NHS ironies


nhsThe top two BBC Radio 4 news bulletins on Thursday morning were ironically indicative of the problems of the NHS.

The first was a report by the Care Quality Commission (CQC) that elderly patients in many English hospitals weren’t fed or watered properly nor treated with dignity. This was immediately followed by British Medical Association (BMA) report demanding the government’s proposed reforms for the NHS to be scrapped.

No surprise that the BBC didn’t link the two – that reform is urgently needed to deal with problems like care for the elderly - and no surprise that the ultimate in vested interests – the doctors of the NHS – are fighting this tooth and nail. The reports of the CQC and the BMA both suggest enhancing top-down control of health care with not the slightest hint that the NHS structure itself is the problem.

Start with the BMA’s own recommendations, especially these three:

• Change the primary role of Monitor (the economic regulator) to one of protecting and promoting high quality, comprehensive, integrated services, not promoting competition. (Translation: we have nothing to learn from anyone else.)

• The Secretary of State’s powers over the NHS Commissioning Board on appointments, further regulations and its mandate should be subject to explicit safeguards and transparency requirements to avoid unnecessary political interference. (Translation: We will not be accountable to the taxpayers of this nation.)

• Explicitly protect the independence of directors of public health as professionals treating a population by bringing together all public health staff under a single NHS agency. (Translation: The NHS isn’t monolithic enough.)

Meanwhile, the CQC, which, to be fair, only carries out orders, sends shivers down the spines of NHS bureaucrats with this warning from its chair, Jo Williams: “I will be writing to the Chair of every hospital where this inspection programme has identified poor care to ask what they plan to do to address these issues. The key elements that every hospital must have in place are a compassionate staff culture which is driven by strong leadership and supported by good systems.”

Expect to see frenetic hospital staff the instant that missive pops through the letterbox.

Health care is, indeed, a challenge to all policymakers but the UK’s aversion to decentralization and competition is mere proof of Nigel Lawson’s lament that the NHS is “the closest thing the English have to a religion.” And that religion’s priesthood is becoming more fundamentalist and intolerant as it fails to deliver heaven on earth.

In any listing of people’s most pressing needs, food, clothing and shelter come on top and all are extremely well provided by a huge diversity of competing private suppliers, driven by the profit motive.

But the Ayatollahs of the NHS will have none of it. Only 4% of acute-care beds in Britain are provided by private companies. In Germany, it’s 32%, more than are provided by the state with the rest provided by charities. (Now there’s a Big Society!) In that former victim of Stalinist control, Slovakia, two fifths of hospital provision is delivered by private operators. If you want decent services, set the NHS free!