the NHS is broken. 

For those staff who agreed that the NHS is broken though, this rhetoric validated their negative experiences of pressures and resource shortages.

Although the majority of the public appear to agree, many don’t. Speaking to our colleagues within the NHS, staff opinion is also varied. Some find the description unfair, while others had concerns about its effect on staff and public trust. Is it justified to refer to the whole system as broken? There is still fantastic work being done across the NHS, from using artificial intelligence to improve coronary artery disease to tackling health inequalities through prehabilitation initiatives. It can feel like a blow to hear the hours spent working to improve outcomes described in terms of failure. For those staff who agreed that the NHS is broken though, this rhetoric validated their negative experiences of pressures and resource shortages. For them, the description resonated, though without subsequent action, fatigue and a lack of trust follow.  

Language matters. A test case for the impact of messaging is primary care, specifically GP appointments. Recently, the difficulty of securing a GP appointment became a cultural touchpoint when a Strictly Come Dancing contestant made a quip about how hard it is to see a GP – a sentiment that has lingered since the pandemic, and with consequences that are evident daily. When considering a career as a GP, trainees may be explicitly warned about the negative opinion of primary care. Frontline staff, particularly administrative personnel, often bear the brunt of public frustration made worse by media and political rhetoric.  

Language has power, shaping both the public’s perception and the internal dynamics of an already strained system. The experience of primary care reflects this. Current messaging could impact staff wellbeing, innovation and trust in the system.  

• Though opinions may vary, some report that working in an environment consistently described as broken can take a mental toll, especially in the context of already strained working conditions. Furthermore, in 2023, 25% of NHS employees reported harassment or abuse from the public. Will persistently labelling the NHS as broken make ongoing mistreatment more acceptable? When a thing is seen as broken, it may be more prone to mistreatment. Anecdotally, abuse of staff in primary care has increased with worsening public perception.  

• Innovation – a critical component for NHS reform – relies on motivated and empowered staff. The Darzi report recognised this, and case studies showcased by The King’s Fund consistently demonstrate that staff need strong intrinsic motivation to facilitate change. But how does describing the system as broken affect this motivation? Demoralising staff in a system already battered by long waiting lists, funding cuts and overcrowding could stifle the innovation needed to transform. With the government’s bold ambition for reform, negative rhetoric may demotivate crucial changemakers. 

• Trust is also at stake. Patient trust in health care providers is closely tied to positive health outcomes, and when the public is told the system is broken it could erode this critical relationship. Describing the NHS as broken could also impact the trust staff have in the government’s ability to steer future strategy, affecting engagement. If a system has been allowed to break, how can staff trust it won’t happen again? 

Whether you agree that the NHS is truly ‘broken’ or not, this statement has sparked necessary discussions about the real state of our health service. Although Wes Streeting, the Health Secretary, has stated he ‘won’t back down’ from such messaging, there does appear to be some temperance emerging, with the addition of the phrase ‘but not beaten’. In any case this sets the stage for potentially radical reform, with phrases like ‘reform or die’ reflecting the government’s view. Given the impact of the government’s rhetoric, they have certainly turned up the pressure to deliver real reform. They must ensure that they continue to bring both staff and the public with them.