George Orwell created the concept of doublethink in 1984 to describe a state of brainwashing so profound that it is possible to believe two mutually contradictory opinions at the same time.
We have reached this point with the NHS.
Ask people whether the NHS needs more money, and the answer will be as quick as a tendon reflex: yes, our NHS is on its knees, it is at crisis point.
Ask the same people whether we should restructure the NHS, or bring in business, the answer will be just as quick: no, our NHS is the best health service in the world and doesn’t need altering.
Two irreconcilably contrary positions. Doublethink.
The government’s own statements twist history to the point of breaking, as they try to persuade us that the NHS is better prepared than ever for winter.
The health secretary and the Prime Minister have both toured the television studios in recent weeks to claim on the one hand that we’re fabulously resourced and prepared, but at the same time apologising for being so under-resourced and under-prepared that we’re cancelling a month’s worth of elective surgery. Doublethink.
With no extra money, the NHS dealt with 10 per cent more hospital attendances in 2017 than in 2016. In any business, this would be considered a cost-neutral increase in productivity. In the NHS, this is taken for granted.
Partisan statistics make this worse.
It is wonderful to know how many “extra” nurses are employed in the health service, though it’s a bit of a disappointment to find out that this is gross, rather than net, when you bear in mind that people retire or quit.
Governments come and go in a shorter time frame than it takes to train a doctor, rendering most statistics of what a government has done to staffing hospitals fairly irrelevant.
The sad fact is that the NHS is far too big and unwieldy to be run by a government department. And it is too precious to be buffeted around by the whims of whichever government happens to be in power. Foetal hearts and schizophrenia do not pay heed to government philosophy.
We need a debate and a plan: a plan that sets out the next thirty years of health policy, not the next five.
I offer no answers, only questions. As a paediatrician, my experiences are limited and different from my colleagues in other fields. But a grown-up debate needs to answer the following questions.
First, how do we get people home on the day they are medically fit to leave hospital? Patients can only come into hospital if other patients can leave expediently. Better funding for social care? More “cottage” hospitals? Private rehabilitation hotels with a social responsibility?
Second, what does “free at the point of need” mean? The NHS already has exceptions to what is offered for free. Should we be renationalising dentistry? Should we offer basic false legs, but ask patients to pay a supplement for more advanced ones, like we do with fillings? Let’s stop saying that healthcare is completely free except when it isn’t, and work from there.
Third, how responsible are people for their own health?
The call to fine drunks in A&E needs to be opposed robustly. What do we do to the woman who was mugged because she was drunk? Or the man who suffered a small brain haemorrhage in the pub and is behaving drunk but isn’t? The old woman who breaks her hip falling down the stairs but has had a sherry?
I’ve seen all of these cases. They’re not debating points. Blaming the patients for the service that looks after them is backwards thinking.
Fourth, what is private business involvement and how does it provide continuity of care?
America has the most ridiculous healthcare system in the entire world. Why can’t we have a debate about funding that discusses Japan, the Netherlands, Korea, Germany, and New Zealand? Can we learn anything from them?
Fifth, is it possible to improve mental health services without impacting financially on acute medical and surgical services? How can we integrate them?
Sixth, how “national” should a National Health Service be? Should a hospital in Leicester have access to the blood results and notes of a patient in London? How do we facilitate data-sharing? How much money can be spent on a national IT system, and how safe would it be?
Seventh, what is the role of a GP? Should patients be able to go straight to a specialist for some problems? Should paediatricians, obstetricians and psychiatrists be in GP practices? Does having a named doctor matter to people?
And finally, what is expected of our healthcare practitioners? What should the shape of our training be? How general and how specialised are we expected to be? Should paediatricians be pulled into adult A&E when they haven’t treated a smoking-related illnesses, heart attacks, or osteoporosis for 10 years?
What is safety? How can we ask people to be quicker without cutting corners?
These eight topics are at the foundation of our health service’s future. Nothing should be off limits for discussion. No philosophising. No pontificating. No eulogising. And no doublethink.