By Nuwan Dissanayaka

“These are the hands that touch us first…and last” wrote Michael Rosen in his celebratory poem about the NHS a decade ago. And since its birth seventy years ago the NHS has, against the odds, continued to care for us from cradle to grave. It hasn’t achieved Beveridge’s vision of eradicating Want, Disease, Squalor, Ignorance and Idleness, but I doubt anyone today would identify with these anachronistic aspirations.

But in its autumn years, has the NHS lost sight of the spirit of its founding principles? The 1967 book “A Fortunate Man” by John Berger tells the story of John Sassall, a GP living and working in a remote country practice in the Forest of Dean. Much more than a collection of case studies, it paints an intimate and sometimes painful portrait of a dedicated and inspirational man, with a sense of belonging to his rural community of villagers and foresters. A man who subjected himself to deep introspection, he valued the fraternity he formed with his patients.

“'Where you're different Doc is I know I can say F**k You to your face if I want to.' Yet the speaker never has said F**k You to Sassall.

This sentiment resonates with me. My career in psychiatry has taken me to many places. After a grounding in medicine and surgery I embarked on this amazing journey which carried me first to the now-abandoned asylums and from there to the frenetic milieus of the acute wards, the stern sterility of the general hospitals and the claustrophobia of the secure units. I have cared for the young and the old, patients of myriad heritages, in hospital and the community. 

I embarked on this amazing journey which carried me first to the now-abandoned asylums and from there to the frenetic milieus of the acute wards, the stern sterility of the general hospitals and the claustrophobia of the secure units.

My passion has always been psychosis and I have dedicated my last fifteen years to Assertive Outreach, a dwindling specialty devoted to people suffering from psychosis who are unfairly criticised for “not engaging” with services. With our help they do engage and the reason, I think, is rooted in that very same fraternity between clinician and patient that Berger captures so very vividly. My patients often don't stop short in their use of profanity, yet I have been as fortunate as Sassall in my experience of those precious therapeutic relationships.  Like him I see patients out in their communities, the grit of Leeds’s redbrick terraces replacing the weathered Gloucestershire farmhouses.

In the quixotic quest for ultimate efficiency, patients like those I support have been left behind. The asylums desperately did need to close their heavy doors, but in their wake they left behind an abyss into which the most vulnerable were cast. The alienation of frontline clinicians from the commissioning of services has led to the neglect of the few in favour of the many, and the unintended consequence of much-needed innovation has digitally excluded those who lack the skills and means to navigate this strange new landscape. Impenetrable medical jargon has been superseded by equally impenetrable management-speak. And the decimation of primary care has removed the first and last remaining support for many with mental illness.

The asylums desperately did need to close their heavy doors, but in their wake they left behind an abyss into which the most vulnerable were cast. The alienation of frontline clinicians from the commissioning of services has led to the neglect of the few in favour of the many 

Yet there is hope. Every day amongst clinicians and managers in the NHS, I see a growing discontent about the harmful consequences of these changes for patients. This anger carries with it an energy which could, if harnessed and if trusted by decision-makers, enable clinicians and their patients to recapture the original essence of the NHS, to co-produce new and exciting services equipped to compassionately care for us all for the next 70 years. 


This blog is part of our NHS 70 series. Take a look at other posts in the series.