An outgoing NHS trust chief executive has delivered a stark warning that the health service must improve quickly or risk the public turning to "charlatans offering snake oil alternatives".
Nick Hulme, who is departing the East Suffolk and North Essex NHS Foundation Trust after 46 years of service, stated that while the NHS remains "the best system", it is currently "not producing the best results". His blunt assessment comes amid ongoing junior doctor strikes and a winter flu crisis.
A System Running 'Red Hot' and Political Peril
Hulme, who began his career as an 18-year-old porter and rose to become a trust chief, expressed deep concern about the service's vulnerability. "I can't remember a time when the NHS was at such risk," he said. He warned that persistently high waiting lists, despite slight improvements under Labour, provide "dangerous ammunition for Nigel Farage and the Conservatives" and fuel a narrative for those who wish to dismantle the service.
He highlighted the direct link between NHS performance and private healthcare, noting that the "top of Bupa's risk register is the danger that NHS waits fall". The concept of patient "choice", promoted by politicians, is unworkable without spare capacity in a system he describes as running "red hot". Hulme also criticised some consultants for allegedly keeping NHS waiting lists long to fuel demand for their private practices, though he acknowledged the difficulty in confronting powerful professional bodies.
The Pandemic's Lost Lesson and Warped Priorities
Hulme lamented the lost opportunity for lasting change following the Covid-19 pandemic. During the crisis, staff worked collaboratively across traditional boundaries, but he observed that they "went straight back to their restrictive practices" afterwards. This inertia, he suggests, stifles innovation and efficiency.
His experience leading a trust covering both affluent and deeply deprived areas like Jaywick and Clacton exposed the NHS's warped spending priorities. He noted that 70% of his hospital's beds are occupied by patients over 65, with 75% suffering from diseases linked to poverty—smoking, obesity, diabetes, and missed early diagnoses. "The NHS spends expensively on the effects of poverty that could be more cheaply prevented," he argued.
He gave a poignant example of skewed priorities: a Clacton postman with a knee injury, off work and out of sick pay, should be treated before a retiree needing a procedure to get back on the golf course. Yet the system often does the opposite.
Frustrations with Targets and the Road Ahead
Hulme's frustration extends to inspection regimes and productivity puzzles. He was exasperated by a recent Care Quality Commission inspection on whether his trust was "well-led", knowing the judgment would land after his departure. He also questioned why productivity gains are so elusive, even with new technology like the Epic electronic data system. "Why do some wards turn around an empty bed in 20 minutes, others take three and a half hours?" he asked.
Despite his criticisms, Hulme expressed some hope in Labour Health Secretary Wes Streeting's plan for 250 neighbourhood health centres. However, having seen similar plans come and go, such as those in Lord Darzi's 2008 report, he remains wary that hospitals will once again "swallow up all the money".
His final message is one of urgent caution. The founding principles of the NHS are under threat not just from political opponents, but from its own failure to deliver. "Unless the NHS improves fast, people will fall for charlatans," he concluded, departing a service he loves with a mixture of hope and profound fear for its future.
