The toxic British worship of the NHS
Published by UnHerd (2nd December, 2020)
When Michael Gove sought to shore up support for the Government’s polices on lockdown, he invoked the most sacred idol in the land by daring his party sceptics to defy the deity they must all worship. “We had to act,” he wrote at the weekend. “Because if we did not our health service would have been overwhelmed.” The bespectacled cabinet office minister, who once acted in a film as a priest, went on to deliver a chilling sermon about a broken health service filled with overflowing wards, struggling staff, cancelled operations and dying patients if his blasphemous critics did not bow down in faithful obedience to his pious demands.
Gove’s hellfire and brimstone warning was overheated guff. Yet his ploy was clear: few things strike more terror into a Tory politician than being seen as unsympathetic to doctors and nurses. Perhaps he deserves some credit for at least setting out clearly the Government’s stance, something that seems beyond his boss. Yet note how once again this Conservative administration demands complicity from citizens in its efforts to control Covid-19 on the grounds of protecting the National Health Service, just as when the pandemic’s first wave hit the country. The legacy of this obsession was the relegation of social care to secondary importance, which led to thousands of needless deaths in a sector already shattered going into this crisis.
The Government seems to have learned nothing from the carnage in care homes. Gove’s intervention followed a spending review that saw another £6bn bunged to the NHS while social care — starved of cash over the past decade despite surging demand — was swept aside. One Tory bigwig boasted on Twitter how real term spending on the NHS would have risen next year by an astonishing £56.4bn since his party took office in 2010.
He failed to mention, of course, that chancellor Rishi Sunak handed social care a pitiful £300m, plus access to a further £700m through local tax rises that will be soaked up in rising wages. This may, however, finally nudge spending on adult care over the £22.4bn high water mark seen in the year David Cameron became prime minister.
If councils cannot support old folks with dementia and other citizens with complex needs, extra pressure lands on health services, showing the hollow hypocrisy of those ceaseless chants of devotion to the NHS. That fall in social care spending occurred during a decade of rising demand in a growing and ageing population, with additional need coming especially from disabled adults who account now for almost half the spending. “It is hard to believe this level of underfunding could have been tolerated yet it was — at least in part because social care is used by far fewer people than the NHS and does not enjoy the same degree of public recognition,” said Simon Bottery, a Senior Fellow at the King’s Fund think tank.
Spot on. Yet there is no sign still of the chimeric plan to salvage social care that Boris Johnson promised he had in his pocket when he entered Downing Street last year. Part of the problem is under-funding, which leaves desperate people abandoned in their time of immense need and overburdened staff paid insulting sums. And Brexit has made the staffing shortages more acute.
Yet there is also stealthy profiteering by secretive firms based in tax havens and laden with debt that needs sorting, not least since they shift provision away from poorer parts of the country while their economies of scale lead to bigger “homes”. No other part of the state is more in need of reform, no other public service so failing the citizenry, yet no other sector is treated with such dismissive contempt by politicians.
The only public sector workers handed a pay rise by Sunak were those secular saints slaving away on the NHS frontline. Yes, many of them have performed heroically during this pandemic and deserve our gratitude — but so have other public servants. It is hard to see why a general practitioner pocketing a six-figure salary in Devon is more deserving than a junior police officer spending her days pounding the streets of Bolton or Birmingham to enforce the Government’s byzantine Covid rules.
Behind this distorted policy lies sentimental worship of a public service that was corrosive even before a pandemic inflamed the problem. I watched a re-run of the London Olympic opening ceremony during the first lockdown; that chunk filled with dancing doctors, nurses in old-fashioned uniforms and kids bouncing on hospital beds looks even more absurd now.
Despite the intensity of Britain’s devotion to the NHS, there is nothing unique about universal healthcare in a rich European nation; every country in western Europe has it, as does almost every country in eastern Europe. And like it or not, our health service often has worse outcomes than its neighbours on key indicators such as amenable mortality (when people die from potentially preventable conditions), brain strokes, many cancers, even infant mortality. For all the impressive efficiency and improved productivity, it is naïve to think that the NHS’s problems are all down to money, whatever medical trade unions may claim.
This blinkered veneration ends up not just overshadowing the unloved social care sector but harming patients. It might sound sacrilegious but not every health worker is a hero, however dedicated the majority. Consecration of a public service that instills such fear of criticism in politicians impedes proper focus on profound issues of fairness, outcomes and patient safety. Yet there are systemic flaws that tend with sickening inevitability to injure — and sometimes kill — those most in need of help, such as the very old, the very young and those with disabilities.
