I HAVE said for many years that the genius of Primary Care is that it meets patients in the intersectionality of their various conditions.

When I visit the respiratory nurse about my asthma, they are aware of my other conditions when they treat me. I have been seeing the team for over 20 years and am treated as a whole person.

I recently spent three weeks in hospital as an in-patient. I had one of those illnesses that is hard to define and could have been one of several things. Now, let me first say that the people in the NHS were caring and well-intentioned. Secondly, I am fully committed to a health service that is state owned and free from private influence.

The issue I have is that the system is broken and stretched beyond reason.

No-one seemed to take ownership of my condition. The consultant recommended a heart scan and was refused by the cardio department. From day one it was recommended that I had an MRI but due to complications this didn’t happen, and I have since had to make requests at a neighbouring hospital. I was promised physio care when I was discharged from hospital but have heard nothing since.

This complaint is not primarily about me; it is about the dysfunctional nature of healthcare in the UK. Stretched units with the NHS are working as fast as they can but in general must look at themselves in isolation.

The imposition of key performance indicators (KPIs) often used in business has not helped in this matter. They are often at heart functional measurements of the system and tend to be quantitative by nature (functional). They have the tendency to influence behaviour rather than just record activity. In Primary and Secondary Care they may look at how many patients were seen in a particular period (functional) without truly reflecting the complexity (organic) of each person’s situation.

If I had the chance to speak to Wes Streeting (which is highly unlikely) I would make the following points to him and his colleagues:

* Although systems are constantly in need of reform this is not instead of full funding. Staff members are already under pressure and the idea that they have the time for creative reform is ridiculous. It’s like trying to change the curtains in a house whilst the roof is leaking.

* The NHS needs to be patient focussed and not resemble a production line with its many component parts. Secondary Care needs to find a way of owning the journey of a patient in way that sees them more holistically. It needs to be essentially clinically led and not just functionally influenced.

* Staff members need to be recognised and valued. This means ensuring the health service works using committed people who have acceptable contracts rather than relying on bank staff who are called in when needed. There may well eventually be times when they system is quieter than usual, but this is how life works and to the benefit of everyone.

* The NHS is part of a wider story, and each part is affected by the other. When social services, education, policing, and welfare are underfunded then the health service suffers.

Although the popular narrative is that managers are to blame, this is overall a wrong assessment. It must be said though that those further up the NHS structure have made some major mistakes when responding to various government changes.

I am not convinced they have done so on purpose, but the system informs behaviour.

I am reminded of Noam Chomsky’s response to the journalist Andrew Marr when confronting the idea of system bias.

Marr asks: “How can you know that I’m self-censoring?”

Chomsky replies: “I’m not saying you’re self-censoring. I’m sure you believe everything you’re saying. But what I’m saying is that if you believe something different, you wouldn’t be sitting where you’re sitting.”

I feel that with those at the top of the NHS. I am sure their intentions are noble, but they wouldn’t be in post if they thought differently than the politicians.

Over my six decades of life and my many years of working with healthcare teams I have come to see that the genius of the NHS has essentially kept me alive, to die of something different later. This sounds quite negative at first, but its work brings a quality to the whole nation that nothing else can give. I hope Wes Streeting comes to understand this.