Happy Interdependence Day UK…

...the birthday of the NHS is a day to reflect on the value of collective responsibility. Yesterday was, of course, the 04th July, Independence Day in the United States; the shameless celebration of a nations success in establishing an individuals right to screw their neighbour over in pursuit of the American Dream; a dream which is now dead for the majority precisely because of the rapacious desire of a tiny minority to pursue their dream at the expense of everyone else. Hey ho Tom, hindsight is a wonderful thing I hear you say, but foresight on this issue wouldn’t have been so difficult either; it is not rocket science to predict that if you unleash everyone within a culture of selfish individualism, it will only end well for a domineering minority. The democratic experiment we know as the USA may one day be viewed as the greatest missed opportunity of modern man; a disparate group of people who freed themselves from tyranny so they could stand on each other’s heads at will. So I think that on the 05th July, the birthday of the NHS in the UK, us Brits (I would include Europe but let’s not go there) should celebrate Interdependence Day; a kick-against self-centred individualistic independence that reminds us of the benefits collective responsibility offers. There is after all to my mind, no greater example of a civilised society than the provision of universal healthcare, funded by all to be available free at the point of use by those who need it when they need it. As John Ruskin observed, there is no wealth but life, and though he was a privileged sort with the time to pontificate and no sense of what it is like to be without, on this matter, I think I have to agree with him.

This 05th July (in case you hadn’t noticed) is the 70th birthday of the NHS. It is also a hundred years since the end of World War One, a hundred years since the vote was finally given to women and it is nearly thirty years to the day my sister Alison had an abortion as a result of the illegal behaviour of a trainee Mental Health Nurse when she was a mental health patient in Carlisle. Alison never recovered from this experience and took her life in 1991. Having worked in the NHS myself I have seen and experienced the best and the worst and whilst the concept of universal healthcare is most definitely to be celebrated and protected, the divisive often self-serving culture within large parts of the management circles in the NHS is most certainly not. My family have been helped many times by the NHS that we pay towards, we have also been damaged irreparably by the same NHS. The service may be struggling for cash, but it is awash with ineptitude, waste and as one senior clinical consultant so eloquently described it to me, an abundance of fuckwittery. If useless meetings could be converted into cash, the NHS would have enough to lift the country out of debt and austerity would be nothing but a dim and distant memory. While clinical patient-facing staff often struggle to meet the rising tide of demand, management appears to be fixated with the task of chasing the target whilst missing the point. If like me you have sat in meetings where it is decided not to advertise vacant clinical staff posts to ensure the department stays within budget and managers don’t get shouted at, or worse, moved to another NHS Trust, then you will be aware that the needs of the patients are seldom considered in management circles. If like me you have sat in meetings where people are deciding what values nurses should have and what wording to put in the mission statement, you will have found yourself asking, what have we done to people in this great vocation that we need to give them a mission and a set of values, if we have reached a point where poor management and leadership has created a culture in which nurses need mission statements and values, then heads need to be hung in shame and questions must be raised.

Between myself, my mum, my gran and my aunty, we have over 75yrs of NHS employment history in our family. We have the t-shirts, cultural insights, observations and inside-track experience that consultants to the NHS can only dream of. We also have the scars of being failed and betrayed by an NHS culture that turned a blind-eye to the shameless and obvious exploiting of a vulnerable young woman, and this will be with us for a lifetime. We would not wish this experience on anyone else, though we do wish the NHS had learned from it, really learned from it. They haven’t. Countless others, victims of Mid-Staffs, Southern Health and most recently Gosport will tell you that. Oh, the communications (PR) departments will trot out the platitudes that things have changed, but the closed opaque cultures of the NHS will continue to hide mistakes and cover-up poor practice. And to managers who say I am only doing what I am told, I would say you are not stuck in traffic, you are traffic. We all have choices about what we condone and tolerate and thanks to the sacrifices of those who died in its defence, we are fortunate enough to live in a democracy where you will not be shot for speaking out. You might be ostracised by people intent on self-preservation at any cost, but you will live. Systems thinkers sometimes make the excuse for poor behaviour that the system is to blame, but systems are no more than collections of people, people with names, job titles, agendas and egos. We should not excuse or hide the lack of courage to speak out behind such amoral thinking.

