Dr John Havard: The relationship between the British public and the NHS needs patching up

John Havard

John Havard - Credit: Archant

The words NHS and crisis seem to be in a long term relationship. Since 1948 the NHS has tackled injustice and poverty while ensuring care was delivered according to need, not ability to pay.

These values were wedded to the core principles of the NHS but as the relationship has become more difficult I wonder how much is attributable to ‘unreasonable behaviour’ and how much is down to ‘reasonable expectation’ of the maturing users. If users need more for medical reasons, the country has to increase the funding. If users simply want more then we have to cut the cloth accordingly.

Let’s look at needs and wants.


Needs of patients must be assessed objectively and we have to be careful how the edges are blurred. Over the years patients used to come into hospital for a procedure and be discharged to their families. Despite the fact that standard length of stays are much shorter now, people seem to expect the patient to be completely independent before they come home or that the state should provide a care package. Communities have become more selfish (with some exceptions). This may be because people are busier with work and children’s activities. To social workers trying to organise a discharge from hospital, it feels like relative ‘desertion’, which is also grounds for divorce! This is not the same in other countries where the elderly seem to be revered. It is however undeniable that there are changes beyond our control that impact on NHS budgets:

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n Ageing population. Many live alone and can’t cope in a crisis.

n Epidemic of long-term conditions which is testament to how good the NHS has been. These patients are living and hungry consumers of healthcare.

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n The best care immediately available, but no more taxes.

n No responsibility for self care or leading healthier lifestyles. There are definite lifestyle risk conditions but this is often felt to be an NHS problem and not a patient problem.

n Increase in public expectation. Consumers do not think twice before phoning the GP, 111 or 999 and the self management of illness and first aid seem unthinkable. If we dial 999 we want an ambulance there in 8 minutes, even though everybody seems to be dialling now.

System change?

There is reasoning behind the proposal for combining health and social care budgets. If councils have to cope with cuts how can they be expected to provide more carers to enable hospital discharges to occur promptly? In the same way if A&E is congested then ambulances cannot hand over patients and have to queue up outside the hospital. They then fail to reach targets so get fined and have less capacity to put crews on the frontline. They can earn more taking a patient to hospital than trying to manage them at home. The incentives seem perverse.

Torbay have had combined budgets for many years and have provided a better all round service for their residents,who tend to be elderly. They have also cut those staff throughout health and social care who solely check that bills and fees are charged correctly within the internal market and moved them to positions on the frontline.

Consumer change?

The NHS needs to get back to providing joined-up, patient-centred care not focused on supporting particular institutions. The wider public need to nurture the NHS through a difficult time. Drunkenness, drug use and verbal abuse are grounds for divorce. We should care more and patch up the marriage between the NHS and the British public.

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