{"id":38118,"date":"2017-01-10T12:59:56","date_gmt":"2017-01-10T11:59:56","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmj\/?p=38118"},"modified":"2017-09-11T09:24:06","modified_gmt":"2017-09-11T08:24:06","slug":"nick-hopkinson-on-nhs-humanitarian-crisis-denialism","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmj\/2017\/01\/10\/nick-hopkinson-on-nhs-humanitarian-crisis-denialism\/","title":{"rendered":"Nick Hopkinson: NHS humanitarian crisis denial"},"content":{"rendered":"

\"nick_hopkinson\"When I qualified as a doctor in 1993, trolley medicine was completely routine. Post take ward rounds would typically visit people who had been waiting patiently in corridors overnight or longer. I\u2019m ashamed to say it never occurred to me to think of this as a “crisis”\u2014it was just the way things were. The cause was obvious\u2014chronic under-resourcing of the healthcare system. The Wanless report<\/a> estimated that the UK\u2019s cumulative underspend between 1972 and 1998 was \u00a3220 billion (the annual NHS budget in 1998 was \u2248\u00a335 billion). The remedy, bringing the proportion of GDP spent on healthcare in the UK funding up to the European average, was largely effective\u2014adequate resources allowed system changes too and trolley medicine seemed to have been consigned to the past.<\/p>\n

In an unwelcome 90\u2019s revival, trolley waits are back with a vengeance. Patients are dying<\/a>. A&E departments are struggling with the consequences of flat NHS funding since 2010. As NHS providers put it in State of the NHS Provider Sector<\/em><\/a>, there is \u201can inability to cope with activity shocks that five years ago could have been absorbed but now cannot be.\u201d Funding has failed to keep pace with population increase and the NHS is on course for a \u00a320 billion\/year<\/a> deficit by 2020. Social care<\/a> provision is under even greater strain, with an 11% reduction in local authority funding for social care of older people and a 26% fall in the number receiving it.<\/p>\n

In this context Mike Adamson, CEO of British Red Cross, has described the situation as a \u201chumanitarian crisis<\/a>.\u201d This has spawned several varieties of humanitarian crisis denialism. From those who are politically responsible<\/a>, this is to be expected. Critics have accused NHS England of spin following memos<\/a> to Trusts advising them to\u00a0avoid language such as “black alert.”<\/p>\n

More curious is the \u201cit\u2019s not as bad as Aleppo or Yemen so it can\u2019t be a humanitarian crisis\u201d response. One might wish to pause before presuming to explain the term to The Red Cross. Certainly, Mike Adamson\u2019s description of an NHS with \u201clarge numbers of vulnerable people facing a threat to their health, safety, or well-being,\u201d and suffering \u201cprolonged physical and mental distress\u201d on a broad scale, seems to fit the bill. The plight of refugee children stranded in camps in Calais and elsewhere is clearly a humanitarian crisis. Aleppo is worse. The number of people sleeping rough in England has doubled since 2010<\/a>. This is a humanitarian crisis too, even though it\u2019s not as bad as Southern Sudan. It\u2019s not as if \u201chumanitarian crisis\u201d is anywhere near the limits of language. Humanitarian crises differ in nature and degree. Not as bad as Aleppo is a pretty debased standard to judge the performance of a first world health system.<\/p>\n

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Patients waiting more than 4 hours to be admitted <\/em>from NHSE data Oct 2016 <\/em><\/a>\u00a0<\/em><\/p>\n

Some have argued that the phrase will put people off using the NHS so that they come to harm\u2014this is hardly proportionate given the ubiquity of \u201cdon\u2019t go to A&E unless you have to\u201d messaging coming from NHS providers. In any case, it is an argument that would only be justified if there wasn\u2019t a problem, which there patently is\u2014see the graph above showing the increase in the number of patients waiting more than four hours to be admitted.<\/p>\n

It\u2019s also been suggested that use of the term somehow devalues the experience of people in worse situations. This argument, a form of inverse \u201cwhataboutery<\/a>\u201d has little justification. Perhaps the anxiety reflects moral complacency\u2014humanitarian crises happen far away\u2014we couldn\u2019t possibly allow one on our doorstep. Surely if there was a crisis, a crisis long-foretold, we\u2019d have done something to prevent it, or do more now?<\/p>\n

A related \u201cwhataboutery\u201d is that the phrase puts too much emphasis on hospitals rather than some other part of the system\u2014social care, primary care, and preventive strategies. Of course people\u2019s attention needs also to be drawn to what Mike Adamson himself describes<\/a>: \u201cHundreds of thousands of people who used to get support from social care no longer get support as a result of billions of pounds of cuts.\u201d It\u2019s not a zero sum game and this is an argument for more explanation of the wide and interacting consequences of austerity, not for a down-playing of the seriousness of the problem.<\/p>\n

Whatever term you use\u2014the current NHS crisis was neither unpredictable nor unpredicted. Political choices are driving these crises, just as climate change drives extreme weather events. The NHS humanitarian crisis is a political crisis\u2014what are we going to do about it?<\/p>\n

Nicholas S Hopkinson<\/strong> is a reader in Respiratory Medicine, Imperial College London.<\/em><\/p>\n

Competing interests<\/strong>: None declared.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

When I qualified as a doctor in 1993, trolley medicine was completely routine. Post take ward rounds would typically visit people who had been waiting patiently in corridors overnight or longer. I\u2019m ashamed to say it never occurred to me to think of this as a “crisis”\u2014it was just the way things were. The cause […]<\/p>\n

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