The night that set back NHS reform by years

Published in The Daily Mail (August 4th, 2012)

The rest of the world may have been perplexed, but it was 20 minutes that made Britain feel better about itself. The dancing doctors, the nurses in their old-fashioned uniforms, the cute children bouncing on 300 luminous beds that spelt out those sacred three letters: NHS.

What else could have symbolised Britain at its best than Danny Boyle’s tribute to the health service in his breathtaking Olympic opening ceremony? Amid the dark satanic mills and pogoing punks, here was a special moment to give thanks and praise to something British that we deem the envy of the world.

After all, our doctors are deities and the National Health Service is sacrosanct — the one arm of the State beyond criticism. There was even a salute to Great Ormond Street Hospital, which has a unique place in the nation’s affections.

So who could quibble with Danny Boyle’s declamation after his opening night triumph that everyone in Britain loves the NHS? ‘It is something that is very dear to people’s hearts,’ he said. ‘It is an amazing thing to celebrate.’

If only, in my view, that were true. True, the health service is an invaluable institution that has saved many lives. But we should stop and ask ourselves why, if it is quite so wonderful, no other major nation has adopted our system.

Perhaps it is because the last time the World Health Organisation ranked countries’ health systems, Britain came in below Greece, Malta, Oman and Portugal. More recent studies found we had the worst patient care among seven leading industrialised nations and among the lowest cancer survival rates in the Western world.

This may seem harsh, but I believe Britain’s sentimentality over its health system — which will intensify now Boyle has decreed it to be an official strand of our island story — is preventing real reform, a damaging and ultimately  self-defeating national tragedy.

The truth is the NHS is a relic of a bygone age in dire need of life-saving surgery. And if Britons’ misty-eyed myopia prevents us seeing this, the patients who will suffer are those most in need — the old, the disabled and the long-term sick.

At the risk of sounding sacrilegious, Boyle is wrong: not everyone adores the NHS. There are, of course, many dedicated doctors and nurses, while some areas, such as palliative and emergency care, generally work superbly. But for those of us who have seen its underbelly, exposed with all its flaws and imperfections, there is little affection for this outdated institution.

As the father of a child with profound and multiple learning difficulties, I have seen too many blunders, too much insensitivity and too little care for the most vulnerable patients to share the faith in Britain’s national religion these days.

Yet I am not alone. One mother of a disabled child told me how, as she watched the Olympic opening ceremony at a campsite in Dorset, she started raging over the NHS segment to the amazement of her fellow campers. Hailing Great Ormond Street was the final straw.

And in the words of the father of another child with disabilities, it is sickening to hear constantly the mantra of how brilliant the NHS is from people who do not rely on it and are not engaged in a near daily struggle against its inertia and ineptitude.

After writing about my family’s experiences, I have received countless letters and emails from pensioners, parents, sons and daughters — all angered at how the post-war dream of decent healthcare for all has turned into a personal nightmare for their families. They told of deadly mistakes and missing case files, of dirty hospitals and uncaring staff, of dreadful management and bungling bureaucracy.

‘I have been in a similar boat,’ said one mother, a former NHS scientist. ‘Six years of incompetence, laziness, carelessness, political in-fighting, suffering careerists and cowards.’

These are not isolated examples. Spot checks by the Care Quality Commission watchdog found ‘alarming’ failings in basic care for the elderly at more than half the hospitals visited, underlining scathing reports by the Patients’ Association.

One old man was left sitting in his own faeces for hours because a nurse said she did not have time to help. In another case, a family had to beg for pain relief for a dying woman. Stories of elderly patients starved of food, water or simply ignored by staff are horrifically common.

Earlier this year, the Mail exposed how dehydration or malnutrition was linked to the deaths of 1,316 patients in 2010. Last month, an inquest revealed a hospital patient died of dehydration after becoming so desperate for a drink of water that he called the police for help.

Little wonder so many old people fear going to hospital when they risk dying of thirst or hunger in a place that is meant to protect them — especially since these death-rate figures seem to be rising.

All too often there is shameful lack of compassion for those in their twilight years. Care in the community is often no better, few things being more misnamed as a series of appalling scandals has revealed, while patients  with learning difficulties face potentially fatal discrimination.

Mencap, the respected charity, has compiled data on close to 100 deaths over the past decade that were due to discrimination by medical staff. They include a man with Down’s syndrome, starved for 26 days after suffering a stroke, and patients abandoned in agony without medication.

‘We have to point out that people with learning difficulties suffer pain, too,’ said Beverley Dawkins, Mencap’s policy manager for profound and multiple learning difficulties.

