NHS SOS Ed. Jacky Davis and Raymond Tallis (Oneworld, £8.99)
God Bless the NHS By Roger Taylor (Faber, £9.99)
Roger Taylor, author of God Bless the NHS: the Truth Behind the Current Crisis, is a journalist who works on the annual Dr Foster Hospital Guide. The heart of this guide is its analysis of hospital safety and outcomes. In 2009, this survey became the centre of a controversy that revealed the ineptitude of the government’s Care Quality Commission. The Commission—with its 2,000 staff and £150m budget—had given a five out of five rating to Basildon Hospital, despite evidence that mortality rates had indicated for some time that there were problems in the hospital. “It is hard to know which is more shocking—the care provided by the hospital or the high rating it has received,” said Evan Davis, the BBC journalist. After the scandal broke, the public and the media wanted to know which hospitals were safe and which were not. The problem is, there is no definitive answer. As Taylor explains in his book, the fact is that “for much of the healthcare we deliver, we really don’t know whether it is safe or effective.” This state of unknowing dramatically demonstrates the problem that many politicians and journalists face when they need to make quick evaluations or prescriptions for the National Health Service. “Is it a good idea to let more private organisations deliver healthcare?” asks Taylor. “Yes, if it means we get better services more cheaply. But if we cannot tell the difference between a good service and a bad service, all we will get is cheap services.” He goes on: “Is it a good idea to make doctors more responsible for how the money is spent? Yes, if it means they can identify better ways to use the money. But if we can’t tell where it is being spent effectively, they will be better off spending more time with their patients.” The reality is that healthcare is a learning curve. There are few certainties, which goes some way to explain what Taylor calls an “astonishing divide” between the politicians and the people. He writes that for “the past 20 years the corridors of the Department of Health have thronged with people who believe that greater private provision is what the NHS needs, yet if one steps outside and starts to poll the public, one struggles to find people who express any degree of enthusiasm for that idea.” Taylor’s own prescriptions are refreshing. He does not think the NHS is too big. Nor does he challenge “the social solidarity that comes from agreeing to pool our financial resources in order to provide medical services” to those in need. The NHS of the future will still require that financial contribution, he believes, but it will require more from us as patients. “In addition to paying our taxes, we will be asked to contribute two further things—time and information.” That means much more pooling of data and information, and new mechanisms for achieving more informed choices from patients. I have long believed that the essence of the popularity of the NHS, even after much publicised scandals, is that people know only too well that the demand for increasingly expensive healthcare cannot be met. They, unlike some politicians, do not see it as a mere utility—yet they understand that there has to be financial discipline. They value the NHS as a democratically-rationed healthcare system. They are ready to pay increasing taxes for this but their contribution must be set aside to help fund healthcare. The public likes the NHS because it offers fair and comprehensive care. People may complain, they may get angry but most families have deep-seated memories where they do literally bless the NHS. They fear that once the health service becomes privatised and quango-driven, once market principles dominate, their care will become fragmented, more remote and they will sense their doctor’s advice is subject to competitive pressures and profit-based private interests. They are right in their apprehensions. It is in NHS SOS: How the NHS was Betrayed—And How We Can Save It that one finds the soul of a healthcare system that the public is not prepared to see destroyed. This book is written mostly by professionals who work in the NHS, many of whom I know well and support. It does not make comfortable reading. What Winston Churchill, Anthony Eden, Harold Macmillan, Alec Douglas-Home and John Major did not want to do, and Margaret Thatcher’s government deemed too “politically toxic” to proceed with, David Cameron and Nick Clegg, with no democratic mandate whatsoever, have blithely forced through. Charles West’s chapter, “A Failure of Politics,” will make heart-rending reading for Liberal Democrats. West is a party activist and his descriptions of how successive policy conferences were manipulated must be a bitter pill to swallow. Other chapters in NHS SOS deal with the way in which the Labour party from 2000, despite increasing the health service budget, paved the way for the Health and Social Care Act 2012. This included accepting a revision of GP contracts to work only office hours. “The scale of the opt-out from out-of-hours provision was something the government fully anticipated and wanted,” writes Stewart Player in his chapter “Ready for Market.” “Out-of-hours provision also proved to be a useful entry point into primary care for private companies, an opening soon exploited… by such companies as Serco and Harmoni.” In another chapter, “The Silence of the Lambs,” Jacky Davis and David Wrigley forensically dissect the British Medical Association and the Royal Colleges, while in “Hidden in Plain Sight” Oliver Huitson carefully sets out the shameful failure of the BBC and other media sources to report the origins and potential consequences of the Health and Social Care Act. This Act is 457 pages long, with 309 clauses and 23 schedules. It introduces complex structures borrowed from the American medical insurance industry, it abdicates ministerial responsibility and removes essential legal principles about providing for an equitable and comprehensive healthcare system in England. This Act, which has cost us millions of pounds already—money that could have been spent on patient care—must be changed but without another disruptive “top down” reorganisation. A mere 11-clause emergency bill is already before the House of Lords: the National Health Service (amended duties and powers) bill. The bill accepts the organisational changes but reinstates the democratic nature of the NHS. It will be subject to extensive consultation and adaptation over the next two years. All MPs and candidates—Conservatives, Liberal Democrats and Labour—will be systematically challenged before the next election to say whether they will support this emergency legislation. There are millions of voters linked to the NHS and they will be given a focus for political protest by Open Democracy’s “Our NHS” website. Voters in Scotland, Wales and Northern Ireland, in particular, will want some reassurance that their health services, so far largely untouched, will not be pressurised to follow the English pattern in the next parliament. The battle to save the soul of the NHS is not over and it will be led by patients and professionals. People who are not for the status quo, but determined to improve the quality of care, ready to champion cultural change, pursue greater efficiency and increase informed choice for patients.
