Leading article

If you really love the NHS, you know it needs to change

No subject inspires more hypocrisy in our politicians

7 March 2015

9:00 AM

7 March 2015

9:00 AM

To adapt Aeschylus’s aphorism on war and truth, the first casualty in a general election campaign is objectivity. Over the next eight weeks NHS staff can expect nothing but saccharine praise from politicians who are falling over themselves to say how wonderful the health service is, how committed they are to it. The Conservatives may revive their ‘NH-yes’ slogan, promising to safeguard its budget. Labour proposes to protect it from what few reforms the Conservatives promise and even Ukip is posing as ‘the party of the NHS’.

A true friend of the NHS, however, would accept that all is not well, and that ‘protecting’ its current structure is an act of cruelty rather than kindness. We saw why this week in Bill Kirkup’s report into the scandal of the unnecessary deaths of 11 babies and one mother at the maternity unit of Furness General Hospital between 2004 and 2013. The unit, he concludes, was ‘dysfunctional’, with staff ‘deficient in skills and knowledge’. One baby, Joshua Titcombe, succumbed to an infection which staff had ample opportunity to diagnose but failed to do so.

Expectant mothers with dangerous conditions were sent home with inadequate treatment. On one occasion an epidural injection — supposed to be given into the spine — was administered intravenously. Bureaucratic edicts crushed the common sense of nurses: a policy of insisting on natural childbirth was pursued ‘at any cost’, even when circumstances ought to have demanded a caesarean.

But worse than any of these errors, in some respects, was the failure of the Morecambe Bay NHS Foundation Trust, which runs Furness and two other general hospitals, to recognise that there was a problem. The author of an ‘independent’ report commissioned by the trust was instructed not to revisit the circumstances of serious incidents. Midwives rallied round and covered for each others’ failures, referring to themselves as the ‘musketeers’. The ‘maternity risk manager’, whose job should have been to eradicate bad practice, also acted as a representative for colleagues who had made errors.

Of course, the problems at Furness General, like those at Stafford Hospital, need to be put into perspective. Any large organisation, public and private, is going to have poorly performing elements — and the NHS is now the fifth-largest organisation on the planet.

The service cannot be defined by its mistakes. But what matters is how organisations respond when things go wrong. If Furness General were a privately run hospital, it would be unlikely to survive; just look what happened to Winterbourne View, the privately run home for special needs adults in Bristol, which closed after revelations of physical abuse. And rightly so: its closure sent a message to other organisations about the price exacted for failing those in their care. Yet when bad things happen in the public sector, aside from a resignation or two the institution carries on as before, just with ‘tightened procedures’. If Furness General was slated for closure, the local population would almost certainly rally to save it, as the people of Stafford did. As in Stafford, patients who had criticised care at the hospital might well find themselves ostracised. This is the brutal politics of healthcare: no one wants a local hospital unit to close, even if there is a clear case for driving patients further down the road to a better-resourced unit with higher success rates.

Nigel Lawson, a former editor of this magazine, declared that the NHS is the ‘closest thing the English have to a religion’. It isn’t just midwives and administrators who, to use Kirkup’s words, are in ‘denial’ about failures in the NHS. The politicians who oversee it are similarly disinclined to speak honestly. They find it extremely difficult to criticise doctors or nurses — though will have an occasional crack at bureaucrats. They try to pretend that the NHS can offer everyone everything, regardless of cost, when in reality rationing is taking place, always has done and always will do.

Even Conservatives who have backed the wholesale privatisation of other public services find it extremely difficult to speak up for a greater range of healthcare providers. David Cameron came into office promising no more ‘top-down reorganisation’ of the NHS, yet had not worked out that his Health Secretary proposed to do just that, spending £3 billion replacing primary care trusts with remarkably similar bodies called clinical commissioning groups. Yet the boundaries of the NHS have hardly shifted: since the election the proportion of NHS services provided by independent companies has risen from 5 per cent to 6 per cent.

That barely perceptible shift is what Labour’s health spokesman, Andy Burnham, laughably likes to call ‘privatisation’ of the NHS. Yet even this token amount of wider healthcare provision is under threat from Labour.

