We must have honest debate on theNHS

IF YOU have ever wondered what the toughest job in Britain is, I’ve found the answer. It’s got nothing to do with sewers and although brain surgeon probably has its moments, after watching the BBC’s excellent new documentary The Hospital I reckon there’s a health-related job that is even harder: bed manager.

For those who didn’t see the programme, the first episode followed three days in the life of St Mary’s in central London, a big modern hospital under pressure. We met Lesley, a former nurse who now acts as its’ “air traffic controller”, making sure beds, surgeons and patients are all in the right place at the right time. Lesley, the sort of stoic, practical, sometimes wry woman who has kept the NHS going for the last 70 years, likened her job to the building game Jenga: “The tower has never yet come crashing down and my job is to stop that happening. But life here is sometimes a little bit wobbly.”

The reality of what she described with understatement as “wobbles” was the shortage of intensive care beds that required her and senior physicians to take the sort of life and death decisions most of us thankfully never have to conceive of, every single day. I certainly wouldn’t want to be the one deciding whether the only remaining intensive care bed should go to an elderly woman with a ruptured aorta who may not survive the ambulance journey to the hospital or a middle-aged man whose life-saving surgery to remove a tumour has already been cancelled, would you?

The resolution and consequences of this dilemma were difficult, fascinating and heartbreaking to watch. But, as Lesley explained, ultimately she has to do what’s best for the hospital and that sometimes means not doing what is best for a particular patient.

St Mary’s was brave to let the cameras in, not least because it showed it letting patients down in the most moving of circumstances. And I don’t doubt many viewers would have been shocked by the directness – some might say callousness – with which all this was discussed by hospital staff.

But the programme did us a great service by highlighting the realities of the modern NHS, which simultaneously performs the most amazing miracles and also fails us.

‘‘ Politicians must be allowed to put in front of us the sort of policies that even fairly recently would have seemed like electoral suicide

And although it was filmed in a hospital in England, I don’t doubt Scottish hospitals face exactly the same challenges every day.

This is the point where people like me are supposed to lambast governments and politicians for failing to provide enough funding to our hospitals, of course. But, as pointed out by Dr Peter Bennie, chairman of the British Medical Association in Scotland in these very pages today, with NHS funding stagnant since the onset of austerity seven years ago, the public must also face facts.

It is we, after all, who are living longer and getting a wider range of health problems – if you live to 90 there’s a fair chance you’ll have or have had at least two of cancer, heart disease and dementia – that require more expensive health and social care over a longer period of time than ever before.

But with current services already creaking under the pressure it genuinely does not bear thinking about how the NHS will manage in years to come, especially with innovative but expensive new treatments becoming available all the time and our expectations of what the NHS should and could provide growing by the day. The fact we usually refuse to even countenance the closure of local services does not help.

I’d go further than Dr Bennie and say the public is letting the NHS down just as badly – perhaps even more so – as politicians because we wilfully refuse to take our heads out of the sand and have the sort of honest debate about funding and priorities required to move things forward.

We are no longer at a point where we can afford to say we’re not ready for this debate. And yes, that means allowing politicians to put in front of us the sort of policies that even fairly recently would have seemed like electoral suicide, things such as tax rises and contributory schemes akin to the ones they have in Europe, where most countries pay a considerably higher proportion of GDP towards healthcare than Scotland or the UK.

We will also have to be brave enough to answer difficult questions about priorities. What’s most important: providing cancer drugs to give someone an extra six months of life, giving three rounds of IVF treatment to women with fertility problems or making sure nurses are paid fairly? It’s not easy is it? Even Lesley, the indomitable bed manager at St Mary’s might struggle with moral dilemmas like these.

But until we taxpayers decide to face such realities with Lesley’s pragmatism, the NHS we all claim to love so much is doomed to become too sick for us to heal.