The Holy Cow is slain. The shibboleth has crumbled. Our once unimpeachable NHS, which no one dared give anything but gushing praise to, now seems constantly in the news for appalling failings in the most basic standards of human decency. So how do our politicians respond?
The latest reports that hospitals become fatally unsafe at weekends, when top doctors go AWOL, follows admissions that many A&E units are treacherously overloaded. The head of the NHS, Sir David Nicholson, has resigned. We have seen the patient deaths scandal unfold at Stafford Hospital, while 14 other hospitals are now under investigation for suspicious death rates. Many others are crippled by poor care standards and rising debt. It looks like an outright crisis.
The truth is, though, that these problems have been going on for years. The difference now – and the Government deserves credit for this – is that this dirty linen is starting to be washed very publicly. We can expect lots more to come too, including patient feedback scores being published this summer about the state of every hospital in the country.
Cases of seriously bad care are thankfully not widespread, but increased public scrutiny means politicians must at last grasp the problems underlying those that do exist. These lie not with the doctors and nurses on the wards, who are both overworked and undervalued. It’s a disgrace, for example, that state-set pay scales force a front-line nurse to earn less than a junior hospital HR assistant. Meanwhile, the top brass pick their own hours so they can fit in moonlighting for private hospitals that didn’t pay a penny towards their years of training.
No, the blame lies squarely with the bureaucrats and politicians that have run the health service, for years hiding areas where care is not just below par, but downright dangerous. Their worst failing has been total slavery to the idea that the NHS is somehow different from other services, so must be owned, controlled and run by them. This is despite the progressive marketisation, since the 1980s, of how health care actually works in practice and in spite of the fact that healthy competition between hospitals is proven to save lives.
Only in one case, early last year, has any Government in this country allowed a provider from outside the state to operate an NHS hospital. It’s a company run by doctors who took over Hinchingbrooke Hospital in Cambridgeshire, which was under threat of closure due to poor care and financial deficits. Within a year, care has been completely turned around, the finances look better and the local community is keeping its hospital. There are many other places in need of exactly this help, but the system simply doesn’t open up to the organisations that could offer it.
Recently-passed legislation theoretically allows new providers to come into the NHS in future, but so much still depends on the political will to push the policy through. The Government’s main response to failings like Stafford has been to appoint new inspectors and inspection regimes. All fine, but where is the will to drive through the disruptive innovation that will really turn things around? New entrants have improved every other service market in existence for all of history – and the NHS is no different.
The Government has said nothing about this recently, however. In addition, the Labour Party, who under Tony Blair had a successful record in public service reform, now say they’d turn back the clock by reintroducing a state-run monopoly. If anything, the public debate around how to improve the NHS is going backwards, not forwards. And all we get from the NHS leaders is outdated bleating about giving them more money.
The brightest future for our NHS is a system where patients can freely choose any provider they like and avoid ones they don’t. A genuinely open market of this kind will powerfully raise standards, but will take years to emerge – time we don’t have in regard to the many hospitals, like Stafford, which we know face real issues right now. So let’s just take our worst performing institutions and have a genuinely open, transparent competition for innovative, compassionate providers to come in and turn them around. It’s not rocket science.
If politicians want to keep opening the NHS to greater transparency – which is wholly right – they cannot sit on their hands when systemic problems are revealed to the public. The more the mask on poor care falls, the more people will get angry about what they see. Will that at last give our politicians the kick to bring in the change we need?