by Peter Watt
Imagine for a minute if there was a terrible accident that claimed a hundred lives; it would dominate the news for weeks. Or the outbreak of food poisoning caused by some poor hygiene in a major food distributor that made some people ill and perhaps a few poor vulnerable souls to die; it would be a huge story. The horsemeat scandal has been front page news for days and it’s not (yet) a public health concern. And yet 1200 people are allowed to die unnecessarily in a NHS hospital and no one seems to notice! The Francis report into failings at the Mid Staffs hospital was news for a day – and on some outlets it didn’t even top the news schedule for the whole day. Up to ten other hospitals are now being looked at as their mortality rates are worryingly high. What is going on?
It really is bizarre; no matter how many times we read about those unable to help themselves being left in wet or soiled beds or left to starve in one of our hospitals it seems to make no difference. There is an attitude about the NHS that makes it all but un-challengeable. Politicians in particular are scared of the NHS. The Tories decided to ring-fence the NHS budget when they were busy slashing virtually every other departmental budget so scared were they of being seen as anti-NHS. Labour wraps itself in the NHS flag at every opportunity. Labour politicians who’ve tried to tinker with it are castigated – Alan Milburn and John Reid still have the scars. We say things like “the NHS is the envy of the world.” And seem to actually believe it! The truth is that virtually no other country has copied it as a model.
What is true is that many countries rightly envy the fact that we have universal free health care, they don’t though envy the way that we have chosen to deliver it. Yes there are some incredible people working for the NHS that provide a great quality of care. And yes, many of these people work hard and, often under great pressure care for patients with skill and compassion. But every time anyone criticises the NHS as a model of health care delivery, people tell stories of amazing care and lives saved. We remember the care that we had when we or a loved one needed it. We remember that we, and our children were born in NHS hospitals and look with fear at the health care system in the States. Those criticising are branded as anti-NHS and people back off.
And the result of this NHS cult is that we are never quite brave enough to face the truth. That the NHS is inefficient, just think IT procurement! That it is bureaucratic, cumbersome and unresponsive. That it doesn’t deliver universal care as what is delivered depends on where you live. That the rationing of care is already a reality but that we dishonestly pretend otherwise. That whilst there are some really dedicated staff there are also some who need sacking and prosecuting for abusing the vulnerable. That there really are too many hospitals in London and it is right that some should close. That the repeated and frequent stories of cruelty and abuse are a national disgrace that should shame us all. It is worth remembering that the Mid Staffs scandal happened at a time of unprecedented rises in NHS budgets under a Labour government.
And yet we hear that the problems are just the result of cuts and low staff levels.
The party that is rightly so proud of creating the NHS should be the one that is now fighting angrily for a better way. After all, those rich enough can and do buy their way out of the system. In fact, it very well may be that politically it could only be a Labour government that could make the changes needed. The Tories simply wouldn’t be trusted. But Labour could do it; Labour could start to be honest about health care with voters.
Andy Burnham has begun to do this with some genuinely new thinking about lessons learned from the Francis report. He has been thoughtful, insightful and honest in his thinking and acknowledges many of the failings in the NHS and of some of Labour’s reforms. He has drawn three conclusions in response to Francis:
- That NHS culture has become too commercial and target driven;
- That we need ‘whole person care’ that better integrates health and social care’
- That we need a more cautious approach to top-down change.
But is that really it? In response to the inefficiency, the unnecessary deaths and suffering, the dishonest approach to rationing – that is it? Shouldn’t we be demanding the full integration of health and social care provision and an NHS that is more local and locally managed? Are we really saying that the very best way of delivering health to 60,000,000 people is a service directed from Whitehall? And that we are going to avoid talking about the need for further rationing? Of course we should provide free health care and I want my grandkids born in local hospitals. Yes there are some really dedicated staff in the NHS. But unless we face up to the very real failings of the system then we are letting people down. As Robert Francis QC, concluded in his inquiry into Mid Staffs:
“A number of staff and managers at the hospital, rather than reflecting on their role and responsibility, have attempted to minimise the significance of the Healthcare Commission’s findings. The evidence gathered by this Inquiry means there can no longer be any excuses for denying the scale of failure. If anything, it is greater than has been revealed to date. The deficiencies at the Trust were systemic, deep-rooted and too fundamental to brush off as isolated incidents.”
It’s time for Labour to be brave.
Peter Watt was general secretary of the Labour party