Chris Tuckett finds 'Patients First: How to Save the NHS' offers 'sensible and pragmatic' solutions

The NHS is 'absolutely rooted in politics'

Before reviewing any book, I try to reflect on my own biases first. This seemed particularly important when approaching a book purporting to offer a solution to the myriad problems currently facing the NHS. The NHS is an inherently political construct, at the mercy of government intervention, public bodies, regulators, patient groups, and the prevailing attitudes of the public.

As an ‘NHS manager’ I am aware that I approach the NHS with a very specific view. Other aspects that may be worth declaring are that I am a clinician (a physiotherapist) and a true floating voter. Having once voted for the Conservatives when I felt David Cameron’s ‘big society’ was an appealing proposition back in the 2010s, to feeling unable to align with either extreme of Johnson or Corbyn in the intervening years. I am now approaching this upcoming election with a strong sway towards Labour and the much-needed boring, grown-up politics offered by Starmer and Reeves. I like to think of myself as a centrist, with no strong political affiliation who will go where the policies seem most sensible. Although policies can be difficult to unearth amid the deafening noise of partisan and polarised discussion, the likes of which frames modern politics today.

And to those who say the NHS ‘should be above politics’, I suggest this view is immature and not aligned with reality. As our biggest employer, the guardian of our nation’s health and one of the largest consumers of public funding, the NHS is absolutely rooted in politics. My final bias is that of a service user. Through three pregnancies, two young children, life-saving support offered to my brother and the recent demise of my mother due to chronic disease, I have had many opportunities to witness the NHS impacting on the lives of people I love. With decidedly mixed results.

Twelve concise chapters 'encompass the key areas' 

The author Leslie Turnberg certainly has the credentials to a book of this scope, and admirably begins by acknowledging his own background which allows the reader to understand the perspective from this book was written. A former president of the Royal College of Physicians and a former president of the Medical Protection Society, he entered the House of Lords in 2000. His book is endorsed by Simon Stevens [the former NHS chief executive], lending it further authority. What follows are 12 concise chapters that encompass the key broad areas in which the NHS needs to improve.

There is the expected focus on primary care and hospital care, which are the bits that are most visible and recognisable to the wider population. But Lord Turnberg also turns his attention to both social care and mental health services – two parts of the healthcare landscape that are rarely at the centre of public consciousness and are certainly neglected by government.

Lord Turnberg also touches on maternity services, which I know from my own experience of working on the national maternity and neonatal safety improvement programme, continue to be a postcode lottery of understaffing, fractured safety cultures and racial health disparities.

And the author also dissects broader themes of trust and mistrust, health research, NHS funding and re-organisations of the health system.

The book offers eminently sensible solutions, recognises that bureaucracy stifles the entire system and that the health and social care workforce have been let down. Whoever is appointed as health secretary, following the general election, would do well to read it

'Helpful and informative' material

The book is thorough in its depiction of the problems facing both the NHS and social care and, in this regard, I found it incredibly helpful and informative to read multiple sources of information and evidence pulled together in one place to clearly illustrate a case. Every chapter finishes with a neat summary of the issues and the solutions that have been offered. The structure of the book is fluent, easy to navigate and logical.

While reading the book I found myself nodding in agreement, placing my head in my hands and rolling my eyes in turn. It’s a book that cannot be called enjoyable. This is not the author’s fault, it’s the subject matter that’s so infuriating. The solutions offered are so sensible, pragmatic, and unambitious that it’s crazy that governments continue to overlook them.

The book is a record of the many, very familiar ways in which the NHS (and social care) makes life hard for its staff (and their patients). Endless bureaucracy, chronic understaffing, low pay, opaque career paths, poor culture, ailing infrastructure, and a very tangible sense of distrust between government, public bodies, and the professions.

Lord Turnberg also makes the excellent point that ideas are not in short supply, rather it’s the implementation of these ideas that is woefully lacking. The sheer number of reports, committee hearings, white papers, investigations, and publications that have appeared over the years is mind-boggling. They all address the issue of how the NHS should improve have become an industry in and of themselves. Huge amounts of activity and effort is expended by senior leaders when discussing, planning, and then attempting to roll out change ideas. Yet in the subsidiarity model currently favoured by NHS England, whereby action and accountability are ever-more distanced from each other, this is again destined to fail.

Good quality and accessible care: still a 'pipedream'?

It seems the basic tenets of good quality, accessible care, delivered by content, supported staff is still considered something of a pipedream. The NHS and the social care system have become overly complex, allowing a differentiated offer to spread across England rather than pursuing a standardised approach. In addition, the workforce has been neglected for far too long.  All of which is of huge disservice to patients and service-users.

Lord Turnberg clearly sets out the past, more recent and current failures. The book offers eminently sensible solutions, recognises that bureaucracy stifles the entire system and that the health and social care workforce have been let down. Whoever is appointed as the new health secretary following the general election, would do well to read it.

My only disagreement is with the book’s title. I would like to see it morph into ‘Staff First’, as I think the book makes the case very strongly that a well-resourced and engaged workforce would solve many ills. And I believe if we put staff first, then patient care becomes the priority by default.

Christopher Tuckett is a physiotherapist by background who is a director of allied health professions at an NHS trust

X:@HealthPhysio