Pragmatism, not sentiment, is what the NHS needs


We don’t agree on much in these violently divided times but one point of consensus is that the NHS has had a good war. In the battle against coronavirus, the health service has confirmed for many its status as the crown jewel in national public life. 

The weekly doorstep ovations may have ceased — there was something slightly unBritish about them anyway — but the gratitude felt has not faded. 

That sentiment is entirely proper. Every hospital employee knew the risk that they might bring home a killer virus, but still they went to work. Medics pressed ahead despite not having enough PPE. Student nurses rushed to sign up for the wards. 

Healthcare workers in some cases sat with patients in their final moments, in place of the loved ones who could not be allowed to get near them. We owe these hard-working, public-spirited professionals our thanks and admiration. 

We also owe them, and ourselves, honesty. The health service that has done a creditable job on Covid-19 is also the health service with serious structural and performance flaws. It is possible — in fact, it is essential — to acknowledge these problems even as we congratulate the NHS on its handling of coronavirus. 

Nowhere are the problems more evident than in waiting times data. The last set of statistics unaffected by Covid-19 was for the final quarter of 2019, yet even those paint a bracing picture of a health service in crisis. 

The Treatment Time Guarantee entitles 100 per cent of eligible patients to be seen within 12 weeks while the Referral to Treatment National Standard demands that 90 per cent be seen within 18 weeks. As of December, the former target was met for only 72 per cent and the latter for 79 per cent. 

Under the New Outpatients National Standard, 95 per cent of outpatients are meant to be treated in 12 weeks or less. The actual figure is 73 per cent. According to the Diagnostics National Standard, no one should wait more than six weeks for a test result. In fact, one in every five patients waits longer. 

Drill down into specific conditions and the reading is just as grim. Cancer patients are meant to begin treatment within 62 days of referral, but only three health boards in Scotland meet this standard. No more than one-tenth of mental ill-health sufferers should wait longer than 18 weeks to start psychological therapies, yet the real figure is more than one-fifth. 

That’s a lot of numbers and percentages but behind them lie ordinary people. They have been failed by a service they put their trust in and are made to feel like blasphemers for daring to raise their substandard treatment. When you put an institution beyond reproach, you get reproachable outcomes. 

At the outset of the pandemic, there were fears the NHS might collapse and the decision was taken to transfer elderly patients to care homes, in some cases without testing them first. That helped the NHS but it brought severe consequences for some parts of the care sector. Even so, the service’s pre-existing problems mean the road to recovery will be a long one. 

Between March and April, there was an 83 per cent drop in planned operations. When the health service begins its transition out of emergency measures, those procedures will still be waiting and will form a backlog along with conditions that have gone untreated because of the lockdown.  

A return to muddling on is not the answer. We should be using this time to rethink how the NHS operates, how it delivers services and how outcomes can be improved. That involves confronting the NHS we have rather than the imagined NHS we idealise. Technology is still not fully put to use, patients wait too long to be seen, there is a postcode lottery for some of the most serious conditions, and despite all the talk mental health continues to be a second-order priority. 

When it comes to the NHS, often the most dangerous thing you can do is ask simple questions. Why in 2020 can I still not book a GP appointment via an app on my phone and why did it take a government lockdown to give me the option of consultations via Skype? Why must patients wait longer for treatment simply because ministers have an ideological aversion to the private sector? Why can’t voluntary organisations with expertise in areas like mental health be contracted in to provide some services? 

Lockdown has shown how technology can make everything from shopping to business meetings more efficient and there is no reason similar use can’t be made by the NHS. Skype consultations should stay but advantage should also be taken of the latest developments in artificial intelligence, such as the option of an approved chatbot for everyday conditions that currently take up GPs’ valuable time. 

Increased cooperation with the independent and voluntary sectors could ease the strain on NHS waiting lists by getting patients seen faster. Often these organisations, particular in the third sector, have more intimate and extensive understanding of their specialist conditions than general medics. This is not something to be scared of, but embraced and put to good use. It doesn’t threaten the NHS or its unpinning principles, it offers to strengthen them. 

Of course, political dogmatism should not lead us to the other extreme. Just as the status quo is deeply flawed, a headlong rush to tear everything up and start again would create entirely new problems. The state might not have all the answers, but neither do the private or voluntary sectors. 

Yet structural reforms have the potential to bring greater efficiency and value for money. Above all, though, they would mean better results for patients. There is no virtue in maintaining a status quo that causes pain and anguish for those whose needs it fails to meet. The NHS is not a jewel to be taken down and polished occasionally but otherwise gazed at reverently. It is a system and if systems don’t work properly, they have to be fixed for the sake of those who rely on them. A little less sentimentality and a little more pragmatism would do the health service the world of good. 

The question is whether we have political leaders capable of acknowledging the problems and willing to expend the political capital required to fix them. The current crop do not fill me with optimism. Jeane Freeman is a manager, not a reformer, but in fairness to the Health Secretary there is no evident appetite for reform from the First Minister. Until that changes, the NHS will not see the improvements it needs and patients will continue to pay the price.


Tory rebels in the House of Lords are plotting with the opposition to lock Chinese telecoms giant Huawei out of the UK, a Sunday newspaper reports. 

Peers are this week expected to try attaching a human rights test to an obscure Bill regulating broadband installation in rented flats. The hope is that the amendment will fatally undermine plans to allow Huawei to help build Britain’s 5G network, a sore point for Conservative backbenchers over which they have already demonstrated their willingness to vote against the government. 

If this legislative chicanery sounds too clever by half, that’s because it is. The government must confront the security implications of the Huawei deal head on; it cannot be shunted out the back door by some sly parliamentary device. 

The Shenzhen-headquartered firm should never have been given the green light in the first place. Now, after China’s secrecy, dishonesty and bad faith over its coronavirus, there can be no doubt: the deal must be cancelled. No tricks, no dodges — it’s leadership that’s needed.


The £900,000 paint job on Boris Johnson’s official plane has finally been complete, you’ll no doubt be relieved to learn. Now the RAF Voyager comes complete with a Union Jack on the tail, much to the consternation of some Scottish nationalists. No wonder: imagine living in a country where the leader flies around in a vanity aircraft.  

Originally published in the Scottish Daily Mail. Letters: scotletters [insert @ symbol] Image by Darko Stojanovic from Pixabay.

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