NHS reform ought to be a Conservative selling point. The party ought to be able to point at creaking hospitals and pledge, as they did with other public services, to remedy this by innovating. There is no need to compromise the principle of healthcare that is free at the point of delivery. Reform just means saying that healthcare does not need to be provided entirely through one monolithic state bureaucracy.

The debate over healthcare spins furiously but goes nowhere. On no other issue is so much political anger unleashed with so little desire to effect meaningful change. We are stuck for the foreseeable future with a fabled NHS where obvious failures like the one at Furness General occur again and again because no one is really brave enough to want to learn from them.


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Show comments
  • Peter Stroud

    Nigel, now Lord Lawson’s remark about the NHS being the closest thing we English have to a religion hit the nail on the head. And this attitude is dangerous, in the extreme. Critics, no matter how well qualified are treated as heretics, and are shouted down, or worse. How strange that Lord Lawson has championed qualified scepticism regarding another pseudo religion: namely man made climate change, or catastrophic anthropogenic global warming, CAGW. Unfortunately, CAGW bis not just an English quasi religion, it is international.

    • victor67

      It might need change but not the Tory variety of opening it up to the free market.
      There is not a shred of evidence this will improve the NHS and more about the 75 Tory MP with a stake in the private companies and their mates in the city.
      We truly live in a corrupt country.

      • MountainousIpswich

        The Tories are not privatising the NHS. This is a straight out Labour Lie. As stated above. The Tories have pushed private provision of NHS services from 5% to 6%.

        Andy Burnham fails to state that when he was Health Secretary he pushed private provision of NHS services from 1% to 5%.

        • victor67

          Wrong they are cherry picking the more profitable parts and selling them to their mates in the city.
          This will create a two tier service.
          The Kings Fund said Lansley reforms cost billions and had no benefit when the focus should have been on improving care.

          The Tories by nature despise big public services.

          • MountainousIpswich

            The Tories have moved the percentage of privatised services within the NHS from 5% to 6%.

            Andy Burnham moved the percentage of privatised services within the NHS from 1% to 5%. Watch his newnight interview with Kirsty Wark where his lies are exposed and he is utterly decimated.

            If you believe Labour on this subject, you’re a fool.

  • Malcolm Stevas

    “No subject inspires more hypocrisy in our politicians” – to which one might append, No subect inspires more cowardice – though they’d probably call it Realpolitik
    Some good points in this, the fundamental one being that change is inevitable and if braver leaders than currently we possess don’t change the NHS, change will be forced upon us as this gargantuan, inefficient bureaucracy collapses like a very expensive dinosaur.
    It’s a sacred cow, biggest of them all, and we need to borrow ideas from other countries for some sort of insurance-based system that combines State support with far greater individual responsibility for healthcare.
    The present “free” (= paid for by other people) at the point of delivery service is not affordable and fails to deliver an appropriately 21stC quality of service.

  • thetrashheap

    The NHS is very far from perfect but people see the American model and think its worse for a huge percentage of the population and more expensive for those its service is good for.
    There are problems with the NHS a huge percentage of those are caused by mass immigration without any planning and the low wages those immigrants are on (so not net contributors).
    But again neoliberals are using mass immigration not only to drive down wages but to drive down state provision of services and push up assett value.

    I’ve been in places that have outsourced IT, THe magnificient savings seem to be largely from lower wages and pension contributions and much of these savings were past onto the provider not those purchasing the services. The IT didn’t get much better and it anything we lost ownership of our own products technical knowledge which was a disaster.

    I’m be very weary of giving the NHS to Serco and its ilk. Personally I’d rather my income tax went up.

    People like to say the public service doesn’t generate wealth but the NHS will pump a lot more money back into the British economy that some tax avoiding US multi-national service provider.

