This comes from a very recent article by James Meek posted to the London Review of Books. I recommend that all those interested in the NHS read the full piece:
In the year of its seventieth anniversary, the 1.3 million people who work for the National Health Service in England find themselves in a surreal situation. They're effectively working within two realities at once, expected simultaneously to inhabit an NHS universe where a radical, highly optimistic reform programme is under way, and a second universe in which the organisation is unmistakeably close to breakdown.
In universe one, the NHS will be upturned to give most of the healthcare people need at home or on their doorstep and admit to the big hospitals only patients with major trauma, or suffering diseases that demand intensive care, or complex surgical or biochemical expertise. Big hospitals are to become centres of research, high technology, rare skills and dramatic, life-saving interventions. Everything else will be diffused to the community. Loosely directed by the head of NHS England, Simon Stevens, money, staff and new investment are being directed towards primary care — family doctors, community nurses, souped-up local clinics, systems to help the chronically unwell live at home.
In universe two a counter-reality prevails: the reality of winter, the reality of need, the reality of an ever increasing number of frail, elderly people converging on the help of last resort, the emergency hospital. This winter, as last winter, the system of emergency medical care in England came to the brink of collapse, with untold knock-on effects for the health system as a whole. There is evidence that in at least one part of the country, the east of England, the emergency system just plain broke.
Politicians may claim otherwise: I believe this narrative and think it well worth sharing.
Hat tip: Andy Crow
Thanks for reading this post.
You can share this post on social media of your choice by clicking these icons:
You can subscribe to this blog's daily email here.
And if you would like to support this blog you can, here:
I am expected to promote and beleive universe one.
I work, and live, in universe two.
Universe one is a beleif system held at the highest levels of the organisation whose inherent structure prevents the reality from being visible through the murky layers of over-re-organised hierarchies.
From above it may seem to be near to perfection. From down here where I have worked for 2 decades, despite sometimes superhuman effort from its workers, it appears to be in the process of slow catastrophic failure.
No one actually lives in universe one
An excellent article by James Meek. It certainly chimes with my personal experience working on the clinical front-line. And James’ observations underline how difficult it is for the non-specialist observer of the NHS to understand what is really going on. There seems to be a crazy, headlong rush of changes, some big, some small, some significantly negative, some maybe not so bad, all super-charged by deliberate underfunding, justified by the deliberate lack of resources.
The NHS is undoubtedly in crisis. It is lead by people, NHS managers and politicians who, supported by pundits of suspect provenance, assure us they have the best interest of the NHS and its patients – us – at heart. That they are managing in difficult circumstances to make changes that will be for the best in the long run. Yet ‘sustainability’ sounds like a weasel word coming out of their mouths. We are left with a feeling that something is badly wrong with the big picture, the plan. As the wheels continue to come off, we can’t quite relax and trust them. We suspect that maybe – just maybe – these people and their plans are not the solution to the problem. They are the problem.
I agree
I said so at the RSM last summer
His book “Private Island…” dealing with the privatisation of everything that wasn’t actually nailed down is a salutary read, especially the section on social housing.
The bulk of the politicians at Westminster are guilty of negligence because despite the work of Keynes and Post-Keynesian economists plus the years of harmful austerity cuts under Blue and Red Tory governments they still haven’t made the effort to determine what constitutes a complete and rational monetary system model for the UK. Democracy, the economy and society in the UK is collapsing because of this wilful and gross negligence. The voters themselves are unlikely to vote for responsible politicians because they too are monetary system illiterate.