FIVE Questions about the NHS – Where will the NHS be in 70 Years?

In collaborating with the BBC for this year’s 70th anniversary of the NHS we wanted to find out how people felt about the future of the NHS, as well as thinking about its past, and so another question that we felt it was important to put forward to the interviewees was; ‘Where will the NHS be in 70 years?’

Taken at face value such a question would appear to be straightforward enough, and yet when you really think about it, this is perhaps a little trickier to answer than it might appear. My own head immediately ran to images of health dystopias, of technology run amuck or Hunger Games-style competitions for healthcare, or else a utopian land of endless funding and truly equal treatment, perhaps even free prescriptions….

What becomes clear in the interviews, however, is that how a person answers this question is very much tied to their deeper feelings about the NHS. For nearly every single one of the fourteen interviews we have released so far you can hear each person speak about fear and, overwhelmingly, hope. Such feelings are natural enough when thinking about the future, but what comes across in these interviews is that it is in fact hope that is the overriding vision of the NHS in 70 years; hope that it will still be here, and hope that it will remain true to its core principles, as a universal service that speaks to the very core of our civilisation.

As this last point highlights, the flipside to that emotional coin is fear; fear that we will lose it, that it will become ‘a series of private companies’, or too much like an American model of healthcare (Dr Elphis Christopher describes this as ‘I do not want us going down the American way’, and suggests that ‘prevention is better than cure’ – perhaps that applies both in terms of our own health and that of the NHS itself). What is striking, however, is that those very feelings of hope and fear are a big part of our previous question – ‘what would you do for the NHS?’ People talk about fighting to keep the NHS, the need to preserve it, and that it may well need to evolve and adapt. One interviewee even spoke proudly of ‘doing everything possible to keep it going’.

And this after all is perhaps something that is key to understanding the relationship between the British public and the NHS; it is for many a living, breathing public institution, part of the fabric of our ourselves and our identity, and that means for making sure that we fight to keep it alive and keep it going. There is a sense for many people that our apathy and neglect could result in a future in which the NHS is lost. Perhaps it is in this way that the NHS does reflect the best in society – not just in the admirable moral principles that underlie its foundations, but in how it can often bring out the best and most civilised in our society, as people stand together to fight for its future.

This then, is far from the nightmarish dystopia that first sprang to my mind, but the utopian future of the NHS is in fact there, in these interviews. People ultimately put their hope ‘In Place of Fear’, as Nye Bevan once called for. Perhaps the last word then should be had by Jackie Serrano who ultimately believes in a better future for the NHS: ‘we can do more, we can do wonders’.

Science Museum Workshop, London

As the excitement builds towards celebrating 70 years of the NHS, a hive of activity is emerging to highlight the importance of this national institution. Visibility has become a key watchword in such activities – media representations in documentaries, news and radio pieces, theatre productions and exhibitions, to mention but a few, are each determined to explore and represent what the NHS means to the British public.

The Science Museum in London has taken up this mantle with no less gusto, with a section of its new Medical Galleries to include a display relating to the history of the NHS. Though not focused on an opening for the anniversary per se, this project opens up important questions regarding how we represent the NHS visually, and it was with this in mind that I was invited to run a standalone 2-hour artist workshop with their steering committee. This, however, is no ordinary steering committee. Composed of group leaders and representatives for the public groups that the Science Museum is working closely with in order to produce the NHS display, including Homerton University Hospital, Adelaide Medical Centre, Watling Medical Centre and A.S.A Disability, the aim for the Museum is that public participation should be a key driver in producing the final NHS display. Short films have been proposed that will be produced by collaboration with these groups, through their stories, memories and ideas of what the NHS means and has meant, with examples of how this might be presented visually. But as any ad execs worth their salt would undoubtedly point out, user-generated content may be the gold dust of today’s media and creative economy, but it is equally difficult to negotiate and produce. This task is made even more tricky when the subject under discussion is suffused with ideas that depend on so many intangibles.But this task is made even more tricky when the subject under discussion – the NHS – is suffused with ideas that depend on so many intangibles. Compassion, inclusion, pride, levelling and security are just some of the values that we associate with the NHS that appear to prove more difficult to represent visually. As one participant put it: ‘you have your work cut out for you’.

However, working from the material generated by participant interviews, and from photos that the participants were asked to send, representing their experiences and thoughts of the NHS, the group quickly ran full steam ahead. By the close of a very fast-flying 2 hours we were able to produce mood boards, images and ideas, that began to go some way to representing the NHS, and its complex network of meanings. ‘NHS word cards’ created from random selections from participant interviews were particularly successful, in which the team was split into groups and asked to create a ‘continuum’ using these words, having been asked to decide which words they most agree or disagree with when thinking about the NHS. The same cards were then used to create themes, and those themes were then used a starting-point, with the images sent in, for the mood boards.The activities were purposefully kept simple, with the workshop taking a much slower step-by-step approach than would otherwise be taken with a more experienced, practical art group, and the use of the usually (somewhat messy) materials I incorporate into workshops was inappropriate to the needs of the Museum and the setting.

