The NHS in a Mess – WHY?

It is dominating the headlines – the winter crisis in the NHS. Long waits for ambulances, huge pressures on the Emergency Departments, people dying in hospital corridors, difficulties getting in to see a GP, Nurses and Paramedics going on strike, low staff morale, a growing sense of anger in the public. Why is this happening? What’s going on? Can we really blame this on Covid-19 and Flu?

 

It’s a lot more complex than that! Our NHS is complex living system, not a machine. You can’t just tinker with a part of it and hope everything will be fixed.

 

I think there are (at least) 15 significant reasons as to why the NHS feels like it is creaking at the seams. And they all need serious attention, if we’re going to get out of this mess, live our best lives and restore it to the best health and care system in the world. Here they are:

 

  1. We have not created health and wellbeing in and with our communities. We have to positively create health. When we don’t, we find ourselves responding to crises. The shocking quality of housing in our most disadvantaged communities is just one example. We need to partner with our communities through genuine participation to build this together.
  2. We have not prevented ill health. Huge cuts to public health budgets since 2010 have led to a demise in prevention services and we have not learned well enough from places like Wigan, where innovative, community-based solutions have been found, despite austerity.
  3. We have not improved population health and not tackled inequality and inequity in our society with any sense of urgency. Yet, this is now affecting all of us due to the overwhelm on our public services. Professor Sir Michael Marmot’s work has proven this again and again.
  4. We have not valued people who work in the health and care sector, especially those who are paid poorly, for the incredibly hard work they do. It’s no wonder they are striking or leaving altogether.
  5. We are living longer than we were when the NHS was incepted, (though life expectancy for women is falling in our least affluent communities) but we have not invested in social care.
  6. We have not built the right infrastructure, with significantly less hospital beds and less doctors per head of population than most other similar countries.
  7. We have not championed the vital role that GPs and Primary Care services play in caring for the health needs of our local communities. We have not developed integrated community teams to the extent that is needed. The Fuller Report will help to change this, if the necessary investments follow.
  8. We have not integrated health policy with other key areas of public policy. For example, greater strategic thinking between the departments of health and education would lead to far better mental health outcomes for our children and young people.
  9. We simply have not invested enough money in our health system, as exposed in a £40 billion gap compared to most EU countries, every year for the last 10 years – that is 20% less per person!
  10. We have not developed fair funding formulae, which worsens inequalities and worsens overall health outcomes. We’re simply not putting the resources into the places that need them most.
  11. We have not recruited enough doctors or nurses and have failed to develop appropriate workforce plans in time for the situation we now find ourselves in.
  12. We have not cared for the wellbeing of NHS and social care staff, leading to high levels of burnout and low morale.
  13. We have not utilised the advantages of sharing patient records across the NHS in safe and timely ways. As a result, there remains much wasted time and effort and poorly joined-up care.
  14. We have not stopped perverse behaviours in the NHS by continuing to allow payment by results, rather than encouraging true, integrated system working. ICBs need much more upfront permission to do this.
  15. We have not planned adequately for winter again! We could have predicted this mess months and even years ago….but action is too little, too late….and the cost to human lives, as we are witnessing, is too great. And yes – of course, Flu and Covid-19 are playing a significant part…..

 

It’s not that difficult. It just requires compassionate, strategic, visionary, joined-up, collaborative leadership! Thankfully, across many levels of the NHS and Local Government there is plenty of this. Simply turn the negatives around. In the end it’s a question of values and who and what we value.

 

 

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Apocalypse Now?

It’s a while since I last wrote a blog. That’s because I’ve been concentrating on finishing my first book and there are only so many hours in a day! It is called ‘Sick Society’ and will hopefully be out soon.

 

However, now that it’s done, I will hopefully have a bit more time for blogging again.

 

Last night, I awoke from a disturbing dream at around 0350h and wasn’t able to go back to sleep. I’ve had many troubling dreams of late – maybe I’m just processing. There have been plenty of tough situations to deal with at work recently, plus the backdrop of what feels like chaos. But I have learned over years to tune into my dreams, following the thread of them.

 

My dream last night consisted of two things: very rough, rising seas buffeting against the coast where I live and multitudes of people in refugee camps. I know exactly why I dreamt about them. Before bed last night, I listened, whilst my wife watched Episode 6 of Frozen Planet 2. A glaciologist, whom we both know, fairly well, was talking about his work. He is studying how the ice caps are melting at an alarming rate. I also read just before going to bed, an article about Greece and Turkey trading insults over the plight of 92 naked refugees, who had suffered utterly degrading treatment. My night was full of the angst of these two realities.

 

We find ourselves in an apocalyptic moment. An apocalypse is often thought to speak of the end of all things. Rather, in its truest sense, the word apocalypse simply means ‘to pull the lid off something’, or to reveal things for what they are. We live in a moment when perhaps more clearly than for a very long time, the facades which are held up to pretend that everything is ok, are well and truly down. Here in front of our naked eyes, we see the stark reality of the way things truly are.

 

Consider the following:

The rate of climate change is accelerating with devastating consequences.

There are now 89.1million people being displaced globally, including 27.1million refugees. All the while, we draw up the bridge and threaten those who flee their war-ridden nations with deportation to places where we will not have to see them.