    • Tom M

      Something I’ve noticed over the years that when discussing changes in the NHS left leaning people will inevitably point to the USA as an example of what could happen if we changed the NHS. Completely ignoring the arguably best health service in the world (the real world that is, not the world that envies the NHS)) some 20 miles from Dover. Never mentioned by the Left ever.
      It is a pubically funded service that has no problem with private finance encouraging private money to build hospitals (called clinics in France) for the benefit of the whole population.
      Critics usually tell me that France’s health service is on the verge of financial collapse or that the poor downtrodden French (tell them that) have to pay insurance to cover the 20% or so of treatment costs the state doesn’t cover (they don’t see a problem with that at all).
      Space prevents me from comparing in detail what you get for your money in France but let me say there is no comparison whatsoever between the NHS and the French Health Service. The NHS appears as a very basic and badly run healthcare system and clearly fails on that level quite often (Mid Staffs and now Morecomb I see).
      However friends of mine in the medical profession in France have a respect for UK medicine quoting publications like the Lancet as being of considerable stature. Mind you none as I am aware of have ever actually been in an NHS hospital for treatment.

      • Johnnydub

        Spot on Tom.

        The real issue with all our public services is producer capture.

        They are run for the benefit of the staff not the public. Policing, education, health – in all areas the standards are cratering and yet we have never spent more money.

        The real reason is accountability. There simply isn’t any. All the failures, the senior NHS staff responsible for Stafford, promoted into other jobs. Same for the senior child protection people at Rotherham.

        Until this changes fuck all will improve. And lets not forget the cancer that is Common Purpose.

  • Patrick Roy

    I love the current (yet again) dialogue about the BBC license fee, and how people must pay £145.50 a year, or the world will surely collapse. How about every person cough up (sorry for the pun) £.40p per day (or just £12.13 a month) to buy a membership to the NHS. And let the BBC go and fend for itself.

  • tartanarse

    MSM will continue to condition the country for the only possible saviour of the NHS from it’s spectacular overnight collapse, privatisation.
    I find it hard to believe that the Tories have allowed this to happen on their watch. I expect all of those MP’s with no interest in big pharma will complain.
    In addition to this, isn’t it a coincidence that three separate health services have suffered this “collapse” all at once?

  • Margot

    Foundation Trusts were a very bad idea – and they’re all soon obliged to become ones. The bottom line becomes all important. A local hospital made economies everywhere it could leading to cheap equipment failing, didn’t renew or update when it should with patients getting poor treatment – but spent money on ‘window-dressing’ to attract patients who couldn’t see behind the shop-front. It’s had numerous infection emergencies and a friend now an in-patient says it’s ‘filthy’. A nurse that had managed to scale the greasy pole of management was made redundant as an economy with a £250,000 pay-out – an economy as she had been on a £170,000 salary (!!!). The CE rarely steps outside her office when she should be doing the rounds of the whole hospital regularly – she might then notice the dirt. Wonder whether something similar to ‘superheads’ are needed to shake hospitals up. Unfortunately foundation hospitals are more or less a law unto themselves, spending ‘our’ money at will.

    • peterthepainter

      What you describe is totally different to my county NHS Foundation Trust.
      It runs three acute hospitals. The current CE is very pro-active. They have invested in staff training and staff participation i.e. the staff at the sharp end have a big input into how things are done.
      Money is tight, that much is true. It would be so under any system. We could do with replacing all three buildings with new, well-planned, dementia-friendly hospitals (just not under a PFI scheme!).
      You could spend the entire nation’s GDP on the NHS and never satisfy everybody.
      Foundation Trusts offer a level of independence from Whitehall bureaucrats.
      Don’t tar them all with the same brush. Some work well.

      A key issue going forward is the lack of community care and convalescent wards. Patients are in hospital beds who need not be. This has a massive knock-on effect at the point of entry (either A&E or elective).
      Local councils are not the people to deal with this.

      I would add that people’s expectations are becoming unrealistic. Neither the NHS nor wider state can remedy every problem. People must take responsibility for their own lives and accept that not all illnesses and traumas will have good outcomes.

      • Margot

        I guess this illustrates part of the problem of ever getting anywhere with the NHS. There are good hospitals and bad hospitals and within any one hospital there are often good wards and bad wards. As we have both done here, everyone comes up with their experiences. You disparage any thought of PFI but the Trust I cited has run a unit providing sub standard treatment in poor surroundings for almost a decade whereas a ‘private’ facility under the next Trust has been providing up to date treatment in comfort for the same time. The patients of the NHS unit have in effect been short-changed for a decade – a postcode lottery in fact. The treatment costs to the NHS have been the same – in fact I believe they have been less at the ‘private’ unit.

