Fire, Fire, Fire…….in the NHS
As an ex-submarine doctor, the words ‘fire, fire, fire’ said loudly with nervous energy were the most dreaded. Even a small fire underwater would hoover the oxygen making the atmosphere unbreathable and reduce conscious levels within seconds. If not rapidly dealt with, the best that could happen in the confined, hot and humid spaces is a lack of oxygen; in the worst case, it takes the people and destroys the submarine’s infrastructure. Fire is an existential threat to the submarine, the way of life, and everyone on board. A well-drilled crew know their only means of survival is to work together, take massive action and only then do they have a chance of quelling the flames and surviving.
Right now, there is a fire; it has taken hold, it has destroyed parts of the infrastructure, and it is taking people with it. The fire is not on board one of our submarines but in the very fabric of the organisation designed to look after all of us, the NHS. And while the context is clearly very different, some of the patterns and solutions are not. If the demand for services is the fire, it has already taken many due to early retirement, mental health problems, and some have paid the ultimate price. This fire was increasing rapidly before COVID-19, but the global pandemic has poured fuel onto the pyre of patient demand and overwhelming pressure on those trying to put it out. Made worse by a decade of NHS cuts and austerity.
Patients understandably have frustrations at not being able to access care. They end up in inappropriate services, unable to meet their needs, pouring more fuel into the burning wreck. Right-wing columnists further bash those on the frontline, doing their best work 16 hours a day, with no comeback. Recent assaults on GP staff are at the extreme and frightening end of this spectrum. Even within the NHS, the cracks between specialities and between primary and secondary care abound. These are all symptoms that this fire is out of control, heading into winter with no signs of abating. Shortages in community pharmacists, extended ambulance waits, lack of GP appointments, and soaring Emergency Department numbers are all signs that this fire is starting to eat away at the very infrastructure of the NHS.
The obvious question is, how do we put the fire out? Back on board, there are 3 clear ways to do this. Firstly cooling the fire. As NHS colleagues shouting at each other on social media about what we should be doing doesn’t help, it helps drive an unhelpful narrative and makes things more difficult to resolve. Secondly, smothering the fire. This is suffocating the unhelpful government narrative that things will be OK and there is enough funding, and actively pushing to improve NHS services. Finally, you need to remove fuel from the fire. This is countering narratives in both the media and online who berate those fighting this fire in very difficult situations. This is everyone’s responsibility.
This fire will be difficult to tackle and undoubtedly increase going into the winter, stretching those on the frontline trying to put it out. But it is not just those fighting the fire who are needed on board; it is everyone. Only a crew who stick together and fight the fire as one will succeed. As it is with this country and NHS. Please help fight this fire in whatever way you can. If you are not helping to put the fire out, at least make sure you are not pouring fuel onto a fire in a potentially sinking ship!
