Words are how we change the world. There’s no going back from, ‘I now pronounce you man and wife’, or ‘We have entered the war.’ One reason the NHS has endured so long in our hearts and minds is because of the oratory of its founder, Nye Bevan: ‘Illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalised, but a misfortune, the cost of which should be shared by the community.’
This idea of not penalising the sick for being sick, and of pooling risk and resources to help those who need it most, is still fundamental to the NHS, but I sense support for it has slipped a little as the language has changed from passionate rhetoric to incomprehensible management ‘wonk’. ‘Wonk’ was the word I (carefully) chose to describe Andrew Lansley’s Health and Social Care Bill, when I debated its likely effects on the NHS with him on BBC One’s Question Time, in October 2011.1 Even he agreed that the Bill was unreadable; yet we were asked to trust that it would sweep away red tape and bureaucracy, and deliver power and resources to the front line. Lansley—in a borrowed sound-bite—promised patients ‘no decision about me, without me.’ I doubted all of his claims. Thirty months later, you can decide who was right.
The writing has been on the wall for the NHS in England ever since the purchaser/provider split opened the door to ‘marketisation’, over 25 years ago. The language changed, too. Of all the examples of ‘wonk’ I’ve collected over the years, my favourite was a 2004 advertisement: ‘Applications are invited to become a Blue Sky Practitioner reporting to the Blue Sky Lead in the New Modernization Agency. The workstreams will work to a generic cycle based on a hypothesis-driven, creative problem-solving process to create improvement products. … You will undertake horizon scanning and futures research … creating curve leverage systems for rapid diffusion … helping customers articulate and understand mess.’
Or how about this from a friend of mine who resigned as clinical director of a mental health service, when he was told that the ‘core purpose of your role is to drive the business development strategy, in line with the business proposition, scanning the mental health environment for new opportunities and identifying and stimulating new business solutions that fit with the corporate vision’? He said, rather wearily, ‘All I want to do is help the mentally ill.’
For the NHS to survive, it desperately needs clinicians to step up to the plate and lead. To do this, we must rediscover the language of compassion and never lose sight of our patients. When I qualified, we sometimes wouldn’t tell patients if they had cancer, for fear of upsetting them. Now, we have league tables of cancer outcomes. The problems of the NHS are shared with every other Western health service but we are on track to becoming the most open and transparent health service in the world. However, there’s a delicate balance to be had between trust and truth. Patients now realise that half of all doctors and hospitals will be below average in any one year, and we need wise and compassionate communicators, who are trusted by the public, to make sense of it all.
Politicians have long since burnt their boats when it comes to public trust, and despite Lansley’s promise to cut bureaucracy, the vice-like grip from the centre of the NHS feels as tight as ever. How ridiculous of the NHS to decide to pass on patient data to third parties, without patients being able to see their own data first! There’s a danger for NHS staff that the little drops of cynicism, forged from broken promises that fall on our shoulders every day, are turning into a huge, impenetrable crust. We hide behind it and obsess about when to take the pension, before that dwindles further. It’s time to break through the crust, speak up, and rediscover Bevan’s vision before it’s too late. Good luck!1
- BBC website. BBC One: Question Time. GP tells Andrew Lansley NHS reforms are ‘wonk’. news.bbc.co.uk/1/hi/programmes/question_time/9615324.stm (accessed 12 February 2014). G