Chris Lancelot on…a diagnosis for the nhs

I have always been intrigued by the way in which groups and organisations can behave like individual people, even to the extent of exhibiting the same sorts of psychopathology.

Groups of people can become depressed (when no-one wants to talk), anxious (when everyone talks at once), or even schizophrenic (when a sub-group is so alienated from the main group that it goes off to meet separately).

And so I began wondering: if the NHS were a patient, what would be the diagnosis?

Clearly the patient is very sick, because it is not functioning properly — yet it is being provided with vast resources so it can’t be suffering from simple malnutrition. Perhaps it has diabetes, classically described as ‘starvation in the midst of plenty’?  In diabetes the cells are crying out for glucose, yet there is an abundance in the blood:  it just can’t easily move to the tissues. In the NHS, large amounts of money don’t move to where they are truly needed — the front line.

Or maybe the NHS is suffering from cerebral palsy. In cerebral palsy the brain can think subtle actions, but these commands aren’t transmitted in coherent form to the muscles. Two weeks ago a stack of patient group directives thudded onto my desk. I signed them without even a glance at them. I simply don’t have the time to read all this, even though it has obviously been prepared with considerable thought and care.

Doesn’t cerebral palsy parallel the situation in which the central NHS and its managers devise all manner of complex plans which don’t actually result in peripheral action because of lack of time or resources for healthcare workers?

Or perhaps the diagnosis is MS, because not only do commands fail to get out properly from the centre to the peripheries, but sensory information doesn’t get back reliably to the centre. Ministers and high-ranking managers are protected from hearing the truth from the coalface because there are so few routine channels for ordinary health workers to communicate their difficulties and problems.

Are any of these the right diagnosis? Maybe there is multiple pathology here. Clearly the NHS is sick, possibly even terminal.

What diagnosis would you make, and why? I’d be interested to hear your responses — email me at the address below and GP will publish the best of them.

Dr Lancelot is a GP from Lancashire. Email him at

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