Viewpoint: Is the machine about to stop?

In 1909 author EM Forster published a short story, The Machine Stops.

The tale is a work of science fiction with a philosophical edge. It describes a futuristic dystopian world where humankind has abandoned the surface of the Earth to live in individual rooms (cells) contained in a vast worldwide machine. The machine provides for their every need and function including communication and medicine.

But the story speaks about more than just global dependence on technology. It is a metaphor for an organisation or system where people become increasingly diminished and insignificant.

In Forster’s story the principal character states towards the end of the tale: “The Machine is stopping, I know it; I know the signs.” Things start to go wrong, subtly at first while the inhabitants adjust and adapt to the defects, but becoming increasingly serious, eventually leading to the inevitable disastrous conclusion.

So is the NHS machine stopping – are we heading for a cataclysmic healthcare disaster?

Warning signs are certainly there, and have been worsening for some time as more Trusts are put into “special measures.” A 2016-17 deficit of around £1bn is predicted.

There are shortages in multiple specialities, and we hear of A&Es closing due to inability to recruit. This winter four-hour targets have been replaced by long trolley waits in corridors, with some hospitals even employing teams of “corridor nurses.”

Operations are delayed, cancer targets missed, and waiting lists lengthening. Mental health services are at breaking point. General practice is under severe strain.

A BBC analysis published at the start of February showed that since early December patient numbers on hospital wards had been at unsafe levels in nine out of 10 hospitals, with bed occupancies above 85 per cent, rising to 97 per cent in some cases.

Much of this is detailed by the GMC in its annual report of 2016, which paints a deeply worrying picture.

This report should be read and seriously digested by the profession and all those responsible for running the NHS. Among many things it highlights the poor morale and alienation among junior doctors who are the future of the service, related partly to the recent contract debacle but also to a range of non-contractual issues.

Consultants see personal pressures increasing year on year while reported levels of stress, depression and anxiety are at an all-time high.

So, is the NHS in terminal decline? In the short to medium term, “the end is not yet nigh,” due to the incredible dedication and commitment of the NHS staff at all levels who endlessly rise to the challenge and adapt to the inexorable increasing demands.

Yet in the face of myriad warning signs, the politicians have no answers other than to take a lead from another science fiction
work and engage in breath-taking Orwellian double-speak.

The machine is not stopping yet, but the future remains highly uncertain.

Dr Tom Goodfellow is a retired Consultant Radiologist and past HCSA Executive member.