Lowering Of Unrealistic Public Expectations Is Only Way To Save NHS

January 22, 1999

The NHS: possibilities for the endgame. Think more about reducing expectation

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The demise of the NHS may lie in the mismatch between what is expected by patients and what can be provided by the health service, says Dr Richard Smith in an editorial in this week's BMJ. As well as improving the provision of our health care, Smith suggests that "...it would also seem sensible to work on expectations: death is inevitable; most major diseases cannot be cured; antibiotics are no use for the flu;

artificial hips wear out; hospitals are dangerous places; drugs all have side effects".

Speculating on the future of the NHS, amid "...the current media frenzy over the latest NHS crisis..." Dr Smith fears for the staff who suffer from the fallout of the mismatch between expectation and provision. "They are caught like hamsters in a wheel that must go faster and faster", he says and rather than being compensated for their poor pay by the feeling that they are doing an important job well, they are now dogged by a feeling of failure - "They now have low pay and disappointment." As a consequence, nurses and mangers are leaving the sector, while doctors contemplate providing their services outside the NHS.

Dr Smith concludes that the 'best health system in the world' is not one which provides "...everything for everybody..." but one that "..determines what society wants to spend on health care and then provides explicitly limited, evidence based services in a humane and open way without asking the impossible of its staff."

Contact: Dr Richard Smith, Editor, BMJ Tavistock Square, London t: +44 171 383 6102
f: +44 171 383 6418
email: rsmith@bmj.com


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