Another shocking NHS story:
"Ian
Birrell: Why I don't believe that the NHS is sacrosanct";
Ian Birrell: Why I don't believe that the NHS is sacrosanct
In this heartfelt polemic,
based on his family's experiences in the health service, our writer argues that it suffers from deep flaws – and
we are wrong to ignore them
It was a simple thing. Another
blood test, some more investigations into whatever flawed gene or missing protein might be the cause of my daughter's
troubled life, with her terrible seizures, her blindness, her inability to walk or talk or eat unaided. Over the past
15 years, there have been many such attempts to identify her condition.
One year later,
we asked the doctor, a top geneticist at one of the world's most famous hospitals, what had happened to the results.
His office told us a rambling story about financial restrictions and the need to send such tests to a laboratory in
Germany. They said there was little he could do but promised to pursue our case.
It was a bare-faced
lie. The precious vial of blood had been dumped in storage and forgotten. The following day it was despatched to a laboratory
in Wales and 40 days later the specialists came up trumps. They identified her condition, an obscure genetic mutation
called CDKL5.
The breakthrough was rather mind-blowing, giving us some peace of mind and the
chance to talk to families of the hundred or so other children worldwide identified with the condition. It was also life-changing,
since it means our other child and close relatives are in no danger of passing on the condition. Indeed, had we known
sooner we might have even tried for more children.
But the most shocking thing was not the lying.
Nor even the incompetence. It was our total lack of surprise at the turn of events, since after 15 years suffering from
the failings of the National Health Service we are prepared for almost any ineptitude.
Of course,
everyone loves the NHS now. It is officially sacrosanct. Our doctors are deities, our health care the envy of the world.
And anyone who says anything different is an unpatriotic schmuck who should go and join those losers in the United States.
(Although American doctors terrified of litigation would have done all the tests possible on my daughter if I'd
sufficient insurance, and would think twice about lying to patients.)
So forgive a harsh dose of
reality. I used to share these delusional views, wrapped in a comforting blanket of national pride over Bevan's legacy.
But that was before the birth of our daughter sent us hurtling into the hell of our health service. Since then, hours
and days and months and years have been spent battling bureaucracy, fighting lethargy and observing inefficiency while
all the time guarding against the latest outbreak of incompetence.
Despite my daughter being
under palliative care, my wife currently spends two hours a day struggling against the system, to say nothing of the other
endless appointments that go with being primary carer of a severely disabled child. Right now, following some dramatic
hormonal and physical changes, we are waiting to talk to one of our daughter's doctors: the first call went in three
weeks ago, followed by three more phone calls and one email. No reply yet.
Or take the request
for a bigger size of nappies, urgently needed because of our daughter's sudden weight spurt. A simple thing to sort,
you might think. Not in the parallel universe of the NHS. It has taken four weeks, three phone calls, two home visits
from community nurses to assess our needs and fill in the requisite forms – and still looks like being one more week
before there is any hope of delivery. It may seem comical, but the result is a distressed child and endless extra laundry.
The warning signs of what lay ahead came on our first visit to Great Ormond Street, when there
was a young couple who had travelled down from the north-east of England in front of us, their tiny sick baby almost lost
in its blankets. "Didn't anyone tell you – your appointment's been cancelled?" the receptionist
told them breezily. They looked at each other despairingly.
Such insensitivity is all too typical.
When my daughter was seven she underwent a major review at a specialised unit in Surrey, spending three days and nights
with sensors connected to brain-scanning devices glued to her head, under constant video surveillance while my exhausted
wife comforted her and stopped her ripping off the electronic pads. A huge strain, but worth it given the hope of a
breakthrough. When we went to get the results a few weeks later, there was the usual wait. After eventually summoning
us, the neurologist asked why we were there. Then she opened our daughter's notes and asked what was wrong with her.
Then she couldn't find the results. We stormed out, me in fury, my wife in tears.
There
are countless other examples. The celebrated neurologist who measured our heads before blithely asserting that our daughter
– suffering up to 30 fits a day – would just have a slightly lower IQ than the average person. The GP who gave
her an MMR injection against our wishes, despite warnings it might prove fatal. The nurse who, having been told our daughter
was blind, asked if she would like to watch a video. And that is to say nothing of the endless minor irritations: the over-crowded
waiting rooms, the blasé receptionists, the unanswered emails, the blinkered attitudes to people with disabilities.
