The ‘Impossibility’ of working in the current NHS: sacrifice to a primitive god

Abstract

This paper explores the current crisis in the NHS, focusing on the ‘impossible’ demands faced by staff and the underlying psychodynamic factors that perpetuate these challenges. Drawing on the author’s experience as a consultant psychiatrist from 2008 to 2018, the paper examines how idealisation of the NHS has fostered an unconscious dependency on a fantasy of omnipotent care, akin to an idealised love. Rising demand, workforce shortages, and financial pressures have exacerbated these unrealistic expectations, contributing to systemic dysfunction. The paper delves into the social systems of defence that protect staff from anxiety but obstruct progress, contributing to a punitive and dysfunctional work culture. It argues that confronting the unconscious expectations of ‘perfect care’ is essential to breaking free from these destructive dynamics. Only by balancing compassion with realistic boundaries can the NHS move toward sustainable, effective healthcare delivery.