Shibley’s thought provoking post on communications touches on some serious issues.

He asks why we fail to get over the message that the NHS is being privatised and sold off?

In part it is because those with the siren voices have said similar things about every other change to the NHS; in part it is because privatisation in the sense the public understands it is not happening (at least not yet); and also perhaps the message that more private providers will be delivering NHS services has got over but the response is “so what”?  The opinion polls and focus groups show that most don’t care much, especially amongst younger more consumerist groups. We are becoming a market society.

Despite our efforts, for two decades the false doctrine of markets and competition has dominated health policy and our collective problem is that the alternative has never been articulated in a credible way.  Those who passionately support a publicly owned publicly provided NHS (of the kind described by Alex Scott Samuel) cannot begin to explain how we could get to that happy state from where we are. In reality they are arguing for a different kind of state not for a different NHS within our mixed economy, EU member state.

The discussion of how we might restore the best characteristics of our NHS are limited by the pragmatism that there is no money and what there is needs to be spent on social care; the NHS will not easily survive yet another top down whole system reorganisation; and we are stuck with a lot of pro competition domestic and euro legislation.

During the passage of the White Paper/Bill/Act the small band who opposed the whole thing from the outset found they were up against the mainstream which though lots of the principles sounded good.  It took two years to build a sold coalition opposition and it lasted for about one week. But the arguments hardly engaged the public – throughout discussions in parliament it was clear that the constitutional, structural and technical arguments had no resonance in terms of patients or their experiences of the NHS.

We love the NHS but don’t understand it at all. Attitudes to the NHS are known to be perverse.  We appear to want the NHS to provide everything possible, whether or not it is effective.  We want a District General Hospital in every town – no matter what the clinical advantages are of larger units.  We want an ambulance at the end of every street and an A&E within a short bus ride!!!

The SHA has been running a series of events about the NHS for activists and especially councillors and with the best will in the world the level of understanding about the NHS and how it functions is poor.  We have heard that many older people are stunned (probably less so in recent years) when they find they are expected to pay for their social care needs – they thought that was part of the free NHS.  We know we have very high levels of satisfaction with the NHS yet also many instances of poor or very poor care – I suspect everyone knows of a friend or relative who got poor care.

Those most hostile to markets and competition argue for a fully publicly owned and provided NHS (without any provider/commissioner split) and appear to suggest that just removing any idea of markets will save billions and somehow transform quality.  That lacks credibility outside the groups that all share the same view.

In short our NHS faces the same major problems as every other health system in the major economies, and some serious measures are necessary to balance the impossible tensions between funding, access and quality – but most of the public do not accept that to be the case.  And the pro markets argument prevails because the alternative has not yet been properly articulated in ways the general public find compelling.

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