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Despite a concentrated media campaign, opponents of the Health and Social Care Bill failed to halt its progress in the House of Lords yesterday. The Government will be relieved that another hurdle has been cleared, but it's hard to find anyone who seems genuinely enthusiastic about the potential of this much-mangled piece of legislation. In trying to please both patients and doctors, and in attempting to reduce administrative bureaucracy while setting up new, equally bureaucratic structures, the Government is in serious danger of pleasing no-one. Health Minister Simon Burns made a valiant attempt to defend the bill to ConservativeHome readers yesterday. But his article in the Telegraph, in which he portrayed the notorious Summary Care Record as a key instrument of control for patients, was anything but reassuring. If the new patient power is to rest on this hideously expensive, inefficient and unpopular IT project, then the Coalition's Health team really has run out of arguments.

Of course professional bodies and health service unions will object to almost any change to the NHS, fearing a shift in power away from their own sphere of control. Labour, in combination with disaffected Liberal Democrats, has provided predictable opposition from the left (notwithstanding the market-led reforms instigated by the last government). But there has been little support for the bill from the right either, mainly because the reforms do not provide a real increase in purchasing power for patients. Simon Burns wants to put the NHS “on the side of patients and the doctors and nurses who care for them”. But there are times when patients, doctors and nurses cannot be on the same side. When their interests diverge, who takes priority?


The public, not surprisingly, is confused. Enemies of reform have been able to exploit that confusion by making wild allegations: former Children's Commissioner Al Aynsley-Green claims that the reforms will lead to more “Baby P” child deaths, while a bunch of celebs writing to the Independent suggests people will “die in the streets.” The constitutional objections to the bill raised in the Lords by by Peter Hennessy and David Owen sounded more plausible, but were, in truth, based on similar levels of prejudice and misunderstanding. Listening to Hennessy on the Today programme earlier this week I could engage with his case that the reforms dilute the responsibility of the Secretary of State, but I was completely unconvinced by his reasoning. Rather than arguing against the creation of another unaccountable quango, Hennessy took refuge in the usual sentimental claptrap about the NHS being a great historic institution. Because the NHS provides “intimate” services, Hennessy claimed, it cannot be subject to the market like any other service. What nonsense. The intimate nature of healthcare is a very good reason for imposing more market discipline and greater choice. Using a bedpan on a mixed-sex ward, or taking a post-operative shower in a filthy communal bathroom, is a very poor substitute for a single room with ensuite facilities in a privately-run hospital.

As today's report from the Care Quality Commission shows, romanticising the NHS as a national treasure is ludicrously out of touch with the reality of the health service most of us now experience. I know I am not alone in being angry and disgusted at the appalling treatment my dying mother received in hospital less than two years ago. The CQC gives an all too familiar account of disgraceful treatment of elderly patients. Unannounced inspections found a total of 20 hospitals breaking the law by offering unsafe or inappropriate care: neglect of basic standards of cleanliness, patients being spoken to rudely or ignored, being starved of food or drink through failure to help them. Nearly half of the 100 hospitals inspected failed to treat patients with dignity.

Rather like those helpless elderly patients, politicians are still much too fearful of criticising NHS failings. On the radio this morning Health Secretary Andrew Lansley pointed out that it was his idea to call for unannounced inspections, but his description of the NHS as a “learning organisation” which measures “quality and outcomes” felt like another missed opportunity to show some real anger on behalf of all those people who have been failed by the NHS.

Yes, there are many excellent and compassionate doctors and nurses, and some of our most complex and acute care provision is outstanding. But this should not blind us to the dismal nature of routine hospital care at the two points when almost all of us will encounter the NHS – the beginning and end of life. With an increase in the birth rate and a shortage of midwives, the experience of giving birth has become more pressured and fraught; maternal mortality rates have not improved for 20 years. Far from being reassured and confident, women in labour are too often made to feel ungrateful and demanding. The same is clearly true of geriatric care, to the point where no responsible adult feels confident about leaving an elderly relative alone in hospital.

So why do we allow the debate about health reform to be dominated by defenders of the status quo? It's time for the Government to get on the side of the anxious pregnant mothers, the frail and hungry old people, the MRSA victims and their relatives. Instead of constantly trying to placate the health lobby, the reforms should be explicitly directed at empowering patients. That must include giving them purchasing power, not fobbing them off with Clinical Senates and Summary Care Records.

10 comments for: Jill Kirby: Health ministers should start talking about patients, not systems

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