It used to be said money was the problem, but that fails to explain why American health outcomes
are not drastically better, given their profligacy. Or indeed, why Scottish death rates from heart disease, cancer and
strokes were so much worse when spending levels were one-fifth higher than in England; it cannot be blamed entirely
on haggis suppers. And it is striking that for all the money poured in recently, there is little evidence of further
improvement in cancer survival rates, for example, or of solving the postcode lottery.
There
is no doubt that nearly tripling the health budget in a decade has led to visible advances, especially in the infrastructure.
Some of the new hospitals are vast improvements on the crumbling Victorian buildings they replaced, and seemingly small
things such as spruced-up waiting rooms and toys for children make a big difference. Unfortunately, it is equally clear
that billions have been wasted, poured into a centralised monopoly that focuses on the manipulation of a target culture
rather than delivery and innovation. It was little surprise to learn that more managers than doctors were hired last
year. And all too often these managers seem to reinforce rather than challenge the patronising attitudes that often predominate,
while failing to tackle glaring waste.
One visit to the gastroenterology department of a major
teaching hospital summed up many of the enduring problems. Like any hospital regulars, we booked the first appointment
to ensure the wait would not be too long. The young consultant was courteous and empathetic, going out of his way to
explain the pros and cons of the invasive surgery under discussion. At one point he needed to call a colleague, so picked
up the receiver of an old phone on his desk rather than the high-tech device jutting out of his computer screen. He
explained that the new system cost £3m but didn't work properly, so no one in the hospital bothered to use it.
After 10 minutes, we left his consulting room. The waiting area felt tense, with harassed parents,
bored children, raised voices and too few seats. This unfortunate doctor had to see more than 50 patients during his
two-and-a-half hour clinic – or one patient every three minutes, with no time for reading notes, let alone a break.
And we had already ruined his schedule. No wonder people were getting exasperated.
These are,
of course, just snapshots over more than a decade. We may have been desperately unlucky, and friends who have suffered
heart problems, cycling accidents or had very premature babies will testify to flawless treatment. But then I know of
other friends with equally terrible experiences of arrogant doctors, disinterested nurses, lost files and suchlike. I could
tell you of the single mother in Scotland rung in the middle of the night and asked if she would like doctors to resuscitate
her profoundly-disabled child – and then they did nothing until the mother reached the hospital and berated them.
Or the parents of another child with a life-threatening tumour whose care was a litany of mistakes, but when they complained
to the hospital's chief executive the notes went mysteriously missing. Or the elderly cancer patient constantly
ignored by her doctors. And so on and so on.
For all the rhetoric, this is daily reality in
our health service. This is not to denigrate the many fine workers, both on the frontline and behind the scenes. We
have come across doctors, nurses, paramedics, therapists and many others who have been supportive, caring and inspirational.
Some have gone way beyond the call of duty to help in times of distress or difficulty, such as our palliative care team
and the community nurses. But equally, we have come across too many ground down by a sclerotic system that crushes out
the idealism or caring nature that presumably made them join the health service.
Clearly there
is systemic failure. And it is a question of management, not money. Some of the worst problems encountered have been at
the hallowed Great Ormond Street Hospital for Sick Children, which uses the strength of its brand to suck up money and
increase its reach. Many in the medical world are infuriated by its endless growth, but scared to take on the behemoth.
But behind the soft-focus fund-raising and cuddly image lurks inefficiency and, all too often, needless insensitivity.
Indeed, should you feel moved to give money to help sick children, I would advise you to give
to the children's hospice movement instead. As I write, my daughter is at Shooting Star in Hampton, Middlesex, a particularly
deserving recipient. It is interesting to note that this sector, which derives a paltry five per cent of its income
from statutory sources, does not seem bedevilled with the woes that afflicts so much of the public sector.
Anyone who has used health services in other Western nations knows that visiting the doctor or a hospital does not always
have to be a frustrating experience. It is possible to run a health service around the needs of the patients, with appointments
kept, notes read and consultations in a pleasant, friendly environment.
Given the swelling black
hole in public finances, ageing population and rising costs of health care, Britain needs a serious debate about the future
of the NHS. Sadly, the indications of the past fortnight are that we are too infantile to have such a discourse. A deranged
Tory MEP became engulfed in the crossfire over Obama's reforms after some fatuous remarks in the US media, and back
home – in a depressing foretaste of the election campaign – Labour uses it to smear the Conservatives, and
panicked Tories rush to pay homage at the altar of Aneurin Bevan.
