It is time to stop prostrating ourselves before the NHS God

Private partnerships and competition can help prevent catastrophes like that which saw over a thousand patients die at the Mid-Staffordshire NHS Trust

Share
Fact File
  • 1,200 Patients who died through neglect at Mid-Staffordshire NHS Trust

It’ll never catch on. The “duty of candour”, that is. If you hadn’t heard, that was the main element in last weekend’s leak of reforms to be suggested by the official report into the horrifying events at the Mid-Staffordshire NHS Trust. This was the hospital where between 2005 and 2009 as many as 1,200 patients met their deaths directly as a result of neglect by staff. Some had been reduced to drinking water from bowls of flowers left by relatives, so unconcerned were the nurses by their patients’ plight.

Yet the whole process of attempting to regulate bad practice in the NHS out of existence seems doomed to repeat the failures of the past. After all, the regulator of hospitals, the Healthcare Commission, had passed Mid-Staffs as fine, even after it had received notification of the abnormal death rates: it just assumed that the figures must be wrong.

 More importantly, good care can never be a matter of ticking a box, regardless if one of those boxes includes such a basic question of integrity: “Have you at all times fulfilled your duty of candour?”. Would you expect anyone to answer such a question honestly, if he or she had lied to a patient? To be fair, the proposed new statutory “duty of candour” seems most geared to ensuring that, when things do go wrong, the medical staff involved admit this at the outset, thus avoiding the long legal battles which ill-treated families currently have to fight in order to establish the truth about what happened to their relatives.

Low expectations

Yet one pervasive problem is that, at least among older patients in this country, expectations of quality of care are extraordinarily low: if that were not the case, the disgusting abuse at Mid-Staffordshire – far and away the worst example of a number of institutional failures within the NHS – would not have taken so long to come to public attention. This might be a function of the quasi-religious faith that so many have in the National Health Service, which means that, as with rotten priests in the Catholic Church, those suffering ill-treatment or even abuse feel it would be heretical to complain or ask awkward questions.

There is also the fact that treatment in the NHS seems to be free. Of course, it is not: the public pays for it through taxes – indeed, over the past 20 years that sum has tripled from £40bn to £120bn. Yet because it is free at the point of use, it is easy to see how the patients can be made to feel grateful for whatever they get, as if all the treatment were an act of charity by the staff. Above all, there is no real choice of provider. Imagine if all the hotels in the country were compulsorily owned by the same company, and it was impossible to take one’s custom elsewhere to a rival firm: how good would you expect things to be? Anyone who spent time in Russian hotels under the Soviet system would know the answer.

Yet there are signs that this might slowly be changing, even though the Coalition felt forced by pressure exerted by the British Medical Association and the public sector trade unions to water down its legislative commitment to encourage more competition between hospitals. Three months ago, I visited Hinchinbrooke Hospital in Cambridgeshire, the first NHS district general hospital to be run by a private group. That group is Circle, Europe’s largest medical partnership, which consists of almost 2,000 doctors, and has ambitions to run many others of the 30 NHS hospitals which are said to be failing.

Last month, the National Audit Office criticised Circle for running up a further £4m in debts at Hinchinbrooke, more than twice the £1.9m deficit it had projected when it successfully tendered for the contract back in 2011. Yet the objections from the unions at that time were much more primordial: the introduction of private management would cause patients to be slaughtered. Thus Unison declared: “This is a disgrace, putting patients at serious risk. Privatisation, which brings in the profit motive, will damage our NHS.” Meanwhile, the Labour Health shadow Secretary of State, Andy Burnham, said: “This is not what patients, public or NHS staff want.”

Yet when I went to see what was going on, it was clear that great improvements had been made. The Accident and Emergency department, which had been “served a notice” under the previous management, had become, according to the official figures, the top performing such unit among all hospitals in the region, based on the speed with which patients were being seen. As a result, more people needing A&E were choosing to go to Hinchinbrooke, and fewer to the two main neighbouring hospitals: that is competition working for the benefit of the health service – or at least it would improve overall, if the funds follow the patients’ choices. The risk is that commissioning bodies within the NHS instead direct flows to the least-well performing, in order to disguise the level of failure.

