Like most citizens of the UK, I am both proud of and thankful for the National Health Service, while also being frustrated with the general state of it. The principles of free healthcare for all are so sound and incontrovertible that we are willing to forgive a great deal of slowness, inefficiency and eccentricity. But there’s only so much slack we can give it before we should start to worry – is it breaking?
All is not well in the NHS. Waiting lists extend. Junior doctors strike. There never seems to be enough money, and it seems harder than it used to be to get an appointment for anything. When this happens, important diagnoses don’t happen in time, creating unnecessary suffering.
I expect I am not alone in wishing the NHS could be better, without really knowing what needs to change. So I’d recommend Dr Gavin Francis book Free for All. It’s short and to the point, describing the founding principles of the health service, where it has gone wrong in the past, and some ways that it could be improved.
Some of the NHS’s ills can be traced back to the beginning, and the compromises made to get the country’s doctors on board with a national scheme. Then there have been a variety of political decisions made over treatments and pricing that have warped incentives or put the wrong people in charge of things. Most recently, two more factors have been piled on that have brought the NHS into crisis.
The first is a decade of under-investment from central government, a result of Conservative austerity. Francis describes the archaic computing systems, the overcrowding, the time pressures. This isn’t just about throwing more money at healthcare, but investing in systems and infrastructure that has been neglected, including training new doctors and other staff. This will not be quick to fix.
The other big kicker has been Covid. We all know the pressure that the healthcare system was under during the worst of the pandemic. What’s less appreciated is how that pressure has continued because of so many delayed treatments, and people who waited until it was over to trouble their doctors with something that was bothering them. “Then began the onslaught,” says Francis, “the delayed presentations of serious disease, the surge of demand as the backed-up problems and pent-up misery of two years of lockdowns came crashing back through GP surgeries and A&E.” We are still working through this, at a level of demand that just barely functions in summer and is always overwhelmed in winter.
Writing as a GP, Francis describes what he finds so rewarding about his work, and the bits of it that get him down. He describes patients and colleagues and the ways that the current system doesn’t work for them. It’s patient-centred and humane, low on finger-pointing and positive about solutions. It’s personal and practical, shining a light on the processes and decision making that we patient citizens don’t usually see. A few myths are corrected, such as the perennial rumour that it has too many managers, or that we can’t afford anything better. The NHS has fewer managers than other industries, and other rich countries spend more on healthcare – we have a system we have settled for, not the best we can afford.
As the subtitle of the book suggests, the crisis in the NHS is serious enough that those within it talk seriously about whether it can be saved. There is an urgency to the book then, and big decisions will be made by the new government that will either begin to patch things up or see the NHS fall apart entirely. It’s a good time to get a bit more informed, and Free for All will be well worth the short amount of time it takes to read it.
- Free for All is available from Earthbound Books.
The Earthbound Report 
Thanks Jeremy – good to know of this