Oh dear, it is barely a week since I wrote elsewhere that everyone knows “the NHS is much better” nowadays. Since then there has been a steady trickle of bad news, from Mid Staffs trust and from Birmingham children’s hospital, and poor cancer mortality outcomes.
Is there any good news? A bit. Let’s try to find it once we have disposed of the gloom. It’s not easy. Apart from dogged patient protest groups, no one comes well out of the lethal care scandal at 362-bed Stafford hospital.
That goes for politicians and the media, and all levels of bureaucracy, local and national, managerial and regulatory. All have been pilloried by the same MPs and media which, with a few local exceptions, failed to make enough fuss soon enough.
And where were the staff whistleblowers, people ask me?
Target of blame
All good questions, though I am wary of glib answers. When Alan Johnson apologised to MPs (Gordon Brown had already done so) Andrew Lansley and Norman Lamb, the health secretary’s Tory and Lib Dem shadows, were keen to blame Whitehall targets, at least in part.
Well, up to a point. Ditto constant reorganisation, another thread in this saga, and the board’s obsessive quest for foundation trust status. But Johnson was right to insist that no amount of management madness excuses grossly negligent treatment of the sick. Where were the head of nursing and medical director? The local coroner too?
The same answer surely applies to the predictable analysis offered by Professor Allyson Pollock, academic scourge of the private finance initiative. In The Guardian she blamed an “under-funded, market-orientated system” which led, she claimed, to money being wasted on “bonanza” payments to private providers, marketing costs and private finance costs.
My hunch is the myriad investigations (is it five?) now launched to make sure the Stafford stable door is really shut will not blame cash shortages.
At Stafford - to quote one Whitehall chum - “everything that could have gone wrong went wrong… the only way to explain it is the complete dysfunctionality of the board.”
I floated the suggestion that small hospitals - the kind local MPs and voters so love - are more vulnerable to this kind of disaster than big ones, for which I was ticked off by a learned professor for “big is beautiful” heresy.
A dog that has not yet barked is the abolition of community health councils and unsatisfactory accountability of foundations. We now know Stafford’s board increasingly met privately and failed to focus on patient care. Little wonder local MPs, led by Tory Bill Cash, are calling for a full public inquiry with the power to subpoena witnesses to testify under oath.
Cash tells me that Whitehall loves multiple inquiries - “Sir Humphrey’s scattergun approach” - because it prevents key questions being answered in one coherent report.
Alan Johnson’s explanation is that the different inquiries have different timescales. Sir George Alberti will report within a month on accident and emergency: the individual case notes review, for instance, will be painstakingly slow. Hmm. We’ll see. Someone must explain why regulators don’t seem to phone each other much.
On the upside
I promised something cheerful. It seems Mr Johnson is well placed to defend the NHS budget against looming “savings”, though it will have to contribute to the Treasury’s £5bn “efficiency” savings, plus whatever the scary April budget produces.
Tory policy is also shifting as next year’s borrowing heads to 11 per cent of national income. David Cameron is warning that the public sector must be cut, wages frozen, waste trimmed, etc.
The Tory leader treads a tightrope here. Norman Tebbit leads the jeers when he or George Osborne hint that they can’t afford to cut Labour’s 45p tax on those earning £150,000-plus and Ken Clarke suggests (rightly) that near abolition of inheritance tax should not be a priority. But my inquiries suggest that the NHS is likely to remain the most protected service in Cameron’s campaign pledges.
“We must commit to it 100 per cent,” a top Cameroon assures me.