        • peterthepainter

          Margot, PFI is bankrupting Trusts. It is not only the borrowed money but also the exorbitant maintenance contracts that go with the contracts.
          Proper financing for capital projects should come from central funds.
          All told, the PFI total repayment will be somewhere in the region of £300 billion…..much of that being the profit for the private contractors.

          • Margot

            The NHS unit and private unit were set up at about the same time. The private unit is not PFI but takes NHS patients. The NHS unit was badly designed and not maintained – nor updated, so that it has been providing sub-standard treatment for 7-8 years. The private unit has provided up to date treatment in comfort . No one has ever been held to account for what has happened at the NHS unit. That Trust is now being FORCED to do something and are looking to some sort of PFI contract with a new unit – which would never have been necessary if the original one had been equivalent a the time of building to the private one. The private unit – in another Trust’s area carries on. The new unit – whether NHS or private will not be ready for another year – another year of sub-standard treatment. To me it is a no brainer.
            I have worked in the NHS and when I started I and most others would have defended it to the death. When I see what that particular Trust had done it becomes clear that there is no-one in charge to see when a Trust goes bananas with its spending power. They are the equivalent of benefit claimants cited by IDS spending on booze and box sets and only beans at the end of the week. In the time when that Trust has not updated nor maintained that unit they have spent millions on frivolities, in no way related to healthcare.

          • peterthepainter

            Obviously I cannot comment on your local Trust (other than to sympathise).
            Maintenance of buildings (and their historic unsuitability) is a major problem everywhere. It is an area people think can be cut to the bone. This is ignorance. A coat of paint is not just a coat of paint but a coating protecting the fabric of the building. Services hidden behind ceilings (wiring, plumbing etc) need maintenance and replacing before problems occur. Very much a case of a stitch in time saving nine. This is the situation in even the best run Trusts. Sometimes HSE notifications force the issue but a not a good way of doing things.
            Personally I would replace all old Victorian era facilities, then the later ones. Why? Because they are not suitable for today’s (or tomorrow’s) needs. They are not dementia friendly – and cannot be made so. Not talking about dementia wards but whole hospitals – dementia patients need other service areas; surgery, medical, ortho etc.
            Having had a pet rant, please do not despair. In my area, things are improving at a rate. I suspect that this will be happening everywhere – if not now, then soon.

          • Margot

            I may not have explained things clearly. The two units were set up at about the same time. The private one contained everything needed to what was obviously a standard built on experience and has probably needed little doing since – it was an industrial type construction. The NHS one was badly designed and because of this in order to make it comparable with the other would have needed alterations and improvements from the start. These of course were never done. If even some had been done the unit might have been able to have been of use for some time. As it is the Trust is now being forced to provide in some way or another a completely new unit. No one has been accountable for the enormous waste of money and as I said the Trust has frittered its money away on things of little relevance to healthcare at the coalface. You seem to think things will improve generally. For the hundreds of patients who have been passing through the NHS unit receiving sub-standard treatment for nearly 10 years that is not good enough – and all because there is no one checking where the money is going. From what I have heard the Trust in which the private unit lies have been very careful where there money goes. They must have decided it was better to farm out that service – and their patients have been the winners.

  • Terence Hale

    “If you really love the NHS, you know it needs to change”. Once working in the NHS and going to Switzerland’s hospitals. I have a good impression of Mr. Hunt, who developed from a funny boy to a serious politician.

  • The criticism of failures of management and care in a number of instances is fair and they must be addressed – no doubt they are being. But most of the Service runs well most of the time. The idea that contracting out some activities is desirable is, for me anyway, uncontroversial and I have said so. But the idea that the greater involvement of the private sector is the solution to operational failures is preposterous. Look at Hinchingbrooke. The NHS is publicly owned, publicly accountable and publicly run. Part of the latter is to contract some things out. There is no paradox here – if a private provider can give a service to an acceptable standard and at an acceptable price why not? But this should not be proposed nor opposed for ideological reasons. The NHS needs less politics and improved management.