Global financial uncertainty, with market volatility, rising inflation rates and stalling economic growth is leading to rising poverty. The gap is widening between the richest and poorest, globally, nationally and regionally. The cost of simply living is becoming unaffordable.

Huge food insecurity is driving millions of people globally into poverty, with staggering problems around hunger, rising starvation, famine and drought.

Over a million species are at risk of extinction, with terrible consequences to our loss of biodiversity.

The toxicity of nationalism and sovereignty is laid bare through senseless war and the breaking of unions.

And governments, banks and global financial institutions look to placate and reassure the markets with the same old answers to the same old questions as if they will lead to radically different answers.

 

Our world is sick. Our society is sick. The storms are raging. And millions upon millions of people are crammed into the valley of decision.

 

How do we heal? How do we respond in the face of such devastation, brutality and madness? There is no other way, but that of faith, hope and love.

 

Faith, stares fully into the outrageous abyss of what the apocalypse reveals and refuses to accept that it will always be this way. Faith knows the markets and its associated economic theories do not hold the answers. Rather, it enables us to challenge the inevitability of the status quo and see that the world can and must be made new. Faith trusts that God is with us in the midst of the multiple crises and is bending the arc of history towards goodness, despite what the evidence may tell us. Faith knows that simple small acts of radical kindness, when multiplied a billion times around the globe, can bring about life-giving change.

 

Hope helps us find a way together, even though it feels like we are too late or too far down the road to recover. Hope is not some kind of wishful thinking. It is, rather, as Rebecca Solnit reminds us, an axe we break down doors with, in an emergency. It is true that hope which is continually deferred makes our hearts sick. But hope that is coming is a tree of life and we must eat its fruit and allow it to infuse every cell in our beings. Now is not the time to lose hope.

 

Love, as bell hooks tells us is a verb! It is gutsy, determined and action orientated. Love refuses to stigmatise. Love dares to cross the dividing lines. Love welcomes the stranger and embraces the needy. Love is humble enough to change. Love embraces the ‘enemy’ and lays itself down for the ‘other’. Love always trusts, always hopes and always perseveres. In the midst of the storm, only when we lock eyes with Love can we find the creative force needed to overcome the odds and build health and wellbeing in our communities and our ecology. Love never fails.

 

Whatever else we do, we must not turn our eyes away in this apocalyptic moment. Let the full pain and horror of this moment fully reveal the monstrous truth of the staggering injustice we have built through abusive power. Then let us turn our faces into the winds of change and set our sights on the future which is coming towards us. Let us throw off everything which hinders us and let us walk together into the way of peace.

 

 

 

 

 

 

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An Open Letter to NHS Staff – This ‘crisis’ is not your fault – you’re doing a great job!

Tweet If you work in the NHS, in any capacity, this letter is for you, no matter what your role.   Dear NHS Staff Member,   I write this to you as a GP, who cares for many people who work in the NHS and sees the huge stress many of us feel under. I write [Continue Reading …]

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Solutions for the NHS Workforce Crisis

Tweet This week, the Kingsfund, one of the most respected think-tanks on health and social care in the UK declared that the current NHS staffing levels are becoming a ‘national emergency’.   The latest figures have been published by the regulator, NHS Improvement, for the April to June period.   They showed: ■   11.8% [Continue Reading …]

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Never Let a Good Crisis Go to Waste

Tweet So, the NHS is in another winter crisis. The Oxford English Dictionary defines a crisis  as: 1 A time of intense difficulty or danger. ‘the current economic crisis’ Mass noun ‘the monarchy was in crisis’ 1.1 A time when a difficult or important decision must be made. As modifier ‘the situation has reached crisis point’ [Continue Reading …]

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Social Movements and the Future of Healthcare

Tweet As the crisis in the Western World deepens, and the growing reality sets in that business as usual simply can no longer continue nor solve our problems, our systems must change the way they view, deal with and hold onto power. The NHS is no exception. If we want a health and social care [Continue Reading …]

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Turning To Each Other

Tweet Here are some excerpts from a speech I gave recently at Lancaster City Hall about how in a time of crisis, we can either turn on each other, or turn to each other (my friend Mike Love gave me that line!). When we turn to each other, unimagined possibilities become the fuel of hope [Continue Reading …]

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The Art of Hosting Good Conversations – Morecambe

Tweet Here is a video about a brilliant couple of days a bunch of us had in Morecambe, talking about how we discover what it is to be healthy and be part of a social movement to improve the health and wellbeing of everyone: Share This:

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We Need to Be Ambidextrous in Solving our Health and Social Care Conundrum

Tweet All this week on the BBC, there has been a focus on the NHS and the crisis we are in – don’t panic Mr Mainwaring…..There is a heady mix of opinions being thrown around – Question Time became quite a furore of ideas and thoughts last night – not enough beds, not enough staff, not [Continue Reading …]

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Wake Up to Our Health Crisis

Tweet It’s all over our news today – our health is in a real mess, and this is our wake-up call moment – we really do need to take it seriously. It’s all very well us protesting about the under-funding and under-recruitment in our NHS (and we are right to do so), but we can [Continue Reading …]

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