NHS: sanctity cannot be violated


Dr Dermot J Ward


Margaret Thatcher said of her Trade and Industry Secretary, Lord Young, “other ministers bring me problems, David brings me solutions”.With the richness of recent assaults on NHS reorganisation’s Health and Social Care enabling Bill despite both Coalition partners (Cons/LibDems) agreeing right through the second reading in parliament, the leaders may well be muttering similar incantations as they finger their worry beads. The junior Coalition partner Lib/Dems led by Nick Clegg, following widespread general public and health professions dissatisfaction, have suddenly discovered they too dislike the Bill intensely which they initially embraced. They are now opposing much of Health Secretary Andrew Lansler’s reforms.

Because Nick Clegg had agreed  Coalition NHS policy he has found himself angrily abandoned by his own party who feel betrayed by him (and not just on health but education also). Mind you not too many tears are shed for politicians at the best of times.You may recall the core plank of the reorganisation was to devolve 80% of the NHS annual budget (at present c£80bn) to GP consortia thereby demolishing two swathes of expensive bureaucracy. It’s not difficult to see the attractiveness of such goal to  many doctors and admin folk. It has not escaped notice that if there is to be doctor commissioning (I have no problem with that) it cannot be right to focus so heavily on GPs rather than equally include senior hospital medical in commissioning staff when the major financial cost burden lies in the secondary care system.

Public and professions’ outcry in defence of our NHS‘ has been of tsunami proportions and government was forced to ‘pause‘ implementation so that it could ‘explain‘ to all how truly sensible - but misunderstood- its health plans are. What ignites passionate opposition is any suggestion of allowing even a whiff of private sector tendering for services alongside the public sector. The perceived twin demons are privatisation and competition. The public opposition has all the  fervor of a fanatical religious belief. That belief is despite many of the best healthcare systems in the developed world allowing extensive private sector involvement. 

The general and decent UK citizenry believe they have the finest and fairest healthcare system in the world. It could not be finer in aspiration: “free” for all at point of use and paid for out of general taxation (not insurance as the so-called ‘insurance stamp’ suggests). The major trouble with that is the huge cost and the extent of political micromanagement  constantly brought to bear as witness on average a ‘reorganisation‘ of the NHS every 2 years over the last 30 years. This has polluted patient care and treatment outcomes which  (you might think) would follow the noble aspiration.

Instead there is a gaping gulf between that noble healthcare promise and what the NHS actually delivers: poor treatment outcomes in major morbidity areas such as heart disease and cancers. Then there are the scandals which seem even worse in any civilised society: the large scale inhuman nursing neglect of especially older patients. The latest baleful revelation was published on 26th May this year by the Care Quality Commission (itself a dubious organisation) report. It found that  20% of a sample of about 100 hospitals visited were failing to provide even basic nursing care for elderly patients. Secretly observed, nurses ignored patients to chat and play music. In some wards patients had to be formally prescribed water after nurses left them thirsty for more than ten hours. There was so much more that has been appalling and be assured this is not a first. And as with previous similar systemic (and individuals’) failings, the mantra following these outrages has been the vacuous “lessons have been learned”.   

I am quite prepared to consider myself paranoid (not paranoid psychotic yet I hope!)about Britain’s NHS. I worked in it for two separate periods of 7 years each, the first as a hospital trainee up to and including SR in the 1960s, the second stint as a consultant in the late 1980s and into the early 1990s and following retiring from a substantive post continued until 2 years ago as visiting independent consultant psychiatrist in both public and private sector hospitals. Recently, I trawled the internet specifically seeking similar incidents of systemic patient neglect in Ireland. Nothing relevant emerged and despite my attempted electronic geographic ring-fencing what did appear were those incidents in Britain.

My first column in a medical newspaper was over 40 years ago. In the intervening years from time to time I have written pieces advising Ireland not to copy the NHS: to beware of what you wish for lest it be granted. This has nothing to do with ancient anti or pro Britain feelings. Indeed I was pleased to note how the Queen’s visit was handled in such a mature, respectful and goodnatured  way on both sides. Good neighborliness is indeed a blessing. More relevantly I see that newly appointed Ireland Minister James Reilly Is, sensibly, looking towards alternative healthcare systems in Europe (Holland especially mentioned).

Sweden is interesting too. You might call it the spiritual home of the high-tax socialist market economy. Yet its health policy embraces co-payment and private sector participation. A patient consulting a doctor there is unlikely to pay less than 15 Euros. This does not raise large amounts but does defray costs a little. They consider however that it brings about significant behavioural changes that limit demand without discernible impact on standards of health. Astonishingly, because this is Sweden, its finance minister claims that health spending in Sweden is now lower as a share of GDP than in the UK. But unlike the UK Sweden has adopted an economic model for health which is pragmatic and Idealogically agnostic. Health outcomes are more important than NHS noble but impossible aspiration.

Looking at the latest NHS reorganisation ructions it would not be in the least surprising if the result of it all, (despite the desperate need  for reform, along even Ireland’s current lines, despite its imperfections or Dutch, or Swedish) is mere re-arrangement of the Titanic deck chairs. No system is perfect. It will be ever thus. The very nature of health services is dealing with illness, suffering and death; distinctly unlike selling sweeties or pleasing perfumes, aspects of simple pleasure. In every business there will be failings and disappointments. Inevitably, our successes are mostly hugely appreciated: our failings, systemic or individual, whether blameworthy, accidental or merely inevitable, tend to be writ large. Problems are legion. Solutions? As scarce as NHS dentists.