Chris Tuckett is impressed by the array of expertise and experience in 'Conversations about the NHS'

This book's release feels timely. As the national discourse again centres on the misdeeds of institutions and individuals operating within health care, it seems that most commentary on how to fix these challenges is hyperbolic, blinkered and ill-informed. Into this maelstrom steps Dinesh Bhugra, who has pulled together a selection of knowledgeable, experienced and sober interviewees offering insight and reason when posed with the question of how to fix the NHS.

The structure of the book is novel as the interviews of each candidate are printed verbatim, which results in an often-meandering prose, although it does lend the book a strong air of integrity as you sense you are reading the words and opinions just as they were originally spoken. For me some judicious editing would have made the reading experience more effortless though, and likely sharpened further the point of view being communicated. As it is, I found it difficult to fully immerse myself in the book for long periods as it felt like I was reading a series of interviews in a magazine or newspaper.

The sterile style aside, it was striking how much agreement there was across the interviewees with regards the larger issues impacting the NHS and how to solve them.

More diversity, please!

Before delving into these I feel it’s incumbent on me to point out the apparent lack of diversity among the interviewees, and how they do not appear to represent the interests of many groups who use or work in and alongside the NHS. Among the 14 contributors, nine are medical doctors by training, one is a nurse and none are from the allied health professions. There are five female contributors, nine male ones and, I believe, just three from an ethnically minoritised background. I recognise that when seeking to draw upon experienced and expert NHS voices this is inevitably impacted by the historical context of those who have long held power and sway over the NHS, which is exemplified by the make-up of the final contributors. Yet I would like to have seen this hegemony challenged. If seeking out new solutions while correctly identifying the inherent challenges that beset the NHS was the aim, then the author should find and amplify the voices of those people and groups most often historically excluded from these discussions.

'Impressive array of expertise and experience'

Having acknowledged the limitations of the contributors, the enormous wealth of expertise and experience that they bring is impressive. Medical, policy-making, patient safety, and political expertise are there in abundance and the patient voice is also included in the form of the Patients Association’s chief executive. And each of their summaries about what is wrong with the NHS share similarities. Broadly the NHS is thought to be too fragmented with health, social care and public health all operating as separate entities with wildly differing levels of funding.

Public health is regarded as the area most impacted by cuts to its budget, with social care a close second. And while the health arena is not thought to be adequately funded, there are many shared views about it needing to better manage its budget, to have more dialogue with the public about what is reasonable for the NHS to continue to fund and where efficiencies can be found to enhance quality. I found this to be an accurate reflection of what I experience day-to-day in health care, with both public health and social care too often excluded from many strategic or operational discussions simply because they do not have funded services or the capacity to contribute in any meaningful way. Yet cuts to both social care and public health ultimately just raise costs to health care further by stoking demand, reducing the resilience of our populations and driving dependency on acute health care as a last resort. Social care is explicitly acknowledged across all the contributors as being in dire need of greater funding, and so it is curious that political parties continue to shrink from the spotlight on this issue, despite the apparent consensus across the expert commentariat.

The dire state of the workforce is the other huge point of agreement across all the contributors, and while there are subtleties to each of their proposed solutions, the need for a fully-costed, adequately long-term and comprehensive workforce plan is made clear by all. The recent emergence of the new NHSE Long-term Workforce Plan would seem to address this demand, although how it fares over the next 10-15 years will largely be affected by how governments adhere to the principle of allowing two-yearly iterative updates to further refine the demands. Interestingly, all the contributors seem to endorse the idea of much greater integration of medical and health professionals during their training, and the removal of silo working as early as possible in fledgling careers. There is some suspicion shared about how 'new' roles are encroaching on tasks historically only performed by doctors, and the belief that this is occurring due to cost-savings rather than need or ability. And technological innovations are also met with some scepticism as these are seen as adjuncts to human-to-human interaction, whereas politicians too often seem to sell them as holistic solutions.

The NHS does have a future

It is also good to read how many of the contributors recognise that health care is now a partnership between the professionals and the users of service, whereas before it was a more paternalistic relationship. I sense there is still a long way to go in this regard, but again the expert consensus seems strong, which suggests government should move quicker in this space too.

Throughout the book the NHS is talked about fondly, with no contributor suggesting a better alternative funding model is available, and all recognising the power of a health service that is free at the point of need. And while they recognise that provision of that service is far from free at a societal level, all agree that it is a cost worth bearing. The NHS does have a future, the patients and experts agree on this, and while politicians prevaricate and stutter, they are wasting this consensus position.

Bravery is required from our political class to converse openly about investing in social care, public health and the NHS as a means of investing in our people, and once they speak up, they will likely find most of society is on their side, and they didn’t need to be so brave after all.

Chris Tuckett, is a physiotherapist and a director of AHPs at an NHS trust

X (Twitter): @HealthPhysio

To read Chris’s review of The Shoulder: Theory and practice, click 

To read Chris's review of Petty's Principles of Musculoskeletal Treatment and Management, click