Ask yourself why Matt Hancock, the flailing health and social care secretary, allows thousands of people with autism and learning disabilities to be locked up in abusive hellholes where they are routinely sedated and stuffed into solitary cells, even fed through hatches like wild animals? Why do we have a psychiatric system so reliant on pharmaceutical and physical restraint? Why is so little done about profiteering private firms earning vast sums while delivering dismal services? Why is diagnosis of autism in girls so dire, despite the devastating consequences when they develop eating disorders or slash their bodies as their mental health deteriorates?
Last week I spoke to another frightened mother trying to stop her daughter being destroyed; this woman was a medic, yet felt powerless against a cruel system that left a traumatised teenager with autism and special needs asking why she was being punished in a secure hospital for the “crime” of being sick? Yet again, it showed to me how Britain has moved on less than it likes to think from the days of Bedlam. Yet where is the outcry as lives are devastated due to the deficiencies in care and inhumane denial of human rights that lies deep in the heart of our beloved health service?
Then there are the mistakes. These are, sadly, inevitable in a huge and highly-pressurised institution that is reliant on human endeavour. Yet look at every major patient safety scandal in recent years and they all have a common narrative of bereaved families and/or brave whistleblowers having to fight against a system that sought to close ranks, cover-up lethal bungles and crush those seeking the truth to protect others from heartache.
There is a lengthening list of these shameful sagas: hundreds of haemophiliacs dying from contaminated blood; elderly patients dying in squalor in mid-Staffordshire hospitals; babies dying during cardiac surgery due to lax safety measures in Bristol; more paediatric deaths amid a cover-up in Morecambe Bay.
We learned that hundreds of people with learning disabilities die annually in the health service even before the pandemic due to mistakes and prejudice, thanks to the campaigning zeal of a mother whose teenage son drowned in horrific circumstances in a supposed place of sanctuary.
Earlier this year there was a devastating report into three separate health scandals that exposed a series of blunders by the NHS, regulators and private hospitals. It followed a superb investigation by Baroness Cumberlege, who talked to 700 people about pelvic mesh implants that led to agony for thousands of female patients after childbirth and two drugs that left children with disabilities. She spoke in stark terms about the suffering of these medically-injured families, pointing out that many of the horrific problems could have been avoided. Instead a defensive, disjointed and badly-regulated system was shown to lack leadership, ignore patient concerns and perpetuate mistakes. It was chilling to see how complaints from wounded women were brushed aside by patronising men in positions of power.
The same embedded issues in a “culture of avoidance and denial” were seen again when another inquiry this year disclosed how a rogue breast surgeon subjected more than 1,000 patients to unnecessary and damaging procedures over 14 years before he was stopped and jailed. Lethal maternity failings are being investigated in Shrewsbury and Telford Hospital NHS Trust, which may turn out to be the worst patient safety scandal in NHS history, with dozens of deaths and brain-damaged babies. A probe has been launched into infant deaths in two Kent hospitals that only emerged thanks to the extraordinary tenacity of another traumatised family.
This is the flip side of sanctifying the NHS. We see again and again the dangers of placing this vital public service on a pedestal that calcifies its defences against accountability, criticism or dissent. Compare how a less hallowed institution like the airline industry demands a safety culture while the health service, impervious to criticism, leaves a trail of wrecked lives behind its culture of denial and cover-up. Soaring costs of compensation are a factor — but legal bills would fall sharply if medics and managers stopped seeking to silence those raising concerns and politicians ensured aggrieved parties had less need to spend years in weary battles for justice.
Last week another horror story emerged when Anne and Graeme Dixon were vindicated by a damning report after 19 long and lonely years struggling to get answers over the avoidable death of their infant daughter in the face of obfuscation. The couple were let down by every arm of the state meant to help them: the local health commissioners, the coroner, the police, the NHS chief executive, the parliamentary ombudsman. Then another inquiry was launched on Monday into a series of deaths involving care failures by Essex Partnership University Trust; once again, this is only taking place thanks to the courage of another bereaved parent called Melanie Leahy whose son died aged 20 in a secure mental health unit.
These people are unheralded heroes, fighting through their pain to help others avoid similar trauma. We need to protect patients, not sanctify the institution and place halos on all the staff. As the Dixons said, families should not “have to suffer the hell we’ve been through to learn the truth”. Instead politicians keep ordering inquiries, issuing reports and saying they have learned lessons each time there is another tragedy.
Then they speedily return to spouting their complacent platitudes and praising the NHS while doing nothing to tackle lethal systemic flaws and toxic power imbalances that riddle the health and care systems. It is so much easier to applaud, emote and spew out hollow words than to take any real action that might actually stop suffering and save lives. No wonder they make so many people sick.