Michael White: never say never
We have heard a lot this week about “never events”, which aren’t supposed to happen in the NHS, as the Department of Health continues its eternal pursuit of best practice.
However the national health economy has experienced a few recently which aren’t even on the official list of “very serious, largely preventable happenings”. Sorrows never come singly.
‘Likeable Lamb is more at ease on TV than Jeremy Hunt’s rabbit-in-the-headlines manner’
The press campaign on abuses of the Liverpool care pathway was the most conspicuous of the week’s mishaps. Reading of the distress and anger of families, marshalled by the Mail’s formidable Melanie Phillips among others, it was easy to understand how they felt let down about the way dad died - or mum might have done if a caring son or daughter hadn’t intervened.
Blank denials by doctors or nursing staff that such things could possibly happen, also reported by Phillips, don’t help the NHS’s case. But most professional groups act in the same defensive way when under attack, Fleet Street columnists included. And families are not always the best judge of their loved ones’ conditions. The argument cuts both ways. That said, politicians have to respond to public concerns, especially when they coincide with renewed anxieties about quite separate but related concerns about other vulnerable groups in society.
This week’s arose from the jail sentences handed down to former staff of the horribly mismanaged Winterbourne View care home, which involved abuses of patients with behavioural problems by “thugs” (ex-minister Paul Burstow’s description). Some are still at risk in their new homes, we learned.
Ministers rushed to assure voters that lessons have been learned, but did so just as health secretary Jeremy Hunt was announcing another £50m to help care homes, councils and other providers create a more calming environment for those suffering from dementia: another large and growing group of vulnerable people. It’s another example of contemporary inequality. Some old people have never been so well off, others struggle as the money available to help them shrinks. MPs squabbled at question time again about details of budget cuts: but it’s just detail - everyone knows there’s a squeeze and it will last. The Big Squeeze.
Money seems to have played a part in the Liverpool controversy, with some hospitals paid by results to empty those beds by hook or crook. Death is certainly an “outcome”, although probably not the one this week’s King’s Fund report had in mind when it proposed an outcomes-not-activities reform of payment by results. Mr Hunt still supports the Liverpool care pathway approach, but is adamant it must include full consultation with patients and their families, officials assure me.
Fine, doctors are not God. Two footnotes here are worth adding. One is that Burstow, who never made much impact as the coalition’s Lib Dem health minister, is going round saying that Winterbourne View’s introverted culture - patients kept away from family and community - was earning £3,500 a week per patient for its owners. There is now a crime of “corporate manslaughter”. Perhaps there should be one of “corporate neglect”, he muses.
I think I heard his successor, Norman Lamb, echoing that thought in one of many interviews. Likeable Lamb is already making a bigger impression. He’s more at ease on TV than Hunt’s rabbit-in-the-headlines manner, and is emerging as the public face of the department on all the above issues, the reassuring pair of hands, minister for Radio 4’s Today programme. He’s a friend of Nick Clegg, not a threat to Hunt either.
Don’t think the NHS Commissioning Board, GP commissioners and other Lansley reforms will end the need for ministers to carry the can. It’s the paradox of devolution, especially when money is tight.
Michael White writes about politics for The Guardian.