At the children’s playpark near my Buckinghamshire home, wildflowers were planted during the pandemic. When they erupted into colour, they spelt out ‘NHS’ inside a heart.
That beautiful floral display summed up the way Britain felt about its health service just four years ago. But in a twist that feels equally symbolic, the flowerbed was dug over this spring and the tribute has gone.
Public trust in the NHS, already badly eroded by reckless strikes by junior doctors, nurses, paramedics and consultants, was dealt another blow this week by Sir Brian Langstaff’s excoriating report into the infected blood scandal.
I listened to the news reports of a 40-year catalogue of lies, evasion and incompetence by politicians and the medical and scientific establishment that led to 3,000 deaths and the ruin of 30,000-plus lives with a mixture of anger and despair.
After 50 years as a doctor — both in the NHS and private sectors — I have a clear idea of what’s needed: we must restore the best parts of the service
Anger at the medics who behaved with such callous disregard for the welfare of their patients, and despair because I know, deep down, that the NHS is irretrievably broken but no political leader has the guts or initiative to repair it.
Just as we submitted to the unthinkable during lockdown and gave up our basic freedoms, we are becoming resigned to record waiting lists, bloated bureaucracy and failing hospitals. Across much of the country, a three-week wait for a GP appointment is the norm, and in some areas, including my own, it’s often double that.
Many surgeries will not accept bookings in person but expect patients to call at 8am on the dot, to be entered into a kind of telephone lottery. No wonder private GP services, which offer appointments on demand for £100 a pop, are booming.
The official target for starting cancer treatment — my speciality — is 62 days, a built-in wait that is far too long. And even this target is routinely missed, despite evidence that survival chances in all sorts of cancer fall by about ten per cent for every month’s delay.
The situation in A&E departments nationwide is horrific. Crisis management is now the order of the day — every day: new arrivals are often waiting all day and night to be seen and such is the bed shortage that even seriously ill patients are left on trolleys in corridors or forced to lie on the floor.
Reform is desperately needed. We can’t go on like this.
Professor Karol Sikora is a consultant oncologist in London and a former director of the WHO Cancer Programme
As long as Britain continues to treat the NHS as a substitute religion, the prospect of improving it is remote. But surely the time is now: the mood is shifting and politicians must seize this opportunity to implement radical changes.
After 50 years as a doctor — both in the NHS and private sectors — I have a clear idea of what’s needed: we must restore the best parts of the service that we’ve lost while also embracing the future. This boils down to a six-point plan.
First and most crucially, we all have to admit that the problems are deep-rooted, not superficial. They exist at all levels, not only within management but across the Department of Health and on both sides of the Commons, where politicians are too timid to tackle the crisis and rise to the challenge of creating an NHS for the 21st century.
We are past the stage where the NHS can be fixed with cosmetic tweaks and minor upgrades. Yet politicians talk as though repairing the health service is simply a matter of application and attitude.
Just this week Rishi Sunak was trumpeting advances in artificial intelligence (AI) and claiming that AI cancer detection would revolutionise treatment of the disease.
But the reality is that computerised diagnosis has played an increasing role in oncology for a decade, during which time the waiting lists have grown steadily longer. I welcome technological innovations but it’s wrong to pretend they can magically make the NHS fit for purpose once more.
Politicians have also got to stop imagining they can spin their way out of this. The collapse of healthcare is not a public relations problem.
Point two: the waiting lists. As long as there’s a backlog, the NHS will continue to fail every single patient. We don’t need to make waits shorter — the goal should be to eliminate them. Other countries have achieved it and we’re mad to accept anything less here.
I was in Krakow, Poland, earlier this month, where patients with cancer symptoms are given a diagnostic scan within a week of first seeing their GP, and are in treatment within two weeks.
It’s only 35 years since Poland was a moribund society, choked by its corrupt Communist regime, where owning a car was beyond the wildest hopes of most, never mind accessing effective cancer care.
The Poles have conquered problems far greater than we face. If they can fix their health service, we can fix ours.
Once a British patient reaches the front of a waiting list for cancer treatment, they will get attention that is second to none. Poland cannot claim to offer better — but great care is not much use to patients facing delays that seem endless.
Waiting lists are killers, not only because disease can progress while people are waiting, but also because of their psychological effects. The frustration and terror produced by delay are significant contributory factors in illness.
One way to reduce the backlog is to get our existing services working night and day, and across weekends. Every time there’s a half-empty carpark, there must be spare capacity somewhere in the building. Let’s put it to work.
Thirdly, let’s make use of the tech we’ve all already got: our smartphones. Where are the healthcare apps that could help monitor patients’ health? Currently, those phones are good for little more than dialling 999 or 111.
Point four: we need people in charge who know what they are doing — not junior executives straight out of the graduate scheme for managers but people who have qualifications and experience in the departments they are overseeing. In cancer care, that might be diagnostics, scans, chemotherapy… all these specialisms will benefit hugely from being run by someone who has real-world experience of how they actually work.
It doesn’t have to be a doctor. It could be a nurse or a radiographer. Whoever is appointed should have the job on merit, not because the health service is top-heavy with managers who need to be placed in some office or other.
The fifth point follows from this: the NHS needs to be a meritocracy, where the best people can make progress.
Currently, it is stagnant: a pyramid with no ladders to the higher levels. New Labour tried to correct this, spending £80 million on assessing the feasibility of an ‘NHS University’ to help its staff gain qualifications — but the scheme drifted and died, the money wasted.
We are past the stage where the NHS can be fixed with cosmetic tweaks and minor upgrades
Wasted money… that’s point six. The NHS is not underfunded, it just spends billions every year on the wrong salaries. The number of managers paid more than £100,000 a year is startling. There’s no need for these people. Massive private corporations such as Tesco or Amazon don’t require them.
Thousands of middle managers and bureaucrats in NHS Trusts who contribute nothing but empty PR and diversity training, working nine-to-five in luxurious offices (see point one), have to go.
Inevitably, there will be howls of protest from those whose jobs are affected, with ‘shroud-waving’ accusations that these cuts are costing lives.
I still bear the scars on my own back from the days when I tried to introduce reforms but gave up when I came to the conclusion that the NHS was the last bastion of Communism in this country.
But the truth is we can save countless lives by redirecting money into cutting waiting lists and promoting people on merit. Our National Health Service is not beyond saving.
Now is the time to prove how much it means to Britain… by showing it tough love.
Professor Karol Sikora is a consultant oncologist in London and a former director of the WHO Cancer Programme.