She admitted that she could not help thinking about all these grieving families during Boyle’s Olympic tribute. ‘There is a story of appalling nursing care, and it seems the same with the elderly,’ she said. ‘You have to get members of the family to do round- the-clock vigils to support vulnerable people or you can be in real jeopardy in hospital.’

My own family has seen such blinkered attitudes at first hand — and I have friends who have been confronted by doctors’ shocking indifference to the death of their child. One mother was rung in the night by doctors asking if they should bother resuscitating her profoundly disabled daughter. They did nothing to help her until her mother turned up in panic and began to berate them.

Now it may be painful to accept, but this is the disturbing reality of the beloved National Health Service: families of vulnerable patients mounting vigils to ensure they survive in hospitals.

Ironically, these patients are the very people the NHS was set up to help more than six decades ago — those often failed by the haphazard system that existed before 1948.

It seems incredible people can die of starvation in a modern British hospital. This is the legacy of pumping vast sums of money into an anachronistic system, of a culture of bureaucratic targets and box-ticking, of insisting nurses must be graduates and allowing doctors to become deified — and of politicians too timid to do what they know is right.

Such problems existed from the start. At first, doctors were wary of the NHS, so they were given the incentive of extra money — or had their ‘mouths stuffed with gold’ in its founder Aneurin Bevan’s infamous phrase. Politicians, terrified of being criticised by physicians who persistently oppose reforms, have pursued similar policies to this day.

Almost from birth, the NHS has lurched from crisis to crisis. The first major row came only three years after its foundation, Bevan quitting the Cabinet in fury when Labour Prime Minister Clement Attlee introduced prescription charges to cover rising costs.

The problem is the NHS was designed for the world that existed in the aftermath of World War II and focused on the fight against infant mortality, infectious diseases and industrial injuries. These were tough times — one child in 20 died before its  first birthday, and thousands of people died each year from diseases such as diphtheria, polio and tuberculosis.

So the system was centred on big hospitals — nationalised to appease the medical professionals — filled with expensive equipment and platoons of  all-powerful doctors.

However, the illnesses of the past have been overcome. Remarkable medical advances have transformed healthcare, from the invention of a polio vaccine and birth control pills in the Fifties through to the latest surgical technologies, such as this week’s announcement about new spray-on skin.

Though the UK has among the highest infant mortality rates in western Europe, only around one in 200 children today dies before its first birthday. Now we face a new challenge: to modernise the 20th-century model of healthcare, as former NHS chief executive Lord Crisp has rightly argued, so it is fit for purpose in the 21st century.

As a result of all these amazing medical innovations, Britain’s population is ageing and growing — life expectancy has increased by around 14 years since the NHS was established. We also have more people living with disabilities, often highly complex and multiple conditions. Most develop them during their lifetimes — only one in six people with disabilities is born with them like my daughter.

These are the patients soaking up more than two-thirds of NHS spending, not the high-profile emergency cases the NHS tends to treat well — and yet too often they are crushed and uncared for in the current system.

As costs soar — with spending needing to rise 3.6 per cent a year to stand still and warnings of a £20 billion black hole by 2015 — the NHS must serve them more effectively and efficiently to survive. We must shift focus and funds on to long-term conditions such as dementia, depression, diabetes, cancer and  coronary disease.

The only way to do this is by freeing up money from the old infrastructure, which means closing dozens of hospitals, concentrating specialist units and diverting funds into personalised care based around the home and community.

This will help patients live with disabilities, manage pain and cope with chronic conditions, ensuring more sensitive services. It might also break down the artificial distinction between well-funded health care and ‘Cinderella’ social care services.

Many doctors know this, even as their union leaders fight against threats to entrenched powers. They know the key is better provision of localised services — and that patients in need care little about who provides them if they remain free at point of use and good quality.

Some change is slowly taking place, notably the vital introduction of personal health budgets allowing patients to determine their care. The danger is they get stymied by the system, stifled by professionals feeling threatened or used as an excuse for cuts. Meanwhile, we must lose our irrational fear of the word ‘privatisation’.

We forget that the vast majority of general practitioners are already private contractors and many consultants spend much of their time on highly lucrative private work.

It is worth remembering the worst health disaster of recent years involved the deaths of several hundred patients in the most squalid circumstances in two NHS hospitals in Staffordshire. Needless to say, two of the people in charge were promoted to top NHS jobs. 

Meanwhile, this week we heard a private company has turned round a failing state hospital (Hinchingbrooke in Cambridgeshire) in just six months, with waiting times down, staff morale up and patient care upgraded. Even the food is improving and parking fees are being abolished.

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