The Sunday Times

May 29th, 2011

Our flawed, uncaring NHS is a self-inflicted wound

Most people must know by now that the treatment of old people in National Health Service hospitals is all too often scandalous: it is frequently abusive neglect rather than care. Even so, it came as a surprise last week to learn that a doctor in a Worcestershire hospital actually had to prescribe water for patients on medical charts to make sure they got enough to drink to keep them alive.

This was one of the many sickening findings of an official Care Quality Commission report published last week. It said three of the 12 hospitals in the report had failed to meet legal minimum standards of care. Serious concerns were raised about three others. If these 12 are representative of hospitals nationwide, then a quarter are breaking the law in their so-called care of elderly patients.

What is so infuriating is that we’ve heard it all before. The NHS ombudsman came up with much the same horrifying findings in his Care and Compassion report of February this year. Then there was the astonishing Mid Staffordshire hospital scandal of 2006. The Patients Association has produced damning evidence, time and again, but the scandals keep coming.

Such scandals always whip up a storm of public indignation but this time it occurred to me for the first time that the public should be directing its fury at itself. The painful truth is the British public has got the NHS it deserves. The misery of countless patients, lying in pain and fear, is the fault of the British voter and of the British medico-political establishment. Reform of the NHS is politically nearly impossible — as we are seeing — because of the inflexible, deeply held, quasi-religious beliefs about it that much of the public holds. More or less any proposal for change is blocked by a large swathe of the electorate, or of the medico-political establishment, clinging obstinately to articles of NHS faith. It is a faith that no politician can openly afford to question, as we see daily.

Nigel Lawson famously said the NHS was the religion of the British people. It was in that sense that Tony Blair later said he believed in it, as did David Cameron as well. But religion can be dangerous: it is based on faith, not on evidence. The NHS quasi-religious belief system has many misguided items in its creed, all of which resist argument and change.

The first and most obvious article of faith is that all medical care ought to be run by the state, as a state monopoly. It is equally dogmatic to say nothing must be run by the state, as some right-wing ideologues hold; but it is clear from Germany and France, where medical care is much better, that socialised medicine for all can be delivered in different ways. Even here our excellent hospices, always free, are privately run. Labour itself did a lot of outsourcing.

It is perhaps worth saying that if there is only one health employer, as here — very largely — with the NHS, any constructive critics or whistleblowers among the employees risk everything if they speak out. They will not be able to work anywhere else in the system. I imagine it is that which explains the failure of NHS staff to say what they knew. Otherwise why have doctors and nurses not protested in public about the disgraceful scenes on their wards? Lord Winston did, but late in his career and about his own mother.

Opening up the NHS to competition would mean that unhappy employees could choose to go elsewhere, just as unhappy patients could. But competition is anathema to much of the public and to the vested interests of the NHS priesthood: the unions and the royal colleges. Politicians have to renounce the idea almost daily to stay in office and can introduce it only by stealth.

This faith in state control is related to the conviction that profit is wrong in healthcare. It’s an unthinking belief because NHS healthcare already provides profit — to drugs manufacturers, medical suppliers, transport services and so on, as well as to medical staff who, in accepting pay for their work (quite rightly), are spending their time with patients profitably rather than charitably.

Beyond this it is bizarre to imagine that just because a person makes a profit from his work — making a cake, designing a building or running a group of excellent schools for children with disabilities, say — he must necessarily be providing a poorer service, or a more expensive one, or both. In countless cases the evidence goes the other way.

Then there is the most unexamined article of faith, mouthed by everyone including Cameron, that “cherry-picking” patients is wrong: on no account must private medical providers be allowed to cherry-pick. But why not? If they do, and if they thus leave more difficult cases and medical training to NHS hospitals, that cost could and should be factored into any deal with them. That could easily be done but for quasi-religious objections. It might even be good for the big NHS teaching hospitals by focusing their attention on what is most skilled.

The faithful usually believe that private care is no better, and often worse, than NHS services. This is wilful ignorance. Of course there is bad private care, but the word soon gets around and people won’t pay for it any more — unlike in the NHS. In my wide experience of both, private treatment has been hugely preferable: apart from excellent nursing and the choice of a consultant, it offers better record-keeping, less hospital infection and better medical treatment. But the NHS faithful continue to say in surveys — 80% of those polled — that they are very satisfied with the NHS as it is. They believe, despite the evidence, that all that’s needed is a lot more money in the offertory box.

The uncritical faith in NHS nurses as angels of selfless mercy is finally beginning to fail. But there’s little hope of serious change unless the NHS faithful abandon the belief that all nurses should be of degree level. Of course many should, but taking all nurses out of hospital training into universities and insisting that all must have degrees has been disastrous for skilled bedside nursing. It has devalued it in the eyes of nurses themselves and consigned it to lowly skilled, barely supervised nursing auxiliaries, with the results that everyone is being forced to acknowledge.

We the public have failed consistently to make it clear to politicians, and to the NHS, that the status quo is unacceptable. That’s because we don’t yet quite believe it, not enough of us. Until then, or until the money finally runs out, nothing will change. We have the NHS we deserve.