Who cares about the NHS?

“Most politicians are not really interested in healthcare.” For the Prime Minister David Cameron especially, “politically there’s nothing in it for him.” These are the words of a former NHS chief executive as spoken by an actor in Michael Wynne’s absorbing new play about the health service, Who Cares. Over the past 18 months, Wynne has interviewed doctors, nurses, patients, campaigners and politicians; his play is a collage of verbatim transcripts that add up to a coherent, illuminating and sometimes moving narrative. What he proves is that many people are really interested in talking about healthcare. Especially so given that politicians from all sides in this election campaign religiously declare their love for the NHS, and perhaps promise a sprinkling of extra money until 2020—the Tories £8billion, Labour £2.5billion—but seem unwilling to explain how an institution set up during post-war austerity can serve a society with vastly different needs and expectations.

Wynne became interested in the subject while watching Danny Boyle’s homage to the NHS at the 2012 Olympics opening ceremony. A relative was being treated in hospital at the time and he was feeling emotional. “I just burst out crying when I saw that,” he told The Guardian. “Partly, it was what was going on with my family, but it was also this huge emotional connection. Then I wondered: what is it about the NHS?” It’s a good question. The health service retains huge affection among the population; but our faith has been tested in recent years by scandals such as the one at Stafford Hospital, where a shortage of nurses meant some patients were treated appallingly. Fortunately, Wynne’s play is not a misty-eyed encomium to Nye Bevan: it tackles some of the most difficult issues head-on, and explores the huge variety of reasons why a patient’s NHS experience can sometimes fail to live up to its ideals.

At the opening of the first act, entitled “Diagnosis”, audience members are led round the back offices of the Royal Court, which are mocked up as a hospital waiting room, operating theatre and GP’s surgery. We meet Marjorie, a 60-year-old nurse from Yorkshire who is the play’s beating heart. She followed her father into nursing in the early years of the NHS and as a sister tutor has trained many others. “When I’m dead and gone,” she says, “I can still be helping patients because all my students will be going out and they will be nursing their lifelong patients.” A cheerful lady, she’s always ready with a cup of tea (even the audience got one) who is phlegmatic about what she sees in A&E: drunks off the streets, self-harming psychotics, a miscarrying woman, a cancer patient between chemotherapy. The founders of the NHS could not have easily envisaged any of these cases. Before care in the community, mental hospitals dealt with the mentally disturbed; a district midwife would have seen the pregnant woman and, as a senior consultant tells us in the play, cancer wards were once places where you went to die, not be treated. The NHS now deals with an astonishing one million patients every 36 hours.

Its not only numbers that have rocketed, but also the cost of each treatment. A cardiologist told us that she once treated a heart attack with the clot-busting drug Streptokinase: cost £50. Then came the slightly better TPA: cost £500. Now there’s angioplasty, putting stents in arteries, again slightly more effective but not much more: cost £5,000. (The procedure is comm among because doctors find it “quite sexy and exciting.”) Cardiovascular disease, as another cardiologist Dr Malhotra tells us, is the biggest killer in the western world. Poor diet costs the NHS billions. “Food can be the most powerful form of medicine but also the slowest form of poison,” she says. NHS staff are hardly exemplars in this regard: 50 per cent are overweight or obese, and you can easily find junk food sold in hospitals. In medical school, Dr Malhotra tells us, “there was not a single lecture on the impact of nutrition on health, not a single lecture.”

We have also seen a societal shift in attitudes towards death. You no longer suffer from an illness, you “battle it”; dying is seen as “losing a fight” that could with better tactics and resources have been won. Doctors are magicians who can cure any disease. And so we pressure the NHS to do everything to intervene to prolong life—no matter what. As Nurse Marjorie says, she has heard of a 101-year-old having a pacemaker fitted. This emphasis on medicines and operations—which the NHS in general does very well at providing—means palliative care for the sick has been neglected. In act two, “Diagnosis”, we hear the tragic story of Jacky, whose mother suffered from dreadful treatment towards the end of her life at Stafford Hospital. “I’d say 40 per cent of the staff were just absolute angels,” she says, “they just ran themselves ragged—but 60 per cent of the staff, they just bullied the patients, they bullied the other staff.” On some days the nurses claimed to have lost the keys to the drug cupboard. After she complained to the press, Jacky received hundreds of emails echoing her experiences. She also became the target of hostility from locals who didn’t want their hospital closed.

Solutions are hard to find. Towards the end various politicians, accountants and administrators are all allowed to put forward their competing arguments. Should private provision be abolished and the NHS be returned to its socialist beginnings? But no one minds that GPs are independent providers funded by the NHS. Should we, as the Tories and to some extent Labour want, increase private delivery of services while retaining it as free to use? But Mid Staffs’s problems were caused when the chief executive Martin Yeates needed to save money to convert his hospital into a foundation trust and decided to cut nursing provision. Three quarters of NHS hospitals are in deficit to the combined tune of £860million. One ex-NHS chief executive calls his policy “managed decline”: staff are too dedicated to let the whole thing go under, but a time will come when the services the public demands become unaffordable.

At the heart of Who Cares are the people who make the NHS tick along. People like Dave, a Brighton paramedic, who speaks with quiet pride of the buzz he gets when he’s had a chat with someone, made them a cup of tea or held their hand when they’re frightened. In order for that kindness to remain at the core of healthcare provision we need to think seriously about how much we’re asking the NHS to do. And whether we’re willing to either lower our expectations or pay more in tax to fund the kind of universal, on-demand and up-to-date service the NHS aspires to be.

Who Cares runs at the Royal Court until 16th May