Anchoring an entire society…

As I have commented on many occasions, one of the many successes (and problems) for the NHS is that it has earned a meaning for our society that goes way beyond providing healthcare. Our NHS shows us the sort of social and economic relationships that we would like to have with each other. Relationships where we really are “all in it together”. We understand that whilst most of the time we won’t need its services, we pay for it because others will. We know too that it will be there for us when we need it.

It’s very different from the rest of our society. Most people not only recognise this difference but enjoy it – a lot. And only a few see this as weird.

So when the last paragraph of the long-term plan points out that the NHS is an “anchor institution” people know what this means both to them personally and to our society.

As I tried to explain last week, we understand that towns that have lost their economic and social meaning could look to the NHS to provide that anchor. The point I made was that to do so, to ‘anchor’ a real place with the real hopes and dreams of tens of thousands of people, is a responsibility which demands real actions and activity. The NHS will need to do more.

Once the NHS claims to be an anchor it has to deliver on that role because people will depend on it for their safety, meaning and purpose. The same is true if we are anchoring a whole society.

What does this mean?

For many, the current pace and nature of change is a real worry. People are unsure about some very very important aspects of their and the country’s future. It’s not just Brexit, but the uncertainty caused by some very big changes that appear to be un-anchoring what we have always taken for granted.

In most places the economy is shifting very fast and jobs are shifting with it. What used to be a steel or shipyard town, or a coal village, became a retail town. Now that has gone too. In most places the NHS is either the largest or the second largest employer in the town.

Over the last few weeks I have tried to outline the responsibilities that being such a big employer lays on the NHS. If you are going to be the anchor for a town, or a society, you need to provide real opportunities, and the ladders to access them, for the people in it.

I don’t think the NHS is very good at this. It doesn’t try hard enough to provide opportunities for most of the population to become professional nurses and as of now they can’t if they don’t have A levels. And yet the NHS complains of labour shortages.

An anchor institution also needs to work with young entrepreneurs to provide towns with markets and support in developing the next and subsequent economies in localities. In the past such young entrepreneurs would look to local major industries to provide it with opportunities. And if the they didn’t do this, they were called them out for that failure.

The NHS is pretty bad at this too. The odd testbed may be important for the 10 entrepreneurs that are working with it, but it doesn’t provide £120 billion worth of assistance for the development of new industries.

The core NHS principle, equal access for all free at the point of need, also requires it to do more because although we know that it’s a great principle it often doesn’t happen in practice. The NHS needs to do much more in deprived areas to provide better services that approach equality of access. As I have said many times before the principle is not, “equal access to all for GP services (providing you have a home address)”, it’s equal access irrespective of whether you have an address, it’s equal access because you are human.

I know these are all very big asks for the NHS. But if it is to really anchor our society it must play these and other roles to the full.



I restarted this blog last June to comment on the lead up to, and publication of, the long-term plan. It’s been a lot of fun but I’m going to take another break now..

(Picture is of the anchor graveyard at Santa Luzia, Portugal. The anchors belonged to boats that once brought prosperity to the town through tuna fishing.)  ©Michael Fortune 


One comment

  • Profoundly thought provoking. Making the promise real however requires real people delivering on it with the patient in front of them. Equal access to GP relies upon the GPs in each place honouring their contract with speed, equity and quality, much of which is not measured in any way and this results in highly variable outcomes. Guess what, it’s the deprived communities in most need who come off worse. Overcoming the Inverse Care Law requires determined effort.

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