The NHS: Celebrated and damned
Authors: Kamran Abbasi
Journal: Journal of the Royal Society of Medicine (2014)

Is the National Health Service on the brink of disaster or it the best in the world? I ask this in all innocence since within a few days of each other, reading contradictory headlines in the same newspapers, you might be forgiven for being thoroughly confused. Of course, it is a newspaper's duty to report on developments in a matter of fact way, whichever way they swerve, just as it is a journal's responsibility to entertain any reasonable argument or research that might interest its readers. The vast majority of medical journals are passive enterprises, reacting to articles submitted to them and hence a hostage to the whims of authors. Major newspapers, by contrast, have teams of journalists and editors doing their damndest to dig to the bottom of a story. Admittedly, for some newspapers doing your damndest is a superficial scrape, but such cursoriness is a level of proactivity that medical journals might envy.

According to reports the NHS requires extra funding to prevent longer waiting times and staff cuts. If I told you that the extra funding was less than 1% of the NHS budget, you might be less interested in the story. What difference would that make either way? It is when you point out that we're talking about an extra spending of £2 billion on top of a budget of around £110 billion that you might become more interested. One percent means very little, two billion is something to get worked up about. Some doctors believe that the finances of the NHS cannot be cut any further. Others argue that the service is on the verge of collapse and being systematically destroyed. The question in my mind is how can we know?

Equally, when the Commonwealth Fund rates the NHS as the most efficient in the world, is this news even true? Being the worst is big news. Being the best tends to be merely worthy of note. A middle rating is generally a waste of news print. Whatever our health service scores it is hard to imagine any serious scrutiny of the research methodology for such a ranking system, unless it is a battle between academics. Clearly, the Commonwealth Fund didn't talk to too many of the people who believe that the NHS is beyond a basket case. Again, the question in my mind is how can know?

This not knowing is a fundamental driver for medical journals. Our role is to help answer some of these questions but it is quite tricky when the arguments are played out in the general media, whose agenda may be to get at the truth but it is also to win eyeballs and advertising pounds. The journal business is also one of eyeballs and advertising pounds as well as publishing research papers that will lead to citations, and it is this last element that separates journals from newspapers. But there should be another point of differentiation, which helps us get to the truth of some of the unanswerable questions, and that is the role of medical journals in being a voice of clinicians. In the game of citation-chasing advertising pounds, the clinical voice is often squeezed out. And if I listen to clinical voices from the frontline, our best barometer of the state of our health service, I hear pain. It may not be a disaster just yet, but there is hurt and anger in our lockers and it's coming out.

The JRSM is interested in hearing clinical voices. Why not submit an essay or a shorter, more personal, podium piece to share your views on the well-being and future direction of our celebrated and damned health service?