Political Footballs

Here's an interesting article by Simon Jenkins which appeared in the Guardian the other day - when the complaint from Labour in the House of Commons was that the NHS is being used as a political football.

In reality, it's been that way for many years of course and the situation is not significantly  different in Scotland - worse arguably - since individual cases are raised regularly with the First Minister at First Minister's Questions (FMQs) - as if Alex Salmond is personally responsible for individual cases at local NHS hospitals.

And to be fair the same thing was true when Labour was in power up to 2007 - when any effort to concentrate resources more effectively in particular areas - was opposed tooth and nail by determined local campaigns.

One  of which pitted Labour's Scottish health secretary - Andy Kerr - against Labour's UK Home Secretary - John Reid - who opposed moves to close Monklands Hospital's Accident & Emergency Unit as one of the local Labour MPs, as I recall. 

Two government ministers slugging it out in public over the best way to deploy NHS resources - one a Holyrood MSP the other a Westminster MP - but both drawn from the Labour Party.

I can't think of a better example of the NHS being used as a political football - and as Simon Jenkins says that's a crazy way to run a public service.       

Another NHS crisis? This is no way to run a public service

Grotesquely overcentralised, and with every arm raised in salute to the minister, Britain's healthcare is stuck in a 1940s time-warp

By Simon Jenkins

Will it never stop? Today's Commons shouting match on failing hospitals between the health secretary, Jeremy Hunt, and his opposite number, Andy Burnham, was the worst possible publicity for a national health service, a godsend to privatisers and American rightwingers. Blame was diffused to more reports, inspectors, risk registers, special measures, leadership academies and partisan point-scoring, recalling the worst days of nationalisation. This is no way to run a public service.

The image of the NHS today is of the British army on the Somme, "lions led by donkeys". The lions are nurses, labouring in the trenches. The donkeys are back at the chateau, scoffing seminars, feuding with ministers, arguing on Radio 4's Today programme. Foreigners look on in amazement. This is a health service, for goodness sake, not a state religion.

Lobbyists for the NHS have resisted reform by appealing to public emotion since its foundation. It has served them well – especially the consultants. As for patients, even George Orwell could not have devised the Liverpool Care Pathway, revealed last week as a state death management package. It has nurses shouting at visitors not to give dying relatives a sip of water for fear it might wreck the hospital's deaths target. No one was doing anything "wrong", since everything was done by the book.

Headlines about the NHS being "in crisis" and "on the brink of collapse" have been lobbying fodder for decades. They terrorised Margaret Thatcher, John Mayor and Tony Blair alike. They have grown from a trickle to a torrent. The Mid Staffs inquiry showed lack of care as shocking as the NHS has ever offered – after three decades of constant reform.

Today we read of 14 other hospitals displaying similar standards. We hear of A&E departments "in meltdown", GP services "on the verge of failure", the Welsh NHS being "on its knees". The 111 non-emergency telephone service is reportedly useless. On one evening, Cornwall was said to have just one agency GP to cover the entire county. Last week's Cavendish report on frontline nursing told of wards left in the hands of untrained assistants for hours, indeed whole weekends.

The NHS may be poor at examining patients, but it is tremendous at examining itself. Today's report from Bruce Keogh followed another on Mid Staffs by Robert Francis QC and is to be followed by others. It ran parallel to a report into the Care Quality Commission's report on its own report of dead babies at Morecambe Bay hospital. Babies may suffer but bureaucrats are drunk on inquiry-itis. They can't stop.

What is baffling about the NHS is not so much its performance, which OECD comparison shows to be middling to poor, but its infatuation with its own administration. In opposition, David Cameron declared there would be "no more tiresome, meddlesome, top-down reorganisations". He came to office and immediately ordered one.

Likewise the NHS boss, David Nicholson, shortly leaves office after dismantling and rebuilding the doctor-hospital relationship – yet he could remark that the NHS had "wasted two years" and what it needed was "real and fundamental change". When in 2007 the management guru, Gerry Robinson, tried to galvanise a Rotherham hospital for a television series, the most evocative image was of him collapsing into his car and burying his head in his hands after another day in a madhouse of merciless obstructionism.

Everyone agrees that the NHS is in the grip of too many tiers of control. It is blighted by screaming politicians, private financiers, IT racketeers, management consultants, league tables and targets. It has been tortured by so many reorganisations it can hardly stand up. Yet its instinct is to respond with more bigness and more centralisation. Health is so sensitive a topic that no amount of control is too great. The NHS is a neurotic caricature of a corporate entity.

Most apologists compare it with America's insurance-based health service, as if that were the sole alternative. They carefully choose the most extravagant, wasteful and socially unfair system in the developed world. I prefer comparison with Europe, such as with Denmark. Its health service is constituted like the NHS, free at point of delivery, with national payments to doctors and staff.

There are two differences between the NHS and Denmark. One is that Danish GPs and non-specialist hospitals are run by local county authorities and answer to patients through them. The other is that satisfaction with healthcare in Denmark is at over 90%, while in Britain it hovers round 60%. Denmark's health outcomes are ahead of Britain's, and it is only a little more expensive. There are no annual reorganisations, political shouting matches and constant "crises". It works because it is small.

Any move in a local direction is furiously opposed by Britain's healthcare lobbies. Can you imagine, they cry, local councillors running our beloved NHS? Can you imagine the people we have stopped running schools, houses and planning actually being in charge of GPs and hospitals?

Why Danes can do it and not Britons is a mystery. The fact is that Denmark runs a popular local service that has avoided Whitehall's PFI insanity – now bankrupting many hospitals. It has avoided the useless NHS computer, the awful Liverpool Care Pathway and the inhumanities of Mid Staffs. That is centralism at work. So chaotic is it that Hunt and Burnham could not agree on who was responsible for what. Today's NHS accountability is not through politicians but through whistleblowers and the press.

The NHS restlessly morphs between regional authorities, elected foundations (remember them?), hospital trusts, agencies and commissioning boards. It is grotesquely centralised not because anyone believes that is the best way to produce healthcare, but because a nationalised service cannot be otherwise.

Britain has a poor record in cancer care. If that were due to small "inefficient" hospitals where patients knew their doctors and were treated among family and friends, I believe most people would accept it. They would agree a little inefficiency in return for kindness and care. Instead, Britons get poor care and unkindness because the NHS is focused on the national stage, and every arm is raised to salute the minister.

The NHS has outlived the returns to scale it once derived from nationalisation. It is trapped in an emotional 1940s time-warp. For it really to improve, foreign experience should be studied and smaller independent units used to deliver socialised medicine. Until that happens, the hysterical headlines won't stop.