An outgoing NHS trust chief executive with nearly five decades of service has issued a stark warning: the National Health Service must improve rapidly or risk the public falling for "charlatans" offering alternatives.
A Brutally Honest Exit Interview
Nick Hulme, who is leaving his role as chief executive of the East Suffolk and North Essex NHS Foundation Trust, spoke with characteristic bluntness as he prepares to depart the health service after 46 years. He began his career as an 18-year-old porter and rose through the ranks, even spending time inside Boris Johnson's Number 10.
"I can't remember a time when the NHS was at such risk," Hulme stated, pointing to stubbornly high waiting lists despite increased funding and staff under the current government. He warned this situation provides "dangerous ammunition" for political opponents like Nigel Farage and creates a narrative for those who "want to kill the NHS".
The Paradox of a System Under Strain
Hulme described familiar NHS dilemmas, where the system is "running red hot" without the spare capacity to offer genuine patient choice. He expressed frustration with professional silos within organisations like the BMA and Royal Colleges, which he says resist innovations like physician associates used widely across Europe.
He lamented how the collaborative spirit of the pandemic, where staff worked "out of silos", quickly dissipated afterwards, with a return to restrictive practices. The trust head also criticised some consultants for allegedly keeping NHS waiting lists long to fuel demand for their private practices, noting that private healthcare provider Bupa's top risk is NHS waiting times falling.
Inequality and Warped Spending Priorities
Hulme's trust covers both affluent areas like Aldeburgh, with its volunteer-supported cottage hospital, and some of England's poorest communities, including Jaywick and Clacton. He highlighted stark inequalities, where wealthier areas benefit from community fundraising while deprived communities face GP shortages and transport barriers to care.
He revealed that 70% of patients in his hospital beds are over 65, with 75% suffering 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, advocating for a social priority list that would treat a working postman's knee before a retiree's golf injury.
Despite challenges, Hulme expressed some optimism about Labour's proposed 250 neighbourhood health centres, though he remains wary based on past failed initiatives like Ara Darzi's 2008 clinic plans. His final warning was unequivocal: "Unless the NHS improves fast, people will fall for charlatans offering snake oil alternatives. This is the best system, but not producing the best results."