For us here in the UK the ideological divide between us Brits and our stateside cousins is epitomised in their commercial approach to the provision of healthcare; it’s not a human right, it’s just another commodity to be bought and sold. The nation that encourages individualism when it suits, has created the most divisive healthcare system in the developed world; the American concept of every person for themselves is now explicitly, horrifically, unambiguously and tangibly represented in the self-serving sociopathic maniac (no offence Don) they appear to have put in charge of their own country. We are fortunate that we Brits have not (as yet) elected the kind of amoral A-Hole who openly revels in being “clever enough” to avoid paying taxes whenever and however he can; once the leader of a country feels able to unashamedly set out his own stall in such stark individualistic terms, you can be reasonably sure the notion of collective responsibility is mortally wounded if not dead already; the die is cast. And before we all think our garden is much rosier, please remind yourself that our current leaders (?) are committed to being a low tax and low-benefit economy; this has significant implications for the whole country. The countries that continue to rank as the happiest in the world are almost diametrically opposed to that position. These countries spend greater proportions of their GDP on health and their governments appear to have a different view about what their role is and what they have been elected to provide. The current debate in the UK about the need to raise more taxes to pay for healthcare is a red herring, the conversation needs to change, the debate should be about how what is currently collected in taxes is spent; health, or policing the world and providing tax breaks for large corporations and the global elite? The CE of NHS England and author of the oft quoted Five-Year Forward View, now looking distinctly like a four-year rear view mirror, proudly boasted to an audience of adoring executives recently that the UK should be proud it was spending thirty percent less on its healthcare than Germany…really, something to be proud of; “we spend less than other countries on our healthcare”… who in their right mind would stand on stage in front of a group of cash-starved NHS Trusts and be proud of that fact without expecting to get booed off; perhaps he had estimated the levels of sycophancy correctly? But what twisted PR planet did this “good” observation come from? Have these people not looked out the train windows recently and seen the Third Sector picking up the pieces that the NHS can no longer hold up? Spending on healthcare is an investment that benefits us all, individuals, communities and corporations large and small. Companies investing in the UK know that the health needs of the majority of their employees will be met by the public purse; don't tell me that's not part of the attraction. We need to change the language about cost and start to look at the returns, the financial, social and emotional returns we all get when we invest wisely in healthcare.

So while we here in the UK should make time to celebrate our interdependence, manifested as it is in the existence of a publicly funded health service called the NHS, what we shouldn’t do is unthinkingly praise what we have without understanding what it actually is, and what it is not. What it is not and what we do not have in the UK is a system of healthcare; systems are defined as components that work together and our society has many components within it that are harmful to health. If in doubt about the lack of joined-up thinking on obesity that exists in our country, just look at this map of Fast Food outlets in the UK and then ask yourself if the growth of online and high-street gambling and payday loans isn’t linked to the rise in Mental Health issues that affect an ever-increasing proportion of the population. And you can do these things whilst eating a takeout using the latest fast food ordering app; what could be more convenient? In the face of such hotly pursued and obviously lucrative commercial opportunities, the prevention efforts by well-meaning Public Health officials are unfortunately throwing most of our money to the wind. What it also is not, is a truly National Health Service, it is a fragmented loosely managed franchise of individual businesses each with its own ideas about what it should be doing and how it should be doing it; seven and a half thousand independent GP Practices and around two hundred and fifty different NHS Trusts, each with their own vision, mission, sets of values and websites, communication departments and differing versions of patient information…as franchises go, it is probably the most inconsistently managed franchise in the history of the Western World. A few years ago Stuart Rose, now Lord Rose, the former Head Honcho of Marks & Spencer tried to help the NHS establish a common purpose and nationally consistent set of standards, but his simple guidance was kicked into the long grass by the bods at NHS England; after all, what could a former successful captain of industry teach the high flying desk pilots of the NHS?

Steven Covey, one of the wisest men of recent years, the man who wrote the Seven Habits and The Speed of Trust suggested we move through three stages of development, from dependence to independence and finally to interdependence. He posited that we move from a first childlike phase where we expect and sometimes need to be spoon-fed, to a second stage where the pendulum swings the other way and we rebel, the “I don’t need you, I can do this” phase, then to a third stage of maturity where we realise we need each other and we understand that we are all ultimately interdependent, connected. Some might call it socialism, some might call it common sense, but I think it’s a self-evident truth.

So on the 05th July we should most definitely and unashamedly celebrate the concept of the NHS as part of our Interdependence Day, but we should not deny that it, like democracy and society itself, is still very much an imperfect work in progress…