Six out of ten people don't trust the NHS, according to today's Sunday Times (£). So why doesn't David Cameron tear up his commitment to the service, as its critics urge, and commit the Party to ushering in a system based on insurance or payment – like some of those used by other European countries which yield better results? Half of the answer is that there is no intrinsic problem with a system free at the point of use: indeed, the NHS has its strengths (such as emergency care, despite the A & E waits) as well as its weaknesses (such as some cancer survival rates). The other half is political rather than medical. Voters may distrust the institution, but they also distrust the Conservatives – at least, when it comes to reforming it.
An NHS was originally proposed by Henry Willink, Churchill's wartime Minister of Health. But it is Labour that has taken credit for the service, and churned out black propaganda about Tory intentions towards it from the age of Aneurin Bevan until the present day. This explains the caution with which both Cameron and Jeremy Hunt originally approached the revelations about events in Mid-Staffs: had they taken place under a Conservative Government, Tony Blair would have tried to hang the corpses of the dead round Ministers' necks. As the horror of the reports and the culpability of officials began to sink in – not to mention the distorting role of Labour's centrally-commanded targets system – the Health Secretary grew bolder.
He will have been acutely aware of pressure from a disparate group of energetic Conservative MPs – including Charlotte Leslie, Steve Barclay, Phillip Lee, and Chris Skidmore – who have felt less inhibited at the onset about taking the fight to Labour. They were joined on this site last week by David Morris, the MP for Morecambe and Lonsdale, who plainly pinned a share of the responsibility for the death of children in his local hospital on Labour and its former Health Secretary, Andy Burnham. Today's papers are packed with further claims by angry whistleblowers and accusations against NHS chiefs. In the Independent on Sunday, Ian Birrell sets out in detail how Labour is to blame for inventing the Care Quality Commission in the first place.
Hunt isn't frightened of a fight if he believes it must take place. At present, he is limbering up for one with doctors over the contract they agreed with Labour. This is partly because he recognises that the contract shapes how doctors work; how doctors work determines how patients respond – and that if they respond by packing out A & E departments rather than going to GP surgeries, as they have been, an old-fashioned "NHS crisis" on his watch becomes more likely (complete with ambulances stalled outside hospitals and wards closed within them). What he now has to decide is how to respond to what he rightly called, on this site last week, "the silent scandal within the NHS".
Hunt set out his plans, which are good ones: the new "Duty of Candour", publishing more performance data, clearer responsibility for patient care, new "deep-dive" inspections – and so on. None the less, these improvements may not catch the worst scandals: there will be more Morecambe Bays and Mid-Staffs out there. Leslie is pressing for the royal colleges to take charge of inspections and for a major inquiry into cover-ups – not to mention the outright sacking of David Nicholson, which should have taken place after the Mid-Staffs revelations. Certainly, an inquiry is essential if the system's most profound failure is to be confronted: the vulnerability within it of the very old and very young – a flaw deeply rooted in our wider culture.