A refreshing prescription for the NHS – and for politics

Published by The i paper (16th May, 2022)

Jeremy Hunt does not hide his ambition, admitting that he does not rule out another tilt at the top job if there is a vacancy. As others have observed, this silky-smooth operator would offer both his country and party a very different style to the bumbling character who defeated him in the Conservative leadership contest.

He is, after all, a man who made millions setting up his own firm, then survived for six years the tough challenge of being a Tory health secretary. Since then he has enhanced his reputation as chair of the health and social care committee while avoiding blame for the chaotic ineptitude of the government after being dumped from the Cabinet.

Now he has written a book. Usually when ambitious politicians write books they are banal efforts to prove they have some kind of vision, read only by a few obsessive political nerds. Hunt’s effort is rather more interesting. I would even call it important – although I may be biased since my work is mentioned in its pages and he focuses on patient safety issues that I have sought to highlight for many years.

He offers an honest reflection of his time in charge of the NHS, however, which combines some admission of his own failures along with analysis of lethal flaws and some suggested prescriptions.

The timing could not be more explosive, not just because every day exposes the grotesque mistake made by the Tory party in picking such an unsavoury person to lead our country. Polls have repeatedly shown the NHS is central to the national vision, but this book lands at a time when there seems to be a growing acceptance about the urgent need for more serious debate over our creaking health and care services amid soaring costs, ceaseless staffing issues, the struggle to meet needs and often dreadful patient outcomes – not least in terms of avoidable fatalities, social care and treatment of some key conditions when compared with rival systems in rich nations.

As we emerge from the worst public health catastrophe for a century,  the problems are thrown into sharp focus. Clapping, emoting and expressing undying devotion does not solve the sort of profound problems faced by too many families at a time of rapid scientific advances that are increasing life spans and ability to endure chronic conditions.

Yes, funding is crucial. But many of the most complex issues will not simply be solved by throwing more cash into the NHS money pit – not least when the Cinderella care system is left to struggle as a second class service. As I have often highlighted, for instance, ending the abusive detention of people with autism and learning disabilities in costly private psychiatric prisons through more sympathetic communal care would save big sums.

It seems obvious patients and safety should be at the heart of any health or care service. Yet while generations of politicians hid behind platitudes of NHS worship, their timidity enabled the evolution of services driven by diktats of medical leaders and calcified by layers of bureaucracy. The interests of patients became secondary.

Mistakes were covered up, whistleblowers silenced, abuse ignored and – again and again – we saw appalling scandals emerge only due to the incredible tenacity of wounded patients or bereaved families. All too often, the victims are those whose voices are routinely ignored in wider society – women, elderly folk, autistic people and citizens with learning disabilities – as their problems, needs and concerns were swept aside by arrogant senior medics and self-serving managers.

The result, as Hunt writes in Zero: Eliminating Unnecessary Deaths in a Post-Pandemic NHS, is that our country’s most cherished institution ends up harming one in 10 citizens seeking help and is responsible for 150 avoidable fatalities each week. To put this in perspective, that is four times the number dying on UK roads. Hunt highlights also how “the scale of the overall injustice facing people with autism and learning disabilities remains shocking”.

Famously, he placed a white board in his office to record the toll of “Never Events” (wholly preventable serious incidents that occur because guidance wasn’t followed) in the NHS – although it was removed by his successor Matt Hancock.

Mistakes will always happen in any service reliant on human beings, especially one with facing the daily pressures of delivering medical or social care to millions. I agree with Hunt on the need to empower patients and frontline staff, abandon blame culture, harness technology and avoid long, costly legal battles that are so demeaning for everyone except lawyers – although I would add that we must still ensure wronged patients receive justice. Yet as he points out, “most tragedies are treated as ‘inevitable’, when in fact they could be prevented simply and cheaply. We need to become better at learning from mistakes”.

Hunt takes pride in three million more patients being treated in good or outstanding hospitals after his tenure. Yet he admits that he “shied” away from seeking cultural change in the system before seeing that remorseless focus on patient safety should be the foundation stone. He failed to fix social care, let alone transform services for autistic people and those with learning disabilities. Now he admits “citizens seeking support end up being held in conditions that are simply inhumane” as he calls for a ban on long-term admission into secure units for patients with autism, learning disabilities and mental health conditions except after committing crimes.

I find this refreshing. It is easy to be cynical about a politician writing such a book, arguing that the longest-serving health minister should have sorted out these issues during his time in office or is simply making a leadership pitch. Yet we all need to become better at learning from mistakes – including politicians, given their power to waste money and wreck lives. This offers a prescription that goes beyond the NHS.

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