The NHS doesn’t need Tory reorganisation, but it does need reform

by Peter Watt

I am furious about the Lansley NHS reforms, but not just because of their well documented failures.  We all know the arguments against them: another top down reorganisation, competition on price not outcome, cherry picking by the private sector and all that. The Tory-Lib Dem government is, of course, engaging in post-May 5 good cop, bad cop role playing in an attempt to dig themselves out of their hole.  I have no doubt that their instinct for survival will lead them to deal with the worst excesses. The Tories, in particular, are rightly terrified of an NHS-led electoral backlash.

But right now, that is not what’s making me so angry. What is making me angry is the real danger that this row will set back the cause of vital NHS reform for years.

Under Labour, the NHS made some significant progress. We introduced choice for patients and gave them statutory rights about what they could expect from the NHS. A variety of suppliers were introduced into the health market and improved commissioning lead to reduced unit costs, greater numbers of treatments, improving health outcomes and shorter waiting times.

And budgets were increased considerably. In fact, you could argue that budgets were increased faster than the reforms could cope with. The result is that there is undoubtedly room for significant efficiency savings.

So it wasn’t perfect, but it was already improving. In fact, one of the key criticisms of the Lansley reforms is that they are on the whole unnecessary. Labour’s reforms could have been allowed more time to bed in, with some tweaks perhaps, but be left, on the whole, to continue evolutionary change. If they had done that, they could have stuck to their “no unnecessary top down reorganisation” pledge.

So if Lansley’s reforms are unnecessary, do we actually need further reform at all?

The answer is that if you use the NHS for an elective procedure, attend an A&E department or visit your GP then you will probably get pretty good care. But far too many of our most vulnerable population are continuing to get shockingly poor treatment. And no service, let alone one that we are all paying for, can claim to be immune from the need for reform if it treats some people so appallingly. It was only in February this year that the NHS ombudsman report Care and Compassion came out that detailed the failings in care of older people in the NHS. In it, the health service ombudsman, Ann Abraham, says:

“The findings of my investigations reveal an attitude – both personal and institutional – which fails to recognise the humanity and individuality of the people concerned and to respond to them with sensitivity, compassion and professionalism. The reasonable expectation that an older person or their family may have of dignified, pain-free, end of life care, in clean surroundings in hospital is not being fulfilled. Instead, these accounts present a picture of NHS provision that is failing to meet even the most basic standards of care”.

And the report included examples of what this means to the people suffering from poor care:

  • Alzheimer’s sufferer Mrs J, 82, whose husband was denied the chance to be with her when she died at Ealing hospital in west London because he had been “forgotten” in a waiting room.
  • Mrs R, a dementia patient, who was not given a bath or shower during 13 weeks at Southampton University Hospitals NHS trust. She was not helped to eat, despite being unable to feed herself, and suffered nine falls, only one of which was recorded in her notes.
  • “Feisty and independent” Mrs H, who had lived alone until she was 88, was taken from Heartlands hospital in Birmingham to a care home in Tyneside but, when she arrived, was bruised, soaked in urine, dishevelled, and wearing someone else’s clothes, which were held up with large paper clips.

And this was hot on the heels of a report from the patients association, Listen to patients, Speak up for change report from December 2010, which highlighted 17 cases of serious failings of hospital care of older patients from across the NHS.

This is not a resource issue; it is an attitude issue. We need to acknowledge that while most NHS staff are fantastic, some are not. That while most care within the NHS is first rate, some falls well short. The NHS remains a much loved national institution, but the great affection in which it is held should not stop Labour from demanding further reform. Not the bureaucratic and unnecessary reforms on the table at the moment, but reforms that stop this abuse.

And that is what is making me furious. That the present political squabbles over Lansley’s unnecessary changes to the NHS will set back the cause of vital reform that Labour must not back away from. Instead, it must go into the next election demanding reform, because that is what our most vulnerable citizens need.

And, one day, so might you.

Peter Watt is a former general secretary of the Labour party.

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5 Responses to “The NHS doesn’t need Tory reorganisation, but it does need reform”

  1. iain ker says:

    The NHS remains a much loved national institution


    Therein lies the folly.

    Wolseley cars were ‘a much loved national institution’.

    Red telephone boxes (if you weren’t close enough to smell them) were ‘a much loved national institution’.

    Coal-mines (unless you actually had to work down them) were ‘a much loved national institution’.

    The NHS remains a much loved national institution (unless you actually have to use their services)

    Forget the faux-sentiment and deal with, you know, what are these things again, oh yes, THE FACTS.

    NHS chews up a hundred billion quid plus plus of our money every year.

    The mentality of the (pretrendy) left is that if something isn’t working then it’s because it doesn’t have enough money; and the solution is always to throw more money at it.

    Sometimes, like 99% of the time in the public sector, if something isn’t working it’s because it is not properly using the money that’s already been thrown at it. The solution is hardly to throw even more money at it. That generally makes the problem worse.

    In the private sector there is something called ‘the market place’ that in the main and for some thousands of years now has lead to the proper husbanding of resources. In the public sector there is not very much that ensures that money gets properly spent.

