Comment Writer Thomas Barry argues that thinking about the NHS in a new way might help it survive in the 21st century

Written by Thomas Barry
History student at the University of Birmingham
Images by Mat Napo

The NHS backlog is perhaps one of the most definitive products of misconception in modern British history. 

Often perceived as a collection of harrowing statistics such as the seven million patients on waiting-lists or the sixteen thousand patients in critical condition waiting more than twelve hours for treatment every day, the backlog is thought of as an inherently numerical problem. Many of us understand it to be the product of too many patients and too few medical professionals, too little funding and not enough of it actually being properly used for investment. 

Whilst this observation and approach is not inherently wrong, the nature of and solution to the NHS backlog is considerably more nuanced. Having worked for the NHS over the summer, I have gathered some insights that may prove beneficial in how we can better perceive the backlog and what can be done to fix it. But in order to properly do this, it is first necessary to explain the real nature of the NHS.

The nature of and solution to the NHS backlog is considerably more nuanced

Ever since it came about in 1946, the NHS was centred upon being ‘a comprehensive health service designed to secure improvement in…physical and mental health…[and] the prevention, diagnosis and treatment of illness’. It was a large project, nationalising almost all medical institutions and providing a range of services free upon arrival through taxes such as home nursing, home help services (such as midwifery), and specialist hospital care. Since its inception, though, the NHS has expanded in scope and services, becoming increasingly interwoven with the welfare state, and has thus come to the point of crisis we see today.

The 2006 NHS Act attempted to make a considerable and meaningful step forward in managing the health service’s expanded role, but such amendments have not really worked. Despite the Act establishing an extensive hierarchy of management through the creation of new regional management bodies such as Strategic Health Authorities and NHS Trusts, the backlog has only become worse.

The reason for this is not down to government incompetence per se. Rather, it is because the NHS has now become so incredibly broad in its scope, function, and complimentary use with the welfare state that the original conception of the NHS as a ‘comprehensive health service…[that improves] the health of [people]…and [prevents, diagnoses, and treats] illness’, no longer works sufficiently, becoming more of a vague moral imperative than anything else. This moral imperative, far from being a pragmatic guiding principle in any way, has paralysed the efficacy of the changes made by the 2006 Act and diluted the boldest of government interventions into long-term inconsequence.

The original conception of the NHS […] no longer works sufficiently

For the backlog to ever be properly solved, how the NHS is conceived must be redrawn in consideration of its modern day usage. From my own time working for the NHS, I have come to formulate a new conception that I believe is worth, at the very least, ruminating over. It has two parts. Firstly, it is necessary to add a clause to the original phrasing: changing it from ‘a comprehensive health service’ to a ‘comprehensive and comprehensible health service’. Secondly, it is important to make a rational comprehension of the NHS from this added clause, for me, this is perceiving the health service as a living, breathing human being.

To get what I mean, one must visualise human anatomy: there is a skeleton; a collection of muscles, ligaments, and tendons; as well as a variety of organs. For a human body to be operational it needs adequate blood supply as well as a substantial caloric intake coupled with a variety of nutrients. Every one of these are attributable to the functioning of any NHS institution – whether that be hospital, surgical hub, diagnostic centre, or GP surgery. Consider the everyday functions of the skeleton, muscles, organs, and blood: the skeleton provides structure to the body and houses the internal organs, the muscles enable movement, the organs give the body a purpose, and blood keeps the organs alive. All four are entirely related, and can be confidently applied to the proper, long-term operation and maintenance of any NHS institution.

The skeleton actualises through the building itself, needing to be the right size to accommodate patients, as well being structurally well-maintained. The muscles realise through points of accessibility (such as ramps, lifts, stairs, and automatic doors), means of traversing the hospital (like porters and wheelchair), and ambulance stations for emergency and category 2 calls (reflective of fast-twitch and slow-twitch muscle fibres respectively). Organs reflect the patients themselves who transform a large building with fancy technology and well-polished floors into an institution of treatment. Blood takes the form of medical professionals – nurses, doctors, clinical educators, consultants, registrars, GPs – who are fundamental in keeping the organs alive. But of course, whilst these four ensure a body is operational, they do not guarantee that a human being is in fact ‘healthy’.

For someone to be healthy they also require a steady and adequate flow of calories coupled with a hearty variety of macronutrients. Calories are the equivalent to government funding, which like a calorie, can take multiple forms whether that is the wages of the medical professionals or investment into medical equipment. Macronutrients are relatable to forms of treatment (such as chemotherapy), surgical tools, medical instruments, medical imagery technology (such as MRI machines or X-Rays), biochemistry and medicinal research. Micronutrients take the shape of administrative staff, computerised equipment (such as the NHS Spine or EPR), housekeepers, cleaners, and delivery drivers. 

Should government intervention be predicated upon this kind of parameter, I firmly believe that not only will the backlog dissipate but all the problems plaguing the NHS at present, and in the future, will go along with them. By conceptualising the NHS as a human being, interventions made by government can be more effectively localised and have a considerably greater long-term impact, than being overgeneralised and somewhat negligible. Moreover, by actually making the NHS a comprehensible entity like a human body, underlying faults that would be otherwise missed can be swiftly diagnosed and treated. But this structure does not need to be isolated to Westminster, it can be readily applied across the whole UK, with each Trust and Special Health Authorities given the responsibility and powers of ensuring their ‘region’ reflects a healthy human being with healthy bones, well-trained muscles, adequate blood supply, healthy caloric intake, and a good variety of nutrients (that are both macro and micro in nature). 

Ultimately, then, if the NHS backlog is to ever be solved how the NHS is understood by the state must first modernise. The sheer scope that the NHS has come to take on means that it is not enough for governments to predicate their intervention upon a moral imperative, it is fundamental they orientate it upon a pragmatic and comprehensible parameter. My suggestion for this parameter is focused on ensuring the NHS becomes, metaphorically-speaking, a healthy human being. 

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