Chris Lancelot on dehumanisation of the nhs

The recent debacle over Modernising Medical Careers (MMC) has served to highlight how totally impersonal the NHS has become.

The computerised version of MMC functioned like the army: you had little choice over where you were posted. There’s a vacancy — and for the sake of the service, that position must be filled. You want to be a surgeon in London? Never mind — there’s an unfilled psychiatric post in Edinburgh: you will be offered no alternatives. It doesn’t seem to matter to NHS management what effect this might have on the personal or professional lives of junior staff. You’re married to another doctor, with a young family? No matter — the husband is given a job in Basingstoke, his wife in Barnstaple. No one gives a fig about the marriage, nor the children’s schooling.

You study medicine for six years, then try to get a training post. There are none left. Never mind, you can emigrate: who cares about your elderly widowed mother?

Or you’ve trained as a physiotherapist. We are desperately in need of more physiotherapy slots but there’s no money, so newly qualified physios are thrown on the scrap heap. Who cares? Not the NHS.

Or maybe you’re a primary care organisation (PCO) administrator: because of mergers you have had to reapply for your own job on three separate occasions, with all the worry that this has entailed.

It’s not just the staff: the patients are suffering too. Some PCOs insist on a mandatory delay before any operation. The patient is forced to wait, often in pain, for no more important reason than financial target-hitting. Another ploy is to post appointment invitations just a day in advance: if the patient goes out to work they return to find their much-desired appointment slip waiting — for earlier that day. And because an appointment has actually been created, the waiting-time limits haven’t been exceeded, even if the patient didn’t (or couldn’t) attend.

Ironically, at the same time as this dehumanisation is occurring, we are impressing upon students the importance of communication in high-quality patient care. Yet NHS upper management is doing the opposite, stressed to the point where it treats both staff and patients as objects without feelings. Welcome to the new NHS. A less emotionally-fit-for-purpose enterprise is hard to imagine. 

Dr Lancelot is a GP from Lancashire. Email him at

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