    Of course the NHS needs reform, it’s a bloody mess.

    And like it or not the private sector has to play a big part.

    PS I have commented before on here about how deskbound overweight middle-aged men expect people to be impressed by how angry or incandescent or enraged they are.

    So this poster comes out with…’And that is what is making me furious.’

    Prime example. Chillax, fella, you’re middle-aged, you’re overweight, no-one’s impressed, and we don’t want you becoming ‘a statistic’.

    See if the NHS can send you on an anger management course.

    On second thoughts, go private and save the NHS some money.

  2. Jane says:

    I do not live in the capital and therefore you mentioning patient choice is alien to me. I have never been hospitalised but have had outpatients appointment. Although given the appropriate paperwork to make a choice of hospital by my surgery, there were no appointments online on any of the local hospital sites! I had to ring a national number and await an appointment by letter.

    I have lived in many places throughout the country and abroad. I can tell you that the service throughout the country is inconsistent. I have met some excellent NHS staff and some abysmal ones who should have been sacked. As to the NHS being a cherished institution, I do not share this view. I would have done at one time but no longer. All I witness is an institution that worries more about its own interests with the patient or customer having a lower priority. The culture of much of the organisation frightens me (I know best and from experience how dare you look at your medical file in a hospital). I have often accompanied elederly neighbours to hospital and visited many too. I can tell you that I have had to battle to ensure they received a reasonable level of care. I dread the day I will need treatment which will come associated with my age. You see – I have no choice. How different it was when I lived abroad. You will not mind me saying then that unless one experiences different healthcare systems then one is not in a position to hold one above another. Further, a recent survey of doctors suggests that the vast majority would seek private healthcare if needed rather than the NHS which trained them and pays highly for their service.

    Yes the last government which I supported did pour resources into the NHS. Yet this was often done without sufficient control on outcomes. Our surgeons operate less and our GPs work less hours despite huge salary rises. All efforts to place the patient at the centre of the system have failed. We are up against some of the toughest trade unions who represent medical and other staff and by goodness they know how to get people scared. The problem with the NHS is that they have no competition. I can remember Tony Blair discussing the difficulties of reducing waiting lists and when he threatened to refer the list to a private provider – the Trust was able to manage the backlog.

    I am happy with some of the reforms – competition and GPs having a greater input into commissioing. I know that some changes will need to be made but I have faith in Andrew Lansley who has an inordinate amount of knowledge about the NHS. I am appalled at how an organisation which provides the nation’s healthcare is being used as a political football. this is happening and is shameful.

    What I do very much share with you is the great concern regarding poor treatment of the elderly. I have read the report you mentioned as well as the one on Stafford and I am a member of the Patient Organisation. I have also sat on various county NHS panels. I continue to read about incidents of neglect, starvation and poor care. The problem is that we have academised Nursing and have staff who believe that undertaking basic care is beneath them. Neither do I hear of any staff being sacked when they have failed in their duty and this relates not only to nursing but medical staff who have overall responsibility. The culture of the NHS has to change and it seems to me that only patients can do this by demanding a service which we pay for and ensuring that the service is to our liking.

  3. BenM says:


    “In the private sector there is something called ‘the market place’ that in the main and for some thousands of years now has lead to the proper husbanding of resources.”

    Pompous nonsense.

    That “market place” in CDOs led to the worst recession since the Great Depression – actually that was another economic disaster wrought by “the market place”.

    Health is too precious to be left to the private sector, who will duck, dive, stuff-up and generally make an inefficent pigs ear of it.

    The NHS does a great job. It’s the most efficient health service in the G7.

    It certainly does need to be kept topped up with investment, and most voters are happy with that.

    “Choice” was always a red-herring. People really only want the choice of having first class treatment at a hospital or health centre close to home. It’s basic stuff – but attention has been completely diverted by witless promises about a “choice” that no one really wants. My GP couldn’t stop laughing when advising that I had the choice of having my treatment at my nearest hospital in Kent or, wait for it, at a hospital in Inverness! That shows how worthless “choice” is when it comes to a Universal health service.

    Just get on with ensuring the NHS is properly funded so every corner of the land has first rate hospitals and clinics. Keep the private sector at arms length as far as is practicable – fund new treatments as they arise rather than the dividends of unaccountable shareholders.

  4. iain ker says:

    ‘Health is too precious to be left to the private sector, who will duck, dive, stuff-up and generally make an inefficent pigs ear of it. ‘

    Yeah, because the public sector never ducks, dives, stuffs up, or makes a pigs ear of absolutely everything it touches.

    And bee tee double yew, read Joseph Schumpeter – and not just his Wikipedia entry.

  5. Amber Star says:

    And that is what is making me furious. That the present political squabbles over Lansley’s unnecessary changes to the NHS will set back the cause of vital reform that Labour must not back away from.
    It’s not reform that is needed. It is properly conducted over-sight & peer review. And when things are not going well with a hospital or service, find out who is in charge & retrain, or if need be, replace them.

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