There’s one fatal flaw in how this government sees the NHS

Every secretary of state for health and social care shares the same irresistible urge to reorganise the NHS. The current incumbent, Steve Barclay, has recently announced that he too will have a go.

The respected health economist Alan Maynard referred to these efforts as the “redisorganisation” of the NHS. One of his many criticisms was that none of these reorganisations were evaluated, so how could anyone judge whether they made things better or worse?

Barely a day goes by without another tragic story of a premature death attributed to a delay in an ambulance arriving or of an extended waiting time in A&E. These anecdotes are supported by the data, which reveals record waits for ambulances and days (rather than hours) spent in emergency departments waiting for treatment.

Added to this is the current dispute about pay, with more strikes planned over the coming weeks. Understandable as they are, the strikes will add to the substandard service that too many people have experienced when they need care.

Barclay has suggested that the government would consider a pay rise for nurses; but only if they work harder by being more efficient and embracing reform, suggesting that they are luddites unwilling to adopt new ways of working. Nothing could be further from the truth.

This must be one of the most demoralising messages ever delivered by a health secretary to staff who not only gave their all during the Covid pandemic, but have continued to do so despite record numbers of job vacancies and at a time of increasing demand for NHS services.

The health secretary’s view appears to be based on the erroneous idea that staff and the organisations they work for are against innovation. One of many examples of how enterprising staff are is to be found in Shropshire, where the fire service provides transport from hospital to home for patients being discharged. This frees up desperately needed hospital beds for those presenting via A&E.

The problem with the NHS is not an inflexible workforce stuck in its ways. It is years of underinvestment and shoddy management. The current Conservative government views the NHS as a business that can be reformed to become more efficient, in the same way that car manufacturers improve productivity on an assembly line. The obvious flaw in this ideology is that people don’t behave like components; they aren’t uniform and never will be.

Healthcare by its very nature has to be individually tailored and delivered if a person’s needs are to be met and their quality of life improved. There may be commonality among some patients in terms of their symptoms, but they will have varying degrees of support at home and resources that contribute to their recovery.

Even if we were to accept the approach of running the NHS like a business, no chief executive or their board would expect reform when facing record numbers of workforce vacancies and a lack of investment in core services. They would prioritise fixing those aspects before any effort to innovate.

At best it is a distraction, and at worst it is a calculated ploy by this government to suggest that all we need is a reformed NHS to solve all current woes, including long waits for ambulances and assessment in emergency departments. Since 2010, this government has decreased spending on the NHS and public health in real terms. They argue that they are spending record levels of taxpayer’s money on the NHS which is true, but that doesn’t equate to the funding the NHS currently needs.

No amount of reorganisation will solve the shortage in funding that the NHS faces. Acknowledging this and ensuring an adequate budget has to precede any attempt to reform this essential service. The NHS can improve and nurses and doctors aren’t standing in the way of this – the barrier is political not clinical. Unrealistic political expectations continue to be made despite the failure of previous political interventions, and the government appears either unwilling or unable to learn the lessons of past attempts to reform the health service.

There is a real danger of terminal decline in the NHS unless it receives the sustained funding it needs, rather than the intermittent crisis-led funding that this government continues to offer. But funding on its own can’t solve all the ills of the NHS. We need a government that accepts that healthcare is not a commercial enterprise, it is a service based on compassion and care that often can’t be measured but is felt acutely by patients when these values are absent.

We must hold onto to the original tenants of the NHS – that it should be free at the point of need and care is provided in a timely way. Both principles have been abandoned by this government. It is undoubtedly time for reform; not in healthcare but in political thinking.

Ian Hamilton is a senior lecturer in addiction and mental health at the University of York