by Sam Fowles
I really miss the days when the worst we thought Jeremy Hunt could do to the NHS was privatise it. At least you knew what you were getting with privatisation. But what Mr Hunt is doing, incredibly, manages to be worse. It is an act of legislative contortion which would have done credit to Mitt Romney on his most pliable days: In an (apparent) attempt to “get tough” on standards and ensure the high quality of the NHS, Mr Hunt has made certain that it cannot possibly offer anything but a substandard service.
At least one can see a logical argument of privatising the NHS. It may be exceptionally wrongheaded, but the case has a logical progression: Competing providers will force standards up as a result of their competition for consumers. The problem with this is, of course, that demand for healthcare is inherently almost completely elastic. As such, the impact of market forces on quality and price of provision will only ever be exceptionally limited, leading to monopolistic tendencies and, inevitably, substandard service. But at least there is a justification based on some sort of reasoned analysis.
Mr Hunt’s response to the Francis Report is a masterclass in irrationality.
One of the central issues in the report was poor patient care. Beds were not changed, patients were not fed; essentially the care and attention necessary for a decent quality of existence were absent. Unless the nurses at Mid Staffs spent their days playing scrabble and watching repeats of Monarch of the Glen (in my experience, pretty much the only thing on hospital television) one might perhaps assume that neglect is a function of understaffing. Stunningly this was also one of the conclusions of the Francis review.
Much of the review focused on governance issues, particularly regarding oversight organisations and community engagement (which Mr Hunt’s substantive proposals have singularly failed to address). Those sections which concentrated on the day to day running of wards recommended a more labour and resource intensive model. This is hardly surprising. One doesn’t have to be an expert in healthcare management to realise that if, as a patient, you get more focused attention more of the time, you’re going to have a better experience. The logical corollary of this is that, if everyone is to have more focused attention more of the time then the hospital might need to employ more people to provide it.
It should be noted that the Mid Staffordshire scandal took place under a Labour government. However, the Coalition’s reforms have included real terms cuts to hospital budgets leaving the NHS unable to fill over 20 000 nursing vacancies. In restricting the flow of skilled workers, the Coalition’s immigration cap has made it more difficult to bring in doctors and nurses from other states to plug short term gaps in staffing.
Yet rather than actually tackle the problem of understaffing, as Francis suggested, Mr Hunt has decided to fine hospitals which cover up instances of neglect. While neglect is hardly something to be tolerated in the NHS, if an institution has taken steps to cover it up, i.e. actively lied to the public whom it is meant to serve, then perhaps the immediate course of action should be to fire those who instigated the deception rather than further restrict funding for patient services.
Covering up neglect is unforgivable. If the NHS is to be democratically accountable (one of the big advantages of a state run healthcare system) then it needs to be transparent. But fining trusts which cover up neglect will simply mean that they have even less money to spend on patients, thus putting greater stress on staffing and resource levels and increasing the liklihood of future neglect.
Similarly, preventing offending hospitals from benefitting from the NHS Litigation Authority, limits the economies of scale gained from having one fund covering all NHS litigation and payouts. Thus meaning litigation takes up a larger proportion of the total NHS budget meaning less is available for patient care.
You don’t make a lame horse run by whipping it harder. Covering up neglect should be punished and punished hard. But that punishment should fall on the individuals responsible, not on the institution (and, by inevitable extension, patients). Mr Hunt’s reforms will protect negligent and fraudulent bureaucrats at the expense of patients.
It’s rare in public policy that there are simple solutions and, as George Eaton has blogged for the New Statesman, finding the money to the pay for the NHS is anything but simple. However, the practical response to the ward level issues raised in the Francis report is relatively obvious (not least because Mr Francis wrote a three volume report telling us):
- Guarantee the minimum staff requirement for wards and then pay and train those staff to a level that will attract the best talent.
- Institute proper whistle blowing procedures. Francis noted that the abuses in Mid Staffordshire could have been avoided had greater attention been paid to whistleblowers.
- Leave the NHS alone to do its job.
In other words Mr Hunt: either solve the problems or give someone else a shot. Right now you’re just making things worse.