For all the supposed cost-effectiveness
of the NHS, no other country has followed our model, despite what some Republicans might claim. Instead, we should be
looking at what we can learn from abroad. No one in their right mind would want to import the American system here. But
there are elements to admire: their popular community hospitals, the emphasis on effective diagnosis, even aspects of
the much-derided compensation culture. And turning to Europe, there are systems that enshrine consumer choice, meld
public and private systems, are cheaper than our own and have better health outcomes.
France
is famous for its centralised approach to government. It also performs well on almost all health rankings, and has been
top-ranked by the World Health Organisation. Its insurance-based scheme appears a chaotic blend of public and private
partnership, but in reality is a sensible solution that blends the interests of patients with the need for some centralised
direction, professional autonomy and safeguards for the poor. Like elsewhere in Europe, it has found a way that for
all its faults harnesses the benefits of competition within a universal, patient-centred system. We are fumbling our
way there, but it is one step forward and three back.
So what should be done here? I can only offer
a few suggestions towards a wider debate. Firstly, it seems obvious that any organisation employing 1.5 million people
is going to struggle with the concept of dynamism. I suspect the Chinese People's Liberation Army and Indian Railways
– two other similarly-sized employers – suffer from similar deficiencies. Surely it makes sense to break
up the monolith, thereby introducing genuinely competitive elements while retaining the principle of state-financed care
that is free at the point of use. The more patient choice, the better the service will be. And trust me, patients can
make highly-complex choices when it comes to their own health.
Secondly, the target culture
should be made less proscriptive and the quality of managers raised. I don't mind managers, just bad managers. Thirdly,
these managers and all the medical staff should be given greater freedom to experiment and innovate. This means some
failures, but it is vital in any giant organisation. And the Government provides a safety net. Fourthly, there needs
to be as much transparency as possible, covering everything from spending to surgical outcomes. This is the information
age, after all – and it is our money and our health service.
Fifth, health workers must
all realise they are meant to be serving the public. I wonder if medical schools should place greater emphasis on personal
skills rather than just narrow academic criteria. And has the drive towards graduate nurses necessarily been a total boon
for the care of patients? Finally, politicians should stop trying to micro-manage the NHS – and in return voters
and, yes, the media should stop blaming them for everything that goes wrong.
Over the years,
I have raised these issues with many politicians. I suggested to William Hague when he was Tory leader that he just tell
the truth to the electorate and admit the NHS was a disaster zone. He laughed, and replied that he couldn't possibly
say such a thing: "You're far too right-wing on health for us."
Later, I wrote
an article for a weekly journal that ended with a challenge to the then Chancellor, Gordon Brown, at the time that Tony
Blair and Alan Milburn were coming to terms with the need for root-and-branch reform. Unfortunately it was delayed a
couple of weeks, coming out on the day of a group breakfast at Number 11. As I entered the dining room, Mr Brown gave me
a wolfish smile and ushered me to sit down between him and Ed Balls, before the pair took me to task for the next half
hour. Both seemed unabashed statists when it came to health, who saw more money as the answer to all problems and had
little sympathy for the idea of introducing competitive or patient-led elements.
Likewise, David
Cameron's experiences have turned him into a cheerleader for the NHS. He is angered by the failures of specialist education
and shortfalls in respite provision, but was genuinely moved by the healthcare offered to his late son, as I know from
many discussions with him. Days after becoming leader of his party we met for dinner. "I am not going to do what
you want on the NHS," he said. "I will reform it if I get the chance, but I won't rip it apart."
Then there was the senior Labour Cabinet minister who told me about the nightmare he was enduring
with his elderly relative. "I used to think you had been driven a bit nuts on the health service," he concluded.
"Now I think you don't go far enough. It's awful. Absolutely bloody awful. We've got to do something
about it."
I won't hold my breath.
Like the health secretary,
I am an Everton fan. And like Andy Burnham, the national health service and Everton are among the most cherished institutions
in my life. My daughter is still alive, for which I give thanks to the support, dedication and friendship of many in the
health service. But it is precisely because I am such a fervent admirer that I believe it is so shameful that the NHS
is allowed to limp on in its current state. For too many people, especially many of those most in need of its help, it
is something of a disaster zone. The NHS is a sick institution, and cheap political point-scoring will do nothing to
solve the problems. We need to find a cure.