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Trying to be optimistic

Medicine Balls

Phil Hammond

Tuesday, 08 January 2019

AdobeStock_140779446_phblog.jpgAs a doctor, I try to be optimistic without offering false hope. It’s a delicate balance, but if we become too jaded and cynical, and extinguish hope altogether, then life becomes pretty pointless. With patients, I try to offer a path to a life they can still have reason to value, even if what they’re coping with in the present is cruel, unfair and exhausting. But when politicians try the same vision of a hopeful future on me, I struggle to believe them.

The Long-Term NHS Plan is the latest attempt to get us to put our cynicism to one side and embrace a digitally-led, DNA-driven preventative future based on below average funding increases in a health service that’s already been cut to the bone with eight years of austerity and has around 100,000 vacancies. And it doesn’t begin to address the problems in social care.

The disruptive search for the perfect plan or structure for the NHS is an everlasting project, driven more by ideology than evidence. In this century alone, we’ve had another long-term NHS plan (2000), a Health and Social Care Act (2001), the Bristol Inquiry Report (2001), Shifting the Balance of Power (2002), Delivering the NHS Plan (2002), an NHS Improvement Plan (2004), the Wanless Report (2004), Commissioning a Patient-Led NHS aka ‘Our health, our care, our say’ (2006), High quality care for all – Next Stage Review (2008), the Care Quality Commission (2009), Healthy lives, healthy people (2010), Equity & Excellence Liberating the NHS (2010), Commissioning Clusters (2011), the Dilnot Report (2011), another Health and Social Care Act (2012), the Mid Staffs Inquiry Report (2013), an NHS five-year forward view (2014) and Sustainability and Transformation Partnerships (2016). And we're still 100,000 staff short. Let's do another plan!

If I’m ever asked onto Minor Celebrity Mastermind, I’ll choose NHS Redisorganisations 1948-2019. I’ll bet I can send John Humphrys to sleep faster than when he’s doing an early morning Brexit interview. Just about every idea uttered by Simon Stevens, Theresa May and Matt Hancock in launching the new plan could have been cut and pasted from previous plans and inquiry recommendations. The only one I hadn’t come across is ‘every child with cancer will have a genome test so that their treatment will be tailored to what works best for them.’ I’m hoping this has a sound evidence base and isn’t just a sop to Tory friends in the tech industries.

I’ve met plenty of individual politicians over the years who I’ve really liked, and haven’t doubted their commitment to make people’s lives better. But collectively, they’re hopeless. Party politics is aggressively dysfunctional and tribal and, with the winner takes it all first past the post system, the temptation is to promise the world just to get elected or win a Brexit vote, and then pick up the pieces later. You could argue that the betrayal of public services since the 2015 election is far worse than any ‘betrayal of Brexit’. At least the Conservatives managed to deliver their manifesto promise of ‘a straight in-out referendum on our membership of the European Union.’ That same manifesto made a number of promises about health and social care that were ludicrously fanciful at the time, given we were half way through the toughest period of austerity public services have ever seen, and have since failed on a grand scale. The Tories promised, in no particular order: ‘We will offer you the safest and most compassionate care in the world… We will improve standards in all areas of care… We will ensure you receive the best healthcare… We will ensure that people can grow old in comfort and dignity… We will guarantee that you will not have to sell your home to fund your residential social care… We will provide seven-day a week access to your GP and deliver a truly seven-day NHS, so you know you will always have access to a free and high-quality health service when you need it most…’ These promises were as nonsensical as anything the Brexiteers conjured up a year later, the same reckless use of power to gain yet more power.

Brexit has at least allowed our politics, and politicians, to be scrutinised as never before and will hopefully lead to a more honest, realistic future where parties collaborate more and offer informed consent for their proposals – clearly outlining the potential risks and benefits of any policy, with evidence referenced, and with areas of uncertainty and cost or tax implications made clear. It took doctors a long time to work well in teams and tell patients the truth. When I qualified in 1987, many patients weren’t told their diagnosis, their prognosis or whether they would be resuscitated. The truth is tough (we are all going to die) but medicine can only improve as we get better at collaborating and sharing the truth. So it must be with politics. The NHS is not going to be the safest and most compassionate health service in the world any time soon, no matter how many plans we have. It is an average service with average funding that does some brilliant things thanks to brilliant staff but has gaping holes in its founding vision of universal care based on need. Working in it is both tough and worthy – there’s plenty to value, and plenty of jobs with meaning and purpose – but in a society hooked on minimal taxation and riven with anger and social deprivation, demand is just going to keep going up and up. Keep Skyping! And Happy New Year.

Phil Hammond is a hospital doctor, journalist, author, broadcaster and comedian. www.drphilhammond.com, @drphilhammond

Author's Image

Phil Hammond

Phil Hammond is an NHS doctor, journalist, author, broadcaster, speaker and comedian. He qualified in 1987 and worked part time in general practice for over 20 years. For the past seven years he has worked in a specialist NHS team for young people with chronic fatigue. He presented five series of Trust Me, I’m a Doctor on BBC2, encouraging patients to be more involved, assertive and questioning. Phil is Private Eye’s medical correspondent; in 2012, he was shortlisted with Andrew Bousfield for the Martha Gellhorn Prize for Journalism for ‘Shoot the Messenger’, an investigation into the shocking treatment of NHS whistleblowers. In 2013 and 2014, he was judged to be one of the top 100 clinical leaders in the NHS by the Health Service Journal. As a comedian, Phil was half of the award-winning double-act Struck Off and Die, with Tony Gardner. He has done five solo UK tours, appeared on several TV shows, and has written five books.
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