Writing a short polemical book about the NHS when, inevitably, the readers of the book are bound to know far more about the subject than I do, is perhaps not the wisest thing for a political pundit and broadcaster to do. Let me explain why I have written this book. Each and every one of us uses the NHS. We have shared experiences, both good and bad. We all have opinions about what the NHS does well and what it doesn’t do so well. My motivation is not to write a book which contains all the answers to the NHS’s problems. That would be both stupid and impossible. Instead, it is to highlight some issues which are of concern to NHS users, the people who work in the NHS and those tasked with running it.

Any government wanting to get the best out of the NHS starts from a position where they know the NHS has huge amounts of public support. An Ipsos MORI poll in July 2014 found that more than half (52 per cent) of the public say the NHS is what makes them most proud to be British, placing it above the armed forces (47 per cent), the royal family (33 per cent), Team GB (26 per cent) and the BBC (22 per cent). Despite recent coverage of care failings and the increasing financial squeeze, we are prouder of the health service than we were two years ago, shortly after the Olympics (52 per cent now compared with 45 per cent then). Furthermore, according to the Ipsos MORI Global Trends Survey, Britain is the second most positive country, out of nineteen, surveyed about the quality of their healthcare, with only Belgium rating their healthcare more highly.

But . . . And here’s a very big BUT. The same survey found only one in ten of us (9 per cent) say that we expect quality to improve over the coming years, while 43 per cent think it will get worse. This makes us among the least optimistic of the twenty countries surveyed, and reflects concerns about the sustainability of the NHS in the future. So that’s the context. In the book I have tried to identify some issues which I think will dominate the health agenda over the next decade. I want to challenge orthodox NHS thinking and say a few things which I think need to be said, but don’t always seem to form part of the current debate. And forgive me if I use a couple of personal experiences to illustrate some of the points I want to make.

In many ways, senior health professionals and those in government and opposition have much in common – even if that thought might fill the latter with a degree of horror. The government is trying to wrestle with the demands of an empowered, knowledgeable twenty-first-century consumer base while NHS staff are all operating within a structure designed for a mid-twentieth-century command control system of healthcare provision. There is another communality of interest – NHS staff all have a fair idea of what needs to be done, but no one in politics is courageous enough to articulate either the problems or the solutions. And, sadly, I do not see that changing either under any government we might have in the foreseeable future. No one is prepared to think the unthinkable, say the unsayable, much less implement the doable.

The book is loosely based on a lecture I gave a year ago at Queen’s Hospital in Romford. To be honest, I almost declined the invitation, and had even started an email to do just that. But then I thought, no, I’ve gained a lot of knowledge about the NHS in the past few years, partly through personal experience and partly through hosting my LBC show. Dammit, I’m going to do it! I never dreamed it would end up forming the basis of a book. Much to my surprise, the 80 or so NHS professionals who attended my lecture, took what I had to say very well. I had half expected them to boo me at times, as I had some tough things to say, but not a bit of it. Even the union rep came up to me afterwards and said she thought most of what I had said was bang on.

When I finished writing the text for the book I sent it to half a dozen health professionals just to check I hadn’t made any huge howlers. Three of them were GPs, one of them was a surgeon, one was an NHS Trust administrator and one chairs an NHS Trust Hospital. I was releived when their comments came back that they were all remarkably positive.

Here’s the list of chapters…

1 Politics and the NHS
2 Private sector v. public sector
3 Targets, outcomes and a seven-day-a- week NHS
4 What is ‘national’ about the National Health Service?
5 The coming funding gap
6 Care and the patient experience
7 The challenges of population growth and demographic change
8 The challenges of personal responsibility
9 Still the NHS Cinderella: mental health
10 Transparency and the right to know
11 Diet and the nanny state
Conclusion
50 things which could make the NHS better

The NHS: Things That Need to Be Said by Iain Dale, an LBC Book published by Elliott & Thompson on 12 February in hardback at £8.99.

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