NHS desanctified: can we now have a proper debate?

Something I have long suggested is that a “culture of carelessness” has spread throughout many areas of our once hallowed National Health Service. The publication of the Keogh Report, with its findings of 14,000 unnecessary deaths in just 11 Trusts, has finally exploded the nostrum that our NHS is the best in the world.

Keogh reveals that despite record levels of spending the approach of politicians and management over the last decade has led to patients lying in squalor, inadequate care being given, and slow, painful, avoidable deaths. Managers, doctors, nurses and other care staff have nowhere to hide. The numbers of nurses in eight of the eleven trusts highlighted by Keogh had been significantly increased, not reduced, yet something went horribly wrong.

If even a fraction of that number of deaths had occurred in any private sector organisation, a private hospital chain, group of nursing homes, transport company, or among the customers of a major food retailer, then enforcement officers would have swooped and our liberal media establishment, backed by politicians, would have bayed for blood. Arrests would have been made, charges levelled, trials mounted, convictions secured and large fines and long prison sentences passed down by sombre judges scathing in their denunciations of the perpetrators. The Sun newspaper would want the guilty hung, as a minimum.

Yet, so all-embracing has the national self-delusion been for years that it had become absolutely impossible for any political party to go into a General Election arguing that our health service was failing and needed substantial reform to put first the interest of patients, not providers, of taxpayers not bureaucrats, of citizens not unions. The NHS may have been fit for purpose in the 1960s and 1970s, but it is has been demonstrably clapped out as a vehicle on the public service roads in the 21st century, positively dangerous to drive with its out of date controls, dodgy brakes and leaking cylinder head gasket!

Successive government ministers for over a decade were forced to sweep scandalous underperformance under the carpet. That may have saved political and administrative careers, but it denied the body politic the opportunity to drill down, to find the causes, to identify the trends and to put them right.

The NHS reforms introduced in April were largely a solution to a different problem, but there is a chance they may help with some of the underlying issues by genuinely, albeit only gradually, putting patients higher on the NHS agenda. New inspection regimes and no doubt further commissions of inquiry may lift other stones to see just what is crawling around in the dark depths of this labyrinthine, bloated organisation.  Introducing a new commissioning structure and encouraging diversity and plurality of service provision will help. But none of these are a panacea for the systemic problems the organisation is experiencing.

Carelessness has become the paradigm, and we need a paradigm shift as a matter of grave moral, political and financial urgency.

Echoing the soundbite of Tony Blair at a previous General Election, last year the great trades union barons, including the topical Len McCluskey of UNITE, alarmed the nation by claiming at their mass rallies in London that we had only “13 days to save the NHS” and demanded opposition to the NHS and Social Care Bill then going through Parliament.

If those 14,000 deaths are not to have been in vain, may we please, please now have a genuine debate about what is necessary to fix the overgrown behemoth that the NHS has become?

From school onwards we need to instil in our youngsters a respect for the ill, the vulnerable, the disabled, the elderly and the dying. We need to review, as to be fair the Government is seeking to do, the way nurses are trained. We need to change the way doctors are remunerated and the way in which funding flows around the structures and systems of the health service of tomorrow, rewarding not box-ticking but improving outcomes and quality of life. We need to ensure that the fine principles of the Liverpool Care Pathway carry forward into the new end of life care plans to be introduced.

We need to bang the heads of BBC broadcasters together so that they are forced out of their prehistoric view that public provision is good and private sector bad. What should matter is not how much we spend on patients, nor who provides that care, but how good it is and how widely available. It was Tony Blair who argued that what matters are not the old ideologies, but what works.

Politically we must demand an end to party political squabbles about who is at fault and we must heed union voices only when they are genuinely promoting patient interests. We should not permit, but demand the introduction to healthcare provision of experience and excellence from wherever it can be sourced, whether from public, third sector, or private providers.

If as a community we don’t do this, we will sentence another generation to expensive but inadequate healthcare and avoidable death.


Chris Whitehouse