Andy Cowper attempts to find out what does the NHS mean ie what does it stand for.

“What do you mean?”

It’s the most cutting question you can ask someone. In its metaphorical sense, it’s either a request for greater clarity, or a dismissal that the person can’t convey what they’re talking about with adequate clarity.

At the literal sense, the question is as devastating as it is existential.

What do you mean, as in, what do you stand for?

What are you here to do?

It’s an uncomfortable exercise for a professional commentator to think about their meaning. If you take Maslow’s hierarchy of needs as a useful model (and if you’re not stupid, then you do), then commentators such as myself need to be aware where they sit on a graph plotted with “useful” on the x axis and “ornamental” on the y axis.

The meaning of hearting

Why do people “heart” the NHS (and even wear lapel badges and T-shirts to that effect)?

I suspect that one reason is a yearning for community. In 2018, we are all in a lot less things together than we used to be. Our politics is more polarised between left and right than it has been for 30 years (and that’s just within the two biggest Westminister political parties).

As for Brexit… this referendum (a decision making tool that is the demagogue’s delight and the democrat’s despair) has split the country down the middle. 52:48 is a win for the 52, of course.

One of the things that we are still all in together is the NHS

It’s just a shame that the unstoppable force of Johnsonian ambition – pro-having cake and pro-eating it – is going to encounter the immovable object of political reality when the EU points out that frictionless free trade with our nearest economic power bloc is a set menu, and not a la carte.

The nation is going to have to learn this lesson the hard way, it seems.

But one of the things that we are still all in together is the NHS.

O reason not the need

I have long suggested that the point of difference between the NHS and other public services is that it’s the one we can all imagine that we (and our parents and children) will need and use in the future – and if its quality is poor, then so will the quality of their and our lives be.

At a certain point (ie by and large beyond when it affects our own children), the quality and offer of education has lower pertinence. If we can afford to live in a nice area, and have lucky lives, the quality of the police may not have great direct impact on us.

But healthcare is different. Because if we become older people (and the available alternative to becoming older people may start to look less rosy as the years pass us by, and we them), then we know that we are ever more likely to need healthcare.

To work in healthcare is to do a job full of meaning. So why is the culture of the NHS, as evidenced in the staff survey, so problematic?

(Our narrative doesn’t include social care in this positive future need, because potentially needing social care is a clear sign that we are frail and mortal and vulnerable. This is not highly marketable. It is extremely unaspirational. When we want to sell people things, we are generally selling concepts of perfection and perfectability; not concepts of managed decay and gradually growing need for support and help.)

That is part of why we heart the NHS.

And for those who work in the NHS, the interesting corollary of that demand side demographic inevitability is that they can know that their work has huge and effectively whole population meaning.

To work in healthcare is to do a job full of meaning. Rich in the potential to make a real difference to the quality (and perhaps even to the length of quality) of people’s lives.

So why is the culture of the NHS, as evidenced in the staff survey, so problematic?

Why does it feel as if we have got to a point in the national conversation where the NHS is a scapegoat and a whipping boy, rather than an icon?

Why does the NHS (alongside Brexit) jointly top the long running Economist/Ipsos MORI Issues Index?

The £350m a week question

Did any of us realise at the time what a powerful advertising slogan the “we send the EU £350m a week – let’s fund our NHS instead” was?

It hit the heart of the nation.

It was a brilliant strategy to link the weekly gross payment to the EU (and ignore the fact that net, we received more than half straight back).

No wonder that NHS Commissioning Board Sun King Simon Stevens has been assiduously calling for the NHJS Brexit bonus since.

If we get right back to the heart of what motivates most people to go into healthcare, it is what would make all of us most proud in our children. It is the desire to make a positive difference in the world. It is a wanting and a willingness to help.

Did any of us realise at the time what a powerful advertising slogan the “we send the EU £350m a week – let’s fund our NHS instead” was?

Nor should we ever ignore the fact that this meaning can be abused. One thing that should always make us fearful is over certainty that people are doing the right thing. We saw that in spades on both sides in the EU referendum.

We see it in the most gross examples of things going wrong in healthcare, from Mid-Staffs to Liverpool Community to Wirral. Perhaps if we are being Poe faced, “a little learning is a dangerous thing”, but the absence of even a little doubt is a signal to get the hell out of Dodge.

What does the NHS mean?

The NHS means an attempt to make healthcare universally available on the basis of clinical need, regardless of ability to pay.

That’s a good thing.

Maybe it’s about time we should try telling people – who work in it and who use it – that this is what the NHS means.