By Paul Goodman
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A recent British Future poll found that the three institutions which make people most proud to be British are, in reverse order, the Monarchy, the Armed Forces…and, topping the poll, the NHS. The survey thus suggests that Danny Boyle had his finger on the popular pulse when he portrayed those all-singing-and-dancing nurses in his Olympics spectacular. It can be claimed that the Mid-Staffs horror will transform this benign voter view of the NHS, for three main reasons. First, because the shaming details of how patients were treated will make them think again. Second, because the post-Francis Report reforms will work. And third, because Jeremy Hunt will change perceptions of the system through his campaigning as a patients' champion.
I am sceptical. The appalling tales of what happened in Mid-Staffs – the women who arrived to find her mother's hair covered with faeces, the old man forced to stay on a commode for 55 minutes wearing
only a pyjama top – are unlikely, in themselves, to shift public attitudes formed over 65 years. This is not only because the left has a vested interest in championing the ideal of a centrally-planned system designed in an era when communism seemed to be the wave of the future. (Please note Paul Abbott's brilliant blog on this site about the silence of 38 Degrees over Mid-Staffs.) It is also because voters' views are partly shaped by fear. They value the NHS they know because they're frightened of an alternative for which they might to pay upfront.
That much healthcare on the continent is at least as good as Britain's, that people there usually don't pay upfront, and that most people here pay for the NHS through their taxes is therefore beside the point – at least for them. This isn't to say their view is irrational. NHS nursing is not all like mid-Staffs': much of it is good. The health service has strengths – emergency care being one of them, despite the risk of long waits at A & Es. Patient satisfaction ratings have been very high in recent years (all that Labour spending with borrowed money helped to push them up) and have dipped recently for no good reason. And the most daunting healthcare problem isn't hospital care, but social care – as David Davis reminds us on this site today.
In a nutshell, Britain's private spending on healthcare is low by international standards, and our eggs are therefore lumped in the basket of a taxpayer-financed system that has both strengths and weaknesses (cancer survival rates don't compare well with those of some of our competitors). Despite Alan Milburn's involvement of the private sector, which his own Government rowed back on, and the Coaliton's welcome return to fundholding, there is no guarantee that the post-Francis Report changes will work. Hunt reiterated some of them in a speech yesterday: "the prospect of hospital super-heads and a new chief inspector of family doctors".
But as the Health Secretary himself pointed out, there is "regulatory madness" in the NHS. It is therefore hard to see how more regulation – even if it doesn't require primary or secondary legislation – will cure the disease. Nor can Hunt himself shift public attitudes. It is astute of him to try to get ahead of the "NHS funding crisis" – complete with closed wards, protesting staff and patients waiting in ambulances parked outside A & Es – that is likely to happen on his watch. (That it hasn't yet, despite planned real-terms spending increases of 0.1% a year, suggests that the hospital trusts still have formidable amounts of money banked away.) But he knows that he will be cast as the Government's whipping-boy in such an event.
None the less, the Health Secretary's aim of being angrier with the failures of the NHS than any patient has a point. Elsewhere, NHS patients are everyday consumers – with ever-shifting tastes and constantly rising expectations. Healthcare can't be shielded from the trend indefinitely (food standards certainly aren't: consider the horsemeat row). And there are more Mid-Staffs-type scandals coming down the line. The schemes of governments will gradually improve healthcare less than Douglas Carswell-style consumer pressure and information. When a "cutting-edge theatre company" produces a satire parodying the Boyle extraganza – unfair as it may be – we will know that healthcare culture change has well and truly arrived.