The NHS at 60: vulnerable but full of ideas

Abstract

Is fifty the new forty? Is sixty the new fifty? Two years ago I attended an ‘Ideathon’ for Help the Aged – to help the charity develop its strategy – and a clear message emerged: longer, healthier life will mean that the charity’s work will be transformed over the next decade. A generation ago, ‘life begins at forty’ was really a metaphor for the beginning of the end. Now it seems to me, as it did to the bright young brains from companies like Apple gathered to bring fresh thinking and ideas to Help the Aged, that life turns at forty and signals an opportunity to acquire a new career, a different spouse, and possibly even a nip and tuck to make you look ten years younger. For those of you over forty it isn’t too late to abandon your stethoscope or scalpel and enjoy a further twenty years in a career that you might have pursued if medicine hadn’t got in the way. If shelf stacking at B&Q isn’t for you or you don’t fancy the midnight checkout shift at Tesco, you might want to consider one of the many opportunities that the marketplace of the NHS now offers. As the NHS reaches its 60th anniversary (the new 50th, in case you’ve lost my thread), there is a bittersweet irony about one of its key obsessions: clinician engagement. The fact that the NHS is still struggling to engage clinicians after 60 years is a verdict in itself. Nonetheless, for all of you disillusioned with a traditional medical career, a whole of host of healthcare providers and government quangos is in desperate need of your services to engage your fellow clinicians. What this is usually means, however, is that an attempt is made to consult or persuade clinicians of the benefits of a particular healthcare strategy before business and political considerations overrule much of the worthy engagement that has taken place. But don’t be deterred, you will be paid well for moving away from the frontline of clinical work. You might even make a difference by making the clinician’s voice heard and moderating some madcap scheme dreamt up during a desperate brainstorming session. It is easy to be cynical about clinician engagement in the NHS – as I have demonstrated – which is why the new buzz phrases are ‘clinician led’ or ‘putting clinicians at the forefront of service delivery’. The change in language is an attempt to point out that clinicians are the agents of change and not just a sounding board. Whether this linguistic strategy is successful remains to be seen, but the NHS does feel very different to clinicians, with its marketing talk, patient safety and quality agenda, revalidation and job planning, and personal data and technology ambitions. This special issue of JRSM attempts to capture the themes that will govern the future direction of the NHS by examining progress to date. Some of the leading names in UK medicine – players who have shaped and continue to shape healthcare in the UK – pick over the bones of our health service, offering critique, solutions, and personal anguish. But this issue offers much more. Every healthcare professional and patient in the country should be interested in the league table of hospital switchboard response times (JRSM 2008;101:364–371 ). And every doctor in the country, and probably other healthcare professionals and patients too, will be interested in the average salaries calculated for all hospital specialists (JRSM 2008;101:372–380 ). Celebrating an anniversary is often an exercise in banality, but this particular 60th birthday comes at a time when the NHS has never seemed more vulnerable yet so full of ideas. It is a perfect moment for reflection and debate. Clinicians should engage with, lead, and put themselves at the heart of that important debate.