Thatcher made NHS a factory, SNP should restore health service of old – Harry Burns

The decision by Margaret Thatcher’s Government to hand power to NHS managers concerned more about money than patient care and turn doctors into workers on a factory production line is one reason why health service staff are so stressed out, even to the point of suicide, writes Professor Sir Harry Burns.

A supermarket boss brought in by Margaret Thatcher's Government was the author of 1980s NHS reforms that are still having a devastating effect on its staff

Doctors are not unbreakable. I trained in surgery in the Western Infirmary in Glasgow in the late 1970s. It felt like I was part of a family. We looked after each other. If one of us had a problem, colleagues would help out. All staff, whether doctors, nurses, porters or hospital administrators had a common purpose: to ensure services to patients were as good as we could possibly deliver and, as a result, our jobs were immensely satisfying.

We achieved this through clinical and administrative staff arriving at a consensus as to what needed to be done. We were a team and it was a happy place to work. Times have changed. Working in the NHS no longer seems so satisfying. GP surgeries are closing because there are no applicants for vacant partnerships.

Consultant posts are unfilled in many specialties. There are increasing reports of doctors cutting their hours or giving up altogether because of changes to pension taxation rules. The Royal College of Nursing recently reported a shortfall of 40,000 nurses in England alone. Across the UK, there are reports of 100,000 vacancies for frontline NHS staff.

Most worryingly, a recent BMA survey of 4,300 doctors found that eight out of ten felt themselves to be at risk of burnout and four out of ten were suffering from psychological or emotional distress.

One such doctor was Alastair Watt, a consultant physician who single-handedly ran the diabetes service in a general hospital in Devon. The senior consultant on the service had retired in 2012 and, despite many attempts, the vacant post had not been filled. Alastair was clearly under pressure in supporting his patients and his colleagues.

Known as ”the beast” because of his super fitness, he was cycling in the Brecon Beacons in April 2016 when he had an accident and sustained a head injury. He ended up in intensive care and his return to work was difficult.

Twenty months after his accident, he was found dead in a field close to his home. He had injected himself with insulin and an inquest recorded his death as suicide. He left behind a wife and 12-year-old twins, a son and a daughter.

Reading the accounts of his efforts to return to work, it seems the stress of being the only consultant in the diabetes service was an issue. He wanted to support his patients and colleagues but management concerns about his fitness to work caused him great anxiety.

This tragedy reflects many of the problems facing NHS staff who feel unsupported. In 1983, Mrs Thatcher asked Roy Griffiths, then deputy chairman of Sainsbury’s, to review the management of the NHS. Management by consensus was finished.

The Government’s response to Griffiths’ report stated: “We do not undervalue the importance of consensus in a multi-professional organisation like the NHS. But we share the report’s view that consensus, as a management style, will not alone secure effective and timely management action, nor does it necessarily initiate the kind of dynamic approach needed in the health service to ensure the best quality of care and value for money for patients.”

This “effective, timely and dynamic management action” meant the important issues for the NHS became financial control, value for money and increasing efficiency. Power was handed to managers who monitored performance by setting benchmarks and targets.

Some NHS services were privatised. Doctors became workers in a production process.

The Scottish Government has rightly enacted legislation to require health boards to plan and deliver adequate staffing levels. If the NHS wants to attract more doctors to work here, they might try to recreate the supportive and cooperative atmosphere that existed before Mrs Thatcher turned the NHS into a factory.

Patients would benefit and doctors and nurses would have better lives.

Professor Sir Harry Burns is director of global public health at Strathclyde University