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11 July 2020

The Health of the National Health Service (3

Tag(s): Politics & Economics, History
Last week the nation marked the 72nd anniversary of the foundation of the National Health Service with another clap. My wife and I joined in but I must confess that in our very well-mannered road very few others did, unlike earlier in the crisis when nearly everyone in the road would join in the clapping. I think this was more in an act of solidarity and goodwill with neighbours rather than because we are taken in by the idea that the National Health Service is the best in the world. It is in fact very far from being the best in the world.

I have blogged on this subject twice before, previously in the context of general elections when the health service always becomes one of the main features of the election and very little honest discourse takes place.[i] Instead politicians vow that they will defend the National Health Service to their dying day despite all the evidence from independent researchers all over the world that it is in fact one of the worst in the developed world. The OECD produces health care quality indicators carrying 27 measures in 15 advanced countries.

The UK is “better than most” on eight measures, similar on five and “worse than most” on 14 including breast and cervical cancer survival, stroke mortality, and deaths within 30 days of a heart attack. When the Labour government on July 5, 1948 founded the National Health Service what they actually did was to nationalise the 480,000 beds previously managed by some 1400 voluntary and about 1500 municipal hospitals. Every other European country decided not to centralise control and maintain diverse ownership of hospitals. It should be no surprise in the current crisis to see how well some of these countries have managed while the UK has one of the highest rates of mortality.

While the general experience of the majority of British citizens will be positive of the NHS, there is no question that in recent years there have been numerous examples of very severe and scandalous service. There was Mid Staffs, the Alder Hey scandal involving the unauthorised taking of body parts from children, and avoidable deaths of mothers and babies at the Morecambe Bay NHS trust, and at the Shrewsbury and Telford NHS trust. The National Audit Office looked at accident and emergency care in 2010 and found that “despite repeated reports identifying poor practice”, NHS trusts had “taken very little action to improve major trauma care”. The Healthcare Commission’s report in 2009 found complete failure at “virtually every stage” in the care of emergency admissions at Stafford Hospital. It found that there were not enough doctors and nurses, and that vital equipment was not available, wards were dirty, and nurses did not know how to operate cardiac monitors or intravenous drips. The final report from the public enquiry into Mid Staffs in 2013 found “appalling suffering” by many patients, primarily caused by a serious failure of the Trust board, which tolerated poor standards. Just this week there have been numerous new stories about such problems from several different Trusts. As these are new cases still to be investigated I won’t go into detail but it suggests that we ae still a long way from learning lessons from the many problems in the past.

Back in 2005 Tony Blair seemed to acknowledge the problem when he declared war on the “forces of conservatism and reaction” in the public sector. He wanted a patient-led NHS and he said “At its worst the NHS has a very hierarchical tradition with professional divides, and bureaucratic systems and inflexible processes. These can get in the way of good patient care.”

This led to a big push for so-called “contestability” and patients were told that they were now consumers with choices that put them “in the driving seat”. What actually happened was that the GPs got hold of these reforms to advance their own narrow interests. In the first year of their new pay deal their average pay increased by about 30% and all over the country some stopped providing an out of hours service. Not really a good example of putting consumers in the driving seat.

At the beginning of the crisis more than 25,000 patients were moved from hospitals to care homes between March 17th and April 16th, at a time when few coronavirus tests were being carried out. The NHS was prioritised over care homes for PPE. The Office for National Statistics reports that nearly 20,000 care home residents in England and Wales died with Covid-19, over half of the total. We still don’t know how many more deaths or prolonged pain there have been when treatments for other diseases have been cancelled. Prof Karol Sikora, a former NHS consultant, has estimated that a six-month lockdown could cause 50,000 cancer deaths.

Another difficulty in this crisis is the availability of accurate data. Every day we are told how many new cases there are, how many deaths have been reported, and then these are then compared with other countries. But if there’s one thing that Donald Trump has got right it is that the more you test the more cases you will find. This is not to say he is right that that means you should not test. But I am not at all sure that there has been an additional outbreak in Leicester and that the decision to return Leicester to lockdown is justified. Even a report by Public Health England isn’t sure concluding: “Evidence for the scale of the outbreak is limited, and may, in part, be artefactually related to growth and availability of testing.” The report revealed that the rise in cases was purely down to “Pillar 2” tests - tests carried out in the community which have increased rapidly in recent weeks. In Leicester four mobile testing units have been deployed.But there has been no rise in cases of Covid-19 in Leicester identified by “Pillar !” tests – those conducted in a clinical setting, typically on people admitted to hospital with severe symptoms. Nor has there been any rise in admissions to Leicester hospitals, which had been running at between six and ten admissions per day for the past month.

If the government is going to react to headline numbers without understanding the real truth behind those numbers then we can all look forward to being locked down on a frequent basis for the next few years.   

[i] The Health of the National Health Service 15th November, 2014
The Health of the National Health Service (2) 2nd February, 2018
Sources: “Let’s not pretend the NHS, however much voters love it, is the envy of the world” David Green Sunday Telegraph 5th July, 2020
Did testing push poor Leicester into lockdown?”  Ross Clark Sunday Telegraph 5th July, 2020

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