The Museum will continue to work with the groups, as this is an ongoing collaboration for them that will take some time and dedication. However, as a standalone exercise there was much to be gained from this event, and not just for the Museum and the participants in moving forwards with the display. As I left the close of the session, that somewhat brutal, yet insightful, comment from a participant – ‘you have your work cut our for you’ – still rang in my ears. It left me wondering if it is indeed nigh on impossible to represent the NHS and its complex ideologies though static images or objects. Even in TV drama and film, we implicitly assume that the footage we see – an unfolding drama a&e drama, for example –  is the NHS. We assume so unless decidedly told otherwise because the NHS, fundamentally, is medicine for almost all of us.

But more than this, I wondered, when it comes to trying to get to grips with the NHS and its meaning through exhibits, objects and images, are we stuck with either quite literal images that fall short of saying anything meaningful or with depth, or else a collection of visual symbols that most would need a doctorate in Art History to comprehend? Perhaps not. For one thing, there is indeed space for both the literal display– through say, the material culture of campaign banners and protest photographs – but also, and alongside it, the more metaphorical exploration. Indeed, representing ‘intangibles’ is what art, film and even museums, very often, do actually do. So it is perhaps the greater disservice to assume that the public would not have the appetite, or visual literacy, to engage with such displays. Indeed, in my previous research on abortion I wrote 80,000 words explaining how abortion has been used in literature to represent wider, existential concepts, and produced a recent article for Feminist Legal Studies discussing the same obstacles around visual encoding for abortion, but without resigning to ultimate ‘visual defeat’. The British public literacy around the NHS, in fact, was evident in responses to the 2012 Olympic Opening Ceremony. While many nations watched on in utter confusion at the amalgamation of children in hospital beds, fictional heroines and dancing nurses and healthcare staff, the British public knew exactly what all this meant: this was ‘our NHS’. The most invisible visible institution of them all.

Exploring the Radical NHS

As part of the Radicals Assemble: After Hours season at the People’s History Museum in Manchester, members of our team and speakers from Keep our NHS Public Greater Manchester gathered together to voice their thoughts, showcase their research and enter into lively discussion with the public, working under the banner of ‘A National Religion: Activism, Public Opinion and the NHS’. From our project itself, Jenny Crane, Jack Saunders and George Gosling formed part of the panel of speakers, covering topics such as the relationship between the local and the national, and considering how these might affect campaigning challenges and opportunities. The role of activism in the workplace was also discussed, questioning how this might be distinctive within the NHS, as well as the complex role of the use of graffiti in defending the NHS, and how this does – or perhaps does not – align with graffiti’s radical potential.

From Pia Feig and Sue Richardson, representatives from Keep Our NHS Public Greater Manchester, we gained great insight into both the history of their campaigning group, but also some sense of exactly just what it is that the NHS ‘means’ to many people. Pia and Sue were keen to stress that the NHS is ‘not just a folk story’ but an actual need in life, and that it is part of what it feels to be British for many people, and that this is reflected in the level of public support for strikes by NHS staff. They also highlighted that support for the NHS in fact tends to be episodic, and clearly linked to the specific services or even buildings and hospitals that members of the community regularly use. Again this raised the question as to how local support can be translated into wider collective action, while underlying such motivations was undoubtedly the sense that the NHS exists as a marker of a fair society.

Opening questions up to the audience sparked a lively and greatly informative discussion, where questions were asked that provide much thought for further study. One attendee asked ‘to what extent does the New Labour adoption of neoliberal ideas make it difficult to campaign against change?’ – highlighting an emerging potential conflict of interests between Labour supporters and those in support of the NHS. This was clearly a concern for much of the audience, who wondered whether it is more difficult to campaign against changes when it is Labour making those (neoliberal) alterations to the Service. The wider question for much of the group here is whether there has indeed been a move from the NHS’s socialist origins to a neoliberal model?

Given the context of DevoManc, the tensions between the local and the national would appear to be the over-riding theme of the discussion. Reconciling local motivations with national rallying cries is undoubtedly a thorny issue, but something that was called for by most. An example of these difficulties was given in the case of hospitals having their own ‘little ecosystems’, and indeed local hospitals and GPs were said to be integral in building identification with the NHS, which, some in the audience argued, appears to be an almost irrational attachment. At the same time, however, audience members from as far afield as the United States and Germany called for the need to explore the NHS in relation to other international health service provisions, while highlight a praise for the NHS that does not necessarily translate across to other countries. Finally the NHS was proposed to be the last institution embedded in socialist ideology, that (and perhaps somewhat paradoxically) gains support irrespective of politics.

Find out more about our activities at the People’s History Museum