NHS needs bold solutions to survive, says leading psychiatrist

Whether it’s setting up a Bank of England-type body to run it or fining patients for missing appointments, healthcare leaders, policymakers and practitioners past and present have a wealth of ideas about how they would change the NHS for the better.

Professor Dinesh Bhugra, a psychiatrist and former president of the British Medical Association and the Royal College of Psychologists, asked 14 peers, physicians and patients’ representatives for their prescription for the NHS.

The interviews are reproduced in Professor Bhugra’s new book, Conversations about the NHS. Thought-provoking and in some cases, controversial, ideas include:

• Setting up an independent Bank of England-type body to run the NHS – Dr Chaand Nagpaul, a GP and former chair of the BMA. Nagpaul states that we have a “health service that’s at the mercy of political whim” and “just changing the health secretary changes the policies” and he would redesign it to be free of political influence.
• Choosing a health secretary with experience of working in the NHS, rather than someone who is a politically convenient Cabinet appointment for the prime minster – Dr Sarah Hallett, a trainee paediatrician and past chair of the BMA’s junior doctors’ committee.
• Rethinking the criteria for becoming a doctor – Sir David Haslam, past chair of NICE and former president of the BMA. Haslam states that he has long thought that we “choose almost precisely the wrong people to become doctors” and an understanding of human relationships is more useful in medicine now than top scores in maths and science.
• Setting up a network of polyclinics to treat complex chronic illnesses in the community – Dr Richard Horton, editor in chief of The Lancet.
• Overhauling workforce planning to take into account that doctors may want to take time out to bring up families – Dr Max Pemberton, a psychiatrist and journalist. Pemberton argues that the evidence shows that women doctors tend to not work full time and “therefore we need to account for that”.
• Fining patients for missing appointments and going to A&E with minor problems and when drunk – Dr Max Pemberton.
• Recruiting retired people to regularly call and update those on NHS waiting lists – Rachel Power, CEO of the Patients Association.
• Making training more multidisciplinary to prepare healthcare staff for the teamwork that will be part of their day-to-day working lives – Dr Dan Poulter, MP and a hospital doctor
• Putting in place a 20-year-plan for the NHS – Dr Dan Poulter

The case for change

Professor Bhugra sets the scene for the interviews, the transcripts of which make up the body of his book, by describing the history of the NHS and the challenges it faces as it celebrates its 75^th birthday this summer [July 2023].

The combination of increased demand for services, expensive tests and treatments and continual political interference has left this one-time jewel of the welfare state lurching from crisis to crisis, argues Professor Bhugra, who is donating all royalties from Conversations about the NHS to the Patients Association.

Fragmentation within the NHS, such as the division between mental and physical health, has compounded the challenges faced, while failure to acknowledge the role of wider factors such as housing and education on health and wellbeing means “we are patching people up, rather than creating a healthy population”.

“The challenge is for policymakers and stakeholders to realize and recognize these pressures and put strategies in place now so that the NHS survives both as a principle and as an institution,” states Professor Bhugra.

The prescription

His questions for his interviewees include what they would change in the NHS and how they would design the health service, if they were setting it up from scratch

After completing the interviews, each of which forms a chapter in the book, Professor Bhugra distils and reflects on the proposals.

He concludes: “There is no doubt that the NHS is a valued part of society. However, at 75 years and with structures set up three generations go, the time has come to seek bold solutions, rather than merely tinker at the edges.

“The NHS needs and deserves a long-term plan with cross-party consensus and ring-fenced funding to ensure that resources are adequate.

“Health cannot, and should not, be seen in a silo. There must be interconnectedness with education, housing and employment. In addition, public health and health need to be integrated and social care and health must come together.

“Health is everyone’s basic right.”