Bureaucracy free

The most heartening aspect of my visit to Hinchinbrooke was not just talking to a patient who said “I’ve been asking for things and getting what I want; the staff here are prepared to do that little bit extra”. After all, patients could say the same thing about nursing care within a number of the best state-run hospitals. No, what was most encouraging was the high morale among long-term staff who said that they felt completely liberated by the way in which the private management had let them act on their own initiatives and trusted them to do so: the dead hand of NHS bureaucracy – so brilliantly satirised in Getting On, the BBC geriatric ward sitcom  – had been swept away. In return, yes, the medical staff had needed to become more productive: in other words, giving more to the patients.

It is astounding that we should have taken so long to get to this point. In Germany, for example, about a third of general hospitals treating patients paid for by the state are privately run; and it does seem that this is partly a result of a more demanding public. Dr Massoud Fouladi, the medical director of Circle, told me that his experience from working as an ophthalmic surgeon both in Kent and northern France not that much more than 50 miles away, was that “in this country, older patients are completely undemanding compared with those in France. The difference between Ashworth where I practise and Lille is very obvious. Here, patients will endure waits which would cause people to have a fit in France.”

So it’s clear what’s needed in the wake of Staffordshire: not so much yet another new system of state regulation, but the realisation by the British public that it should get up off its knees and stop prostrating itself before the false god of the NHS.

React Now

Latest stories from i100
Have you tried new the Independent Digital Edition apps?
iJobs Job Widget
iJobs General

Head of Marketing and Communications - London - up to £80,000

£70000 - £80000 per annum: Ashdown Group: Group Head of Marketing and Communic...

Nursery Nurse

Negotiable: Randstad Education Manchester: Level 3 Nursery Nurse required for ...

Nursery Nurse

Negotiable: Randstad Education Manchester: L3 Nursery Nurses urgently required...

SEN Teaching Assistant

Negotiable: Randstad Education Manchester: We have a number of schools based S...

Day In a Page

Read Next
 

Ed Miliband's conference speech must show Labour has a head as well as a heart

Patrick Diamond
 

To hear the Yes campaigners, you’d think London was the most evil place on Earth

Yasmin Alibhai Brown
Scottish referendum: The Yes vote was the love that dared speak its name, but it was not to be

Despite the result, this is the end of the status quo

Boyd Tonkin on the fall-out from the Scottish referendum
Manolo Blahnik: The high priest of heels talks flats, Englishness, and why he loves Mary Beard

Manolo Blahnik: Flats, Englishness, and Mary Beard

The shoe designer who has been dubbed 'the patron saint of the stiletto'
The Beatles biographer reveals exclusive original manuscripts of some of the best pop songs ever written

Scrambled eggs and LSD

Behind The Beatles' lyrics - thanks to Hunter Davis's original manuscript copies
'Normcore' fashion: Blending in is the new standing out in latest catwalk non-trend

'Normcore': Blending in is the new standing out

Just when fashion was in grave danger of running out of trends, it only went and invented the non-trend. Rebecca Gonsalves investigates
Dance’s new leading ladies fight back: How female vocalists are now writing their own hits

New leading ladies of dance fight back

How female vocalists are now writing their own hits
Mystery of the Ground Zero wedding photo

A shot in the dark

Mystery of the wedding photo from Ground Zero
His life, the universe and everything

His life, the universe and everything

New biography sheds light on comic genius of Douglas Adams
Save us from small screen superheroes

Save us from small screen superheroes

Shows like Agents of S.H.I.E.L.D are little more than marketing tools
Reach for the skies

Reach for the skies

From pools to football pitches, rooftop living is looking up
These are the 12 best hotel spas in the UK

12 best hotel spas in the UK

Some hotels go all out on facilities; others stand out for the sheer quality of treatments
These Iranian-controlled Shia militias used to specialise in killing American soldiers. Now they are fighting Isis, backed up by US airstrikes

Widespread fear of Isis is producing strange bedfellows

Iranian-controlled Shia militias that used to kill American soldiers are now fighting Isis, helped by US airstrikes
Topshop goes part Athena poster, part last spring Prada

Topshop goes part Athena poster, part last spring Prada

Shoppers don't come to Topshop for the unique
How to make a Lego masterpiece

How to make a Lego masterpiece

Toy breaks out of the nursery and heads for the gallery
Meet the ‘Endies’ – city dwellers who are too poor to have fun

Meet the ‘Endies’ – city dwellers who are too poor to have fun

Urbanites are cursed with an acronym pointing to Employed but No Disposable Income or Savings
Paisley’s decision to make peace with IRA enemies might remind the Arabs of Sadat

Ian Paisley’s decision to make peace with his IRA enemies

His Save Ulster from Sodomy campaign would surely have been supported by many a Sunni imam