Level The Playing Field

Martin Kettle has a thoughtful comment article in today's Guardian - which I enjoyed until  I made the mistake of reading some of the crazy online comments that  followed.

The way to tackle some of the problems which led to the scandal of Mid Staffordshire - if you ask me - is to strengthen the ability of patients and their families to be heard - above the many powerful interest groups which dominate life in the NHS.

Professional bodies and trade unions are very good at representing their own vested interests - they always claim to have the interests of patients at heart - but this cannot be true because it's impossible to face in two directions at the same time.

As an old friend of mine was fond of saying - 'the only person who can ride two horses at the same time, is one with two arses!' - and you don't find them growing on trees.

The people who brought the Mid Staffs scandal to public attention were the families of patients who were left lying in soiled sheets and much worse besides - not doctors or nurses groups or the trade unions.

So part of the answer has to lie in levelling the paying field - to ensure the voices of patients and their families have a much greater say in what goes on in the NHS - in how it is run and inspected, for example, or how it deals with complaints.

Now it shouldn't be a fight for these voices to be heard - but with all the other vested interests around - you would be simply daft to think otherwise.


'No more Mid Staffs' sounds so simple. It will be anything but.

The parties were unified but we know that reform in the NHS, though massively necessary, has defeated many politicians

'A bipartisan approach is undoubtedly attractive if the approach is a good one. But what if it repeats the errors of the past?'

Any visitor who looked in on the House of Commons today during the key exchanges at prime minister's questions, and who then returned to hear the same protagonists debating the Stafford hospital report less than half an hour later, might have wondered what drugs David Cameron and Ed Miliband had been taking in their absence.

The contrast would have been comical if the issues were not so important. At PMQs, where they traded blows on housing benefit, no insult was too cheap and no partisan caricature too crude. Yet in the debate about Robert Francis's final report on the horrendous failures at Stafford hospital, the leaders fell over themselves to compliment one another on their wisdom, tone and sensitivity. Suddenly, consensus was all.

Surveys repeatedly show that the public much prefers politicians to agree and work together rather than knock six bells out of one another. That's why the coalition was so popular when it was formed and why, even now, another one might get the public vote again. Not a PMQs goes by without Speaker Bercow hogging the microphone to remind MPs how much voters hate the political bearpit. So, by that token, the public would have loathed PMQs and loved the civilised debate on Stafford hospital that followed.

On one level, the public would be right. The great thing about a set of exchanges like the ones about Stafford today is that they permit politicians to talk in shades of grey, not in black and white. That approach encourages greater truthfulness and forbearance – Miliband, for instance, was allowed to apologise for the Labour government's failures of supervision at Stafford without the Tory benches turning into a lynch mob against him. Likewise, Cameron was able to talk about the parties' shared love for the NHS – "the closest thing the English have to a religion" as Nigel Lawson once put it – without Labour's usual reflex snorts and sneers.

All this is good, as far as it goes. It is truly pathetic that the British political debate prevents Labour from suggesting there should be a fair deal for benefits claimants without the Tories accusing them of cavalierly running up public debts. And it is equally infantile that any suggestion by a Tory that the NHS might occasionally be less than ideal is met with apocalyptic warnings about the Tories' determination to lay waste the nation's beloved health service.

It was ever thus, however. "There is no subject on which we have been so consistently right as on health, but equally there is no single subject on which it is more believed that we have been consistently wrong," wrote Iain Macleod, pushing the Conservative party to come to terms with the NHS in 1949. But, more than 60 years later, they all too accurately summarise the tale of Andrew Lansley's hapless 2012 reorganisation too, especially as retold in Nicholas Timmins's essential and even poignant recent account.

It would be nice to think we occasionally made a bit of progress in such matters, and that the accumulation of social and cultural changes in modern Britain had advanced to the point at which it was permissible to listen to intelligent Tory thinking on public service reform, or well-grounded Labour ideas about more effective private sector regulation without the tedious "same old, same old" insults being so quickly levelled. The public, one suspects, are ahead of politicians in this respect. They may not like needless change. But the polls show they are very open to the necessary variety.

The Stafford hospital exchanges, however, were a warning to be careful what you wish for. What happened at the Mid Staffordshire NHS trust between 2005 and 2009 was systemic failure. Patients suffered appalling neglect and mistreatment. Complaints were ignored. Relatives were dismissed as busybodies. Whistleblowers were denounced not taken seriously. Management at every level failed to grasp what was happening or ignored it. But it was systemic failure about which both parties agreed at the time and from which it is by no means clear that they have yet learned the deeper lessons.

In his much complimented statement in the Commons today, Cameron apologised handsomely for what happened. He's good at that sort of thing. But he also, remarkably when you think of the readiness to blame Labour in so many other areas, praised the last government for starting to put things right.

Such bipartisanship is undoubtedly attractive. In principle there should be more of it, not less. But in the end the important thing is the approach itself. A bipartisan approach is fine if the approach is a good one. But what if it repeats the errors of the past?

That is the danger with the response to the Francis report. If the problem that spilled into patient mistreatment and neglect in Stafford was, as Cameron says, an excess of attention to financial and management targets at the expense of patient care, it is not evident from today's exchanges that the solution will be much better. Change the culture, said Cameron. Miliband agreed. Ensure staff levels are benchmarked, said Miliband. Cameron concurred. More training. More regulation. A place for targets. The frontbenches were as one on these too. There was even agreement to press on with the gargantuan task of integrating health services and social care.

It all sounds so simple. But if we know anything about the NHS it is that reforming it, while massively necessary, is anything but easy. All health secretaries have tried hard in different ways but most have fallen short. Some have made things worse not better, with grim morale the consequence. Ministers had shiny new tasks for all in the wake of Francis. But shiny new tasks were part of what went so wrong in Stafford. And just because the party leaders think the new approach is better than the last one, it is dangerous to be confident that the outcome will be so very different.


Online Comments (three of hundreds) 

fishandart

06 February 2013 8:41pm

Recommend

68Forget today's rhetoric, over the medium to long term the Tories will see this an opportunity to push forward their agenda for privatisation and profits to be made in the future through the expansion of private healthcare.

Report Share this comment on Twitter Share this comment on Facebook FIGHTCOALITIONFORCES

06 February 2013 8:51pm

Recommend

50 To the Tory mind NHS patients are like rare earth materials to be mined for profit. This careless attitude has no truck with moral qualms unless they produce more profit. They are currently engineering the scenario where we privately pay for our inevitable consumerised profitised decline.

Capitalists itching to monetise disease and decline.

Nice party at the nasty party

Report Share this comment on Twitter Share this comment on Facebook JosephKay

06 February 2013 9:08pm

Recommend

114@FIGHTCOALITIONFORCES - I am sorry if this turns out to be a double post.

The problem is the attitude the two posts above, they forget the hundreds that have dies and instead just attack the Tory Government.

It would appear that tribal politics is more important than hundreds of deaths.

Very constructive, and people recommend the comments!