My patients are already questioning whether we need the NHS. This latest crisis could kill it off for good

Older patients feel as if they've been cheated out of something. They talk as if their National Insurance payments were just that – a policy to be cashed in at times of need

Casualties arriving at UCL Hospital in London. A&E departments are under growing strain during the winter months (Rex)

The NHS is in crisis.

No, this isn’t just another one of those articles. And it won’t be another piece from tired doctor who is angry about something either. That’s taken as a given these days. Plus, I’m supposed to be tired; I’m a doctor. It was exhausting getting into medical school, exhausting studying there, and just as exhausting doing the job. I’m pretty sure I wouldn’t be trusted if I didn’t look knackered. I am angry about what I see happening to the NHS, but you could probably take that as a given also.

Yes, the NHS is in crisis. It is all too apparent to those of us who work in it, as you’ve repeatedly heard. But now patients are increasingly aware of the state of the NHS too.

Over the course of my career, things have never been easy. It’s tough looking after people, meeting their expectations and ultimately saving or changing their lives for the better. Bits of the NHS would come under scrutiny. Assorted scandals, whistleblowing crises and the like, brought individual cases to our attention. Yet we could still trust the NHS.

Now, wherever we look, we get the impression that the whole NHS is in trouble. Individual cases give way to problems affecting the entire health system. Too many patients, too few beds; an ageing population; insufficient funds; people going to the wrong place at the wrong time. Patients are told to go the doctors in good time if they think they are ill, yet stay away from hospital if they aren’t quite ill enough.

I was always taught to avoid talking about sex, religion or politics in consultation. Sex occasionally comes up, especially if it’s causing disease. Religion also makes an odd appearance, but only if relevant to patient care.

But politics? That seems to come up in a lot more often these days.

I meet thousands of people a year in the course of my job. Most love the NHS but find they simply don’t understand how it is run or who by. Navigating the NHS as a patient is difficult. There are confused messages, Byzantine referral pathways or cancelled appointments. It is frustrating. Inevitably, some I meet now question whether the NHS works at all, and say they would prefer an insurance-based system. They may already use private medicine, and get irritated when they need to use the NHS.

Some I meet believe that all the tax they’ve paid over their working life is paying for their care now. It isn’t. It wasn’t saved anywhere special, it was spent on medical care for others at the time. These people see the news coverage of the crisis in the NHS and feel as if they’ve been cheated out of something. They feel as if their National Insurance was just that – a policy to be cashed in at times of need.

I meet people who want the NHS to be all things to all people, infinitely called upon yet finitely resourced; a classic case of having their cake and eating it, with everything supplied by the state.

I meet others who come to me with brilliant ideas about how to run the NHS more efficiently, but – like so many of us – little understanding of the myriad organisations involved that would make change impossible.

And there are those I meet – still in the majority – that will defend the NHS with their dying breath.

Somewhere out there is the answer. In the meantime, the NHS will continue to creak at the seams until something gives, if it hasn’t broken already.

As for me, I’m rather fond of the NHS. I’d like it to be around for a long time to come. But if it doesn’t improve before patient attitudes change permanently, it could be lost for good.