How to fix the NHS and social care

Published by The i paper (14th November, 2022)

Another damning indictment of Britain’s healthcare system was released last week, although such reports arrive so often that it received minimal coverage, with nurses set to strike and hospital wait times hitting record levels. It came from an inquiry led by Oxford University experts into maternal mortality, which the Government vowed to halve over the 15 years to 2025 but which has instead risen. The findings were grim: fatalities during or immediately after pregnancy rose by almost one quarter over the past three years – or 19 per cent if discounting Covid – while barely one-fifth of the women who died received decent care.

This exposes some issues plaguing the NHS. We have worse maternal mortality rates than many neighbours such as Germany, Italy, the Netherlands, Norway, Poland, Slovakia and Spain, a trend seen with many other outcome statistics that implies cash is not necessarily the key issue given variable funding levels. Women are persistently victims of dire care, as revealed by several devastating scandals. We see the impact of inequality, with women in the most deprived areas and from ethnic minorities more than twice as likely to die as those in rich parts and white women. And the leading direct cause of death was suicide, which tripled since their previous study among pregnant women or within six weeks of pregnancy ending.

The study leader, Professor Marian Knight, called maternal mortality rates “a barometer of our health system”. Certainly bias, inequality and dismal mental health care are three key reasons why decades of rising life expectancy suddenly slowed in Britain over the past decade and then fell sharply after the pandemic, although attracting less attention than cancer backlogs or pay complaints.

But at least our complacent nation is waking up to the harsh reality that its health service, far from being the envy of the world, is suffering severe sickness.

After all that clapping and emoting, suddenly it seems no one is happy with the NHS. Politicians are in a pickle since costs constantly soar, soaking up more and more government spending while problems only seem to intensify. Patients are infuriated by lengthening waits for everything from ambulances to scans while often struggling to access basic services such as dentistry and general practice.

Staff complain of being overworked and underpaid, highlighted by nurses voting for their first national strike (although many well-paid doctors find time for lucrative private work). Economists say untreated long-term and mental health conditions hamper growth. Social care is wilting, ignored and unloved yet playing such a pivotal role in freeing up beds, reducing costs and national wellbeing.

Few people in Westminster are more aware of the problems than Jeremy Hunt, who in his new role as chancellor will announce tax rises and spending cuts this week to plug the black hole in public finances. He saw patient safety as paramount during his six-year stint as health secretary and proposed building special cheap housing for nurses, a smart idea blocked by the Treasury with its usual short-term mindset. He has confessed to regret over his failure to fix social care.

Since then, serving as chairman of the Health Select Committee, he hit out at staff shortages and admitted taking his “share of responsibility” after scrapping bursaries for nurses. He has been bold in condemning failures in the psychiatric system, where GPs dole out anti-depressants like boiled sweets but people with chronic conditions often go untreated until they explode. The system is milked by atrocious private firms and reliant on abusive “care” revolving around physical and pharmaceutical restraint.

Hunt demanded a ban on people with autism and learning disabilities being sent into long-term institutional care and condemned inadequate community provision, while arguing for Britain to adopt the world-beating Trieste model that delivered a cost-cutting system of deinstitutionalisation based on effective community provision. Hunt warned recently it is “too tempting” for a chancellor to cut back on medical training to make savings since it takes so long for changes to impact on patient care. Now he is chancellor holding the power of the chequebook.

Yet he is tackling public finances while polls indicate his party has just two years left in office. No doubt the NHS will be protected again with another barely-enough rise in cash and vague talk of “efficiencies”, although this is sticking-plaster politics. There are also, incredibly, suggestions that local authorities – hit so hard in the last bout of Tory austerity – will suffer more cuts despite the impact on social care. As he says, government is about making choices.

So here is a suggestion for Hunt and Rishi Sunak: do something with lasting legacy by asking your political rivals to assist in setting up a genuinely independent inquiry into salvaging our beleaguered health and care systems, remodelling them for a very different society to the post-war world that conceived the NHS. This could be a royal commission, serving as a symbol of our new King’s reign, although it would only work if filled with free-thinking experts – and ideally led by a fearless woman – rather than medical and political stooges. And give it a fixed timescale to deliver.

Normally I would scorn such an idea. Yet everyone says we need debate, but few dare shape it beyond familiar knee-jerk statements. The last thing the NHS needs is another botched reform, adding more layers of calcifying bureaucracy. There should be serious probing of staff pressures, working practices, wasteful inefficiencies, deadly bias against disadvantaged groups and women, disgraceful mental health provision, dire use of technology, treatment failures, pitiful regulation, toxic private firms and collapsing social care.

We must place patients and community services at the heart of the system, empower frontline staff, improve accountability and destroy the cover-up culture. Otherwise services will decline further, decent staff continue to leave and there will be more reports highlighting shocking failures such as young mothers killing themselves due to systemic deficiencies.

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