The man they couldn’t hang
Published in The Independent on Sunday (31st March, 2013)
When the National Health Service rose like a merciful phoenix from the wreckage of a war-torn nation, its founder famously said that if a bedpan was dropped in a hospital corridor, the reverberations should be felt in Westminster. Aneurin Bevan was not far off the mark: for 65 years, this has been the most politicised, precious and protected of public services.
Tomorrow sees an ambitious attempt to change this as the NHS breaks free from its political masters, symbolically moving into new headquarters in Leeds. This is the result of the coalition’s highly controversial health reforms, an attempt to devolve power, increase competition and reduce bureaucracy in a sclerotic service struggling to cope with rising demands from an ageing society at a time of austerity.
For all the furore around these reforms, few would have envisaged the new NHS being born bearing such deep wounds. Smug claims that our healthcare system was the envy of the world have been shaken by shocking revelations of poor care, patients dying in disgusting circumstances, death rates suppressed and whistle-blowers silenced following the report into the mid-Staffordshire scandal.
Little wonder polls show concern over the NHS rising in recent weeks, and this weekend’s row over the planned closure of a children’s heart surgery looks likely to be one of many. Health is vying with unemployment and immigration as the second most important issue after the economy. But the bad news for Conservatives is that just one in five voters believe they have the best policies, their worst figures since the coalition was formed.
This is a blow for the Tories. Under a Prime Minister who passionately believes in the NHS, they have staked considerable capital on recapturing voters’ trust on health. Right-wing calls to lift the ringfence on spending have been resisted; rightly, since to do so would be wrong and political suicide. Yet the party is taking heavy flak, having missed its best chance for a generation to wrest this totemic issue from Labour hands.
It all boils down to one man – and a former Communist to boot. Sir David Nicholson will run the new-look NHS this week, despite everything thrown at him since the Francis report was published last month. He should have fallen on his scalpel and slunk away in shame. Instead the man who oversaw a culture focused on bureaucracy and targets rather than patients, a manager who clearly did not get a grip on multiple flaws and failings, remains in charge of the nation’s biggest employer and most vital public service.
The coalition’s decision to stand by this discredited official lets down taxpayers, staff and patients, especially the heroic relatives who campaigned so courageously. It has also ruined the Health Secretary’s otherwise-smart strategy to position himself as the patients’ champion, improving healthcare by emulating the way the education watchdog Ofsted drove change in schools.
Jeremy Hunt is correct to seek a new culture of care, compassion and accountability; it is desperately needed in many parts of the NHS. The disturbing events at those two Staffordshire hospitals were far from unique, as some of us had been warning for years. But Hunt’s stance looks meaningless when a man indelibly linked to hundreds of needless deaths remains in charge. And yet Hunt is proposing to blacklist health service bosses who fail patients.
Downing Street supported Nicholson as payback for salvaging its botched and badly sold reforms, while also falling for the myth that only this besuited bruiser could mastermind a new system of headache-inducing complexity. They gambled it was better to take the heat now rather than risk the health service unravelling in the run-up to the election, even allowing him to appoint a deputy facing accusations of silencing a whistleblower. As well as being morally wrong, this astonishing error let Labour off the hook by missing a gaping open goal on an issue that has long tormented the Tories.
It was, after all, a Labour government that embarked on a reckless policy of pouring vast sums of money into the NHS without adequate controls, then oversaw the creation of a disfiguring bureaucratic culture in which targets twisted clinical priorities and care was undermined. It was Labour ministers who ignored repeated warnings from staff and patients, then refused dozens of requests for a full public inquiry into events in mid-Staffordshire that could have saved scores of lives.
For all their sanctimonious talk of being the party of the NHS, it was Labour that hid behind platitudes while fatally letting down patients. This was why we had the sickening sight of one former minister after another queuing up to defend Nicholson. But instead of pointing out Labour’s failure, the coalition colluded with the opposition to protect the chief executive, united by fear of any secrets he might reveal if forced out.
So the Tories remain on the back foot over health. The Government must endure Andy Burnham – one of the health secretaries asleep at the helm – claiming there are two weeks to save a doomed service from “Tory cuts”. Ministers will be taunted about “privatisation” by a party that embraced competition so enthusiastically in office that nearly one in five NHS hip replacements and hernia operations are now done by private firms.
Labour has long seemed unassailable over the health service it founded. Both Margaret Thatcher and John Major were harassed over their perceived failure to worship devoutly enough at the altar of the NHS, despite increasing budgets. David Cameron worked hard to win over voters in Opposition, only to see the polling gap open up again after the anger provoked by these reforms.
Standing by their shamed man, the Tories have missed a rare opportunity to gain the upper hand on health and wound their unusually vulnerable rivals. As the election looms over the horizon, with female voters drifting away and NHS financial holes gaping ever larger, this failure may make party strategists feel increasingly ill.