How you can help the NHS to recover from its sick bed

After 10 years reporting on health issues, Pennie Taylor is leaving newspapers behind to work in the NHS. But, she argues, it is not only those employed by the beleaguered service who have a role it its future

WHAT image comes to mind when you think of the National Health Service? To increasing numbers of people it seems to involve genocidal GPs, bungling surgeons and a money-driven, cover-up culture.

Gone are the days when the NHS was simply a source of national pride. Modern pressures mean public mistrust is intensifying and unless that can be stemmed, there is a distinct danger the original dream of universal health care will die.

South of the Border, large tranches of the middle-classes gave up on it years ago. But Scotland has been different - until recently, that is. Over the past 12 months, the number of Scots with BUPA private medical insurance alone has risen by 4%, and the trend is predicted to grow. "All the negative publicity surrounding the winter flu crisis and the long waiting lists seems to have had an effect," said a BUPA spokesman. "People no longer appear to trust the NHS."

As a journalist who has specialised in covering health issues for the past 10 years, I have been partly responsible for exposing the flaws in the system that seem to have have made so many so jumpy. Now I am to change perspective and will soon be joining the National Health Service to see what I can do to help the much-cherished but beleaguered institution to survive.

As Head of Communications for the Lothian University Hospitals' NHS trust in Edinburgh, it will be part of my job to help explain the increasing complexity of healthcare delivery to a public that quite rightly demands to know what is really going on.

The trouble is, the whole issue is shrouded in a miasma of mistrust. You would think I had pledged my soul to Satan, or at the very least taken Monsanto's genetically-modified shilling, to judge by the reactions of some fellow hacks, on learning of my imminent move.

According to the Fourth Estate's finest, swapping the newsroom for the NHS constitutes "selling out" and "joining the other side". The "poacher-turned-gamekeeper" line is the least original. Actually, it feels more like poacher-turned-pheasant. I had expected cynicism, but the vehemence came as a surprise. I own up to being a health service 'anorak', but I view the NHS as a fundamentally well-meaning outfit that struggles against the odds and needs all the help it can get. To my opinion-forming critics, however, it seems more an object of intense antipathy.

To an extent I cannot blame them. In the not-so-distant past many health service managers saw it as their duty to keep information hidden, and journalists grew accustomed to being lied to and misled. Now there is an increasing realisation that if the monumental challenges the National Health Service is facing are to be met, then the people who foot the bill - the taxpayers - have to be consulted.

ALARGE part of the public's lack of understanding is the NHS's own fault. Until the early 1990s nobody took much notice of it. Then the Conservatives railroaded through their market-led reforms, imposing the number-crunchers on hospitals to find out, for the first time, what healthcare really cost.

Competition between hospital trusts was, by some complicated reasoning nobody could adequately explain, meant to deliver greater value for money and boost patient satisfaction. Only it never seemed to work out that way. As costs rose, so did expectation - and complaints. Although it had never been what you might call high, staff morale hit an all-time low.

There is a body of opinion that blames it all on the emergence of the patient-as-consumer, and the so-called "suits" wresting the power from the frontline specialists. Uncomfortable questions were asked about doctors' clinical practice and performance, league tables comparing outcomes drove the message home, and NHS consumerism won the day.

The antagonism and suspicion inflamed by that culture clash has never really died down. Neither has the public interest. Health ranks as a leading concern in whatever opinion poll you care to count. The National Health Service matters to people, and stories about it sell, particularly when they are shocking. The media comes under constant criticism from health professionals for presenting an alarmist, one- sided impression of an incredibly complex debate. However, in journalism, the accepted wisdom is that good news is no news. As one old hack used to say: "We're not interested when they are getting it right, because that's what they ought to be doing. We're only interested in what they are getting wrong."

Admittedly, the nuance of the National Health Service is hard to explain. When it was formed in 1948 there was no blueprint for a universal healthcare system, free at the point of use, and it evolved in sometimes peculiar ways.

The original theory was that once illness was eradicated, the funding needs would fall. Tuberculosis, pneumonia and the traditional scourges may have been beaten back, but contrary to that early expectation the pressure on the service has inexorably increased. There is a truism that NHS demand will always outstrip supply. In other words, no matter how much money is put in, there will never be enough to meet the need. That is a tough one for politicians. In opposition it is relatively easy to criticise lack of funding, but every government is faced with the same intractable dilemma - how to square a desire for low taxation with escalating patient expectation?

One approach has been to eliminate waste, but it seems there is little of that left. Without a massive injection of cash, the doom- mongers have been predicting that the crunch would come. Now they say it is here.

The demands of treating an increasingly ageing population with ever-more complex conditions, and the advent of expensive drug and technological developments, have stretched health service budgets to the limit. That will not stop.

Among leading medics the debate about alternative methods of funding is brisk. Should we means test patient care, or introduce mandatory insurance, and what about paying to see our local GPs? Another option would be a sharp hike in tax, the preferred method of funding when the National Health Service was formed. But that option does not figure large in the on-going debate about the hard choices facing the modern NHS.

Nobody is pretending that very hard decisions do not have to be made about the future of the NHS. The question is, who should make them?

That used to be the prerogative of the so-called experts, who traditionally reached their conclusions behind closed doors and did not feel the need to explain them. Now the public say that they want to be involved, but with that right comes onerous responsibilities.

Now, as never before, the NHS needs help to set its priorities, and that requires the open and honest involvement of all of us.

Over recent weeks, Susan Deacon, health minister, has exhorted senior managers and frontline staff of the NHS to change their entrenched attitudes for the benefit of patients. That applies to the media and general public too.

If the NHS is to thrive, radical solutions to persistent problems must be found. That will require robust and intelligent debate, and a real commitment to finding workable answers. Opting out by paying for private health insurance might seem like a solution to those who can afford it. For many millions of other Scots however that will never be an option.

Anyway, as anyone who has examined the question knows, when it comes to the really important things, patients are still far better off being treated in the NHS, where there are dedicated staff with the most up-to-date skillsand proper back-up should anything go wrong.

Surely it is in all our interests to keep the nerve, pursue the vision put in place 50 years ago, and work to find ways of making the National Health Service work better instead of theorising about how to kill it off.

Sarah-Kate Templeton will be taking over as Health Editor

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