Saturday, 25 January 2014

Cure the NHS

The NHS rarely gets criticised in public- anything short of full-blown adulation is met, in some quarters, like a violent assault on someone's dear old granny.

So, I enjoyed this opinion piece by Dominic Lawson which appeared in the Sunday Times recently although I was shocked to read again about the terrible experience of Julie Bailey, the courageous whistleblower who brought the scandal of up to 1200 unnecessary patient deaths and deplorable standards of care at Mid Staffordshire Hospital to public attention - with her Cure the NHS campaign.

Why is it, I ask myself, that the cowardly treatment meted out to Julie Bailey has not been given more attention in the press?

Where are the community leaders, politicians, church groups and trade unions on an issue like this - because their silence is defining.     

You get what you pay for — which, for most NHS users, is nothing

By Dominic Lawson

When this country had the chance to tell a captive global audience what we do best, the National Health Service was chosen as the crowning glory: a theatrical evocation of its role in our lives was the climax of the opening ceremony of the London Olympic Games last year. When one Conservative MP dared to question this at the time on Twitter, he was ignominiously buried under an avalanche of outrage.

With this in mind, let us consider two official reports issued last week. On Wednesday the Organisation for Economic Co-operation and Development revealed that British survival rates for cancer and strokes were no better than in eastern Europe. Only Poland of the 40 nations surveyed reported worse recovery figures for breast, bowel and cervical cancer. The chief executive of Macmillan Cancer Support said the fact Britain lagged so far behind the rest of western Europe was “simply unacceptable”.

The following day the Care Quality Commission (CQC), in its annual report, stated: “In the aftermath of the failure of care at Mid Staffordshire NHS Foundation Trust, our inspectors’ biggest concern in 2012-13 was that acute hospitals made no improvement in assessing and monitoring the quality of care they provided. We also found no improvement in safety and safeguarding, or in hospital patients being treated with dignity and respect . . . It was clearly unacceptable that this position, poor to begin with, had deteriorated further.”

So that’s two unacceptables, one clearly and one simply. Yet the British public finds it eminently acceptable. The latest annual survey of social attitudes by the King’s Fund health charity revealed that “satisfaction with the way the NHS runs now stands at 61%, the third highest level since the survey began in 1983”. This is the sort of statistic that the public sector unions brandish at the health secretary, Jeremy Hunt, whose attempt to reform the dysfunctional behemoth of the NHS is popularly regarded with suspicion rather than relief.

It is a mystery. If a supermarket treated its customers as badly as the NHS does many of its patients — the CQC said last week that 18% of hospitals failed to reach “basic standards” — it would go out of business. Obviously, the NHS is a monopoly; but that might be expected to increase, not diminish, public anger.

So there must be another reason; and the clue can be found in the story in last week’s Sunday Times about who pays net tax and who doesn’t. The firm BDO UK, using official figures from HM Revenue &Customs, confirmed what had emerged from research done by the Centre for Policy Studies: that it was necessary for an average family to be earning above the median income (£26,000) before it began to be a net payer of tax. Those below this level encompass a vast number of pensioners, whose dependence on the NHS is greatest of all.

The flipside of this is that the top 1% of earners are now paying almost 30% of all income tax. Now, these rich folk are not the sort to create a stink about delays in treatment for cancer in the NHS, for the simple reason that they will all have private health insurance and get the medical care they want, when they want, where they want. They may resent the extent to which they are funding the NHS (the cost of which, in real terms, has more than doubled over the past 20 years, to £120bn per annum); but they don’t suffer its shortcomings and so have little personal interest in its performance. Of course, it’s not necessary to be part of that top 1% to go private; a sizeable proportion of the working population has private health insurance via their employer — including, indeed, leaders of public sector unions.

Yet what about the millions at or below median incomes who are the most likely to use the NHS? Their position is essentially one of supplicant. They know they depend absolutely on it; but they also know they are getting it free — not just in the sense of being free at the point of use, but in the true sense of not paying for it at all.

Psychologically, nothing could be better designed to make users grateful for what they get, not just when they have every reason to be but even if the quality of service might in some areas be third-rate.

A practical illustration of this was given to me by Dr Massoud Faloudi, who has practised as an ophthalmologist both in Kent and just across the Channel in northern France: “If you go to Lille and tell someone that they have to wait 18 weeks for eye surgery, they will faint. But here people will wait 18 months for the same treatment and they think we do a good job for them.”

As Dr Faloudi points out, in France they have co-payment, in which all but the poor contribute a certain amount directly from their own post-tax income. This turns the people being treated into consumers, making them as demanding of their health provider as they might be of any other service for which they pay by credit card.

I discussed this example with Stephen Dorrell, chairman of the Commons health select committee, who has thought more about such issues than any other legislator (having also served as secretary of state for health). He observes: “It is remarkable how people defend their local hospitals based on complete ignorance of the actual performance indicators; and they are unfortunately all too often supported in this by local politicians and newspapers.”

This is an amplification of the view that the NHS is akin to a national religion: the district general hospital is the cathedral and its doctors and nurses the priests in possession of absolute truth and virtue.

In this context, recall that while the coalition government rightly commissioned a public inquiry into what went on at Mid Staffs (where patients dying of thirst desperately drank stagnant water from flower vases), the main whistleblower was run out of town.

Julie Bailey, whose mother was one of the estimated 1,200 “extra” deaths caused by neglect at Mid Staffs, told an interviewer that when her campaign caused the A&E department to be closed pending review, “I was getting cards saying ‘I hope you die in an ambulance on the way to the hospital’ . . . I had my car tyres slashed, ‘bitch’ written on my windows, and ‘shut your effing mouth’.” She decided to move away when her mother’s grave was vandalised. Hunt’s push for more personal accountability within the NHS is vital, but only if more users had Julie Bailey’s attitude would the NHS begin to match up to the panegyric composed by the director Danny Boyle.

Failing that, it would require the politically impossible — a system of co-payment similar to that in France and Germany. By analogy, observe how last week University College London admitted that the fact students were now making substantial personal contributions to the cost of their tuition had made them much more demanding.

Nothing similar will happen in the NHS; we will continue to be the sick man of Europe.