The NHS is ripe for revolution

Published in The Observer (February 6th, 2011)

It was just a small thing, but telling none the less. My son developed an abdominal pain, which was rapidly diagnosed as appendicitis. So he was packed off to the emergency ward of a famous London teaching hospital, where he was prepared for surgery and ordered not to eat or drink.

More than 48 hours later, he was still waiting for the operation. He was tired and fed up, weak with hunger and suffering a raging headache. Opposite, another patient was writhing in obvious agony waiting the same procedure. There was no explanation for the delay, although we assumed it was down to emergencies, so cancelled a family holiday without fuss.

Finally, the surgeon turned up in the middle of the night, visibly angry, to tell my son to go home. His team had been on standby, but managers refused to allow them to open the second of 12 available theatres. He pressed us to make an official complaint, saying this would never have happened in China, where he had just come from.

But we were not surprised. Our other child has profound and multiple learning difficulties, so after 17 years suffering the shortcomings of the National Health Service, there is little that could shock us. Like many long-term carers, I could offer a litany of far more disturbing anecdotes, such as the top geneticist who lied about crucial test results, having misplaced them, or the GP who gave an injection despite warnings it could prove fatal.

Over the years, we have confronted lethargy, complacency and incompetence. We have battled bureaucracy, cursed inefficiency, fought blinkered attitudes to people with disabilities and given thanks for those health workers who offered tireless support in the darkest of hours and most difficult of circumstances. Sadly, not all are such saints.

Our health service is a long way from perfection and, like other branches of the welfare state, too often fails the people most in need. Nigel Lawson once called the NHS the nearest thing Britain has to a national religion. This desire to deify the health service makes the discussion over health reform so dispiriting; such is the myopic devotion of worshippers they fail to accept reality.

Once upon a time, I shared the national delusion over Bevan’s legacy. My faith has been shattered by reality. If I write about my experiences, I receive scores of emails from people with terrible tales, chiefly carers or those with long-term conditions. “Thank you,” wrote a former NHS scientist and mother of a disabled child. “I have been in a similar boat for six years of incompetence, laziness, carelessness, political in-fighting, suffering careerists and cowards. I lose my voice when I have to talk about it.”

The brutal truth is the NHS is becoming out of date. The coalition feels it has no option but to unleash these controversial reforms. As former chief executive Nigel Crisp says, it was designed for the 20th century and the highly successful fight against infectious diseases, industrial injuries and infant mortality. So it is based around big hospitals, with highly trained professionals, hi-tech equipment and little formal role for patients and carers.

But the needs of the population are changing. As our society grows older and richer, it suffers increasing prevalence of long-term conditions such as diabetes, dementia, cancer, coronary and vascular disease. The emphasis must shift to managing pain, coping with multiple conditions and living with disabilities. This requires personalised services based as much in the home and community as in hospital, led by patients and carers with the assistance of local GPs. Often, several agencies will be involved.

Patients are more demanding and expect the best-available treatments. Everywhere, people have become less deferential and want more control of their lives, while technology is forcing transparency and encouraging collaboration. It makes for turbulent times, but the changes can be beneficial. We often end up arguing for cheaper but better services for our daughter than those recommended by supposed experts.

This nation should stop harking back to some mythical golden age and the professionals, whose trade bodies have opposed pretty much every change since the NHS’s foundation, should be more receptive to the emerging world. Some already are: cardiac specialists opted to be open and transparent, collecting and comparing data on patient outcomes. The result is that death rates from heart surgery in England have halved over the past five years.

This sort of openness needs to become common practice. But the combination of patient power, health inflation and the rise in long-term conditions means health costs will soar. Under Labour, the budget more than doubled in real terms. The service improved a little and infrastructure improved a lot, while pay rose and productivity fell. Now, health accounts for £1 in every £6 spent by government – and nearly twice that if you add in social care.

Although protected from spending cuts, health still faces a £20bn shortfall in the next three years. The cost of drugs alone is growing by £600m a year. One Labour health minister compared the wasteful approach of the previous government to giving caviar to a starving man. We cannot carry on pouring in ever larger sums.

It makes sense to focus on outcomes, rather than imposing targets, and to remove politicians as far as possible from day-to-day decisions. Likewise, I welcome the involvement of more medical staff in management; after all, a recent study of 1,200 hospitals in seven countries found those with most clinically qualified staff in management performed best. And the more local a service the better, so long as it is open when patients need it.

But if doctors are given freedom to choose the best services, this conjures up the spectre of privatisation. Boo, hiss. Conventional wisdom insists there can be no place for the profit motive within the sacred confines of the NHS. So we hear breathtaking hypocrisy from Labour, taunting Tories with the dread “P” word despite allowing far more private sector encroachment than Mrs Thatcher dared.

We must shake off this stifling conservatism. Once, people thought there had to be a monopoly telephone provider, until competition proved we did not have to wait three months for a new line. Healthcare is no different. Look at Sweden, that great socialist nirvana, where market-led reforms encouraged private involvement to the benefit of patients. And other European nations are comfortable with competing providers forcing down costs.

The NHS should be cherished. It has, after all, kept my daughter alive. But it cannot survive as a static institution. Like everything else, it must evolve and reinvent itself, especially at a time of profound change. It should not matter who provides a public service, only that it serves the public as effectively and efficiently as possible. And that means all of the public, especially those who need it most.

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