Mid-Staffs the NHS and the U.S.
If this heading baffles, read on. The public enquiry into, literally, hundreds of deaths at this Staffordshire hospital, due to inadequate care, has begun. Everyone even vaguely connected will be called to give evidence, including senior NHS managers and even Ministers. It will be held in public. This is all very good news, especially for the hundreds of surviving relatives of those who fell victim to this failure of near biblical proportions. As bad as the death toll is, the attempts first to cover it up, the opaque previous enquires which failed to uncover the whole truth are equally and at a certain level, more disturbing.
What will be laid bare by these proceedings should dismay. For it will not be just a tale of incompetence and neglect. It will reveal that the NHS is a state within a state, out of control and unaccountable. If an attempt is made to balance the vast talent and dedication of those who work in it, with the money that is spent on it, it is one of the most inefficient and ineffective organisations on the planet. Yet as a nation we love it above all our other treasures. For a politician to condemn it is to commit political suicide. We are of course in a state of denial. A considerable number of savvy Americans have spotted this. It is one of the reasons Obama’s Healthcare project has had such a rough ride.
Gradually bit by bit, this enquiry, in the narrow confines of what went on in a hospital polishing off its patients by the score, will uncover the wider truths about the NHS and how it is run, or better said, how it runs itself. The Coalition knows this, which is why it set up this enquiry to override those which had gone before. This will create the climate where reform will be much easier to push through.
So far the main reform announced, putting the GP’s in charge of their patients and in the driving seat of medical provision is fully supported by this Blog. Indeed similar proposals are contained in the Health chapters of my book 2010 A Blueprint for Change. But there is a fundamental issue from which I suspect the government will draw back. It is this.
Our ancient democracy, currently about to have the modest upgrade of AV voting, is barely in modern terms a democracy at all. The NHS is the largest employer in Europe, it costs over £100 billion each year to run, everybody in it, including the doctors, is a public servant, yet nowhere is any elected official to be seen. When things go wrong there is no head which will fall at the behest of the angry voters, whose lives, literally depend on it. It is the contention of this blog that it is no longer acceptable to have large, very large, indeed enormous, sums of taxpayer money spent without much more direct democratic sanction.
The old Regional Health Authorities have gone and everywhere there are these self governing (and self serving) NHS Trusts and Foundations. But unlike normal charitable trusts and foundations which are common enough in every walk of life, this lot do not use their own money, they use the taxpayers’. This is a wholly improper way to structure public services and one which is out of date, out of time and out of order.
It is quite different in America. There, every public, judicial, and municipal official is elected. An American friend living tempoarily here but voting there showed me the voting ticket for a Presidential election. It was more like a catalogue. I thought it ridiculous. I now know it is not. Because over there if somebody screws up and a public instiution starts killing people, the officials in charge go down at the polls, big time. The discovery that the British NHS was in charge of the people not the other way round, gave rise to the cry of socialism among so many Americans and not just on the right or among the rich, which we found quaint and misguided.
But to Americans socialism is not about caring, it is about big public institutions of whatever hue and purpose seeking to control the habits, lives and money of the ordinary citizen. Because they know that those big Federal institutions are not subject to local democratic control and local is where the people are. This is why there is the Tea Party, why Obama took a drubbing mid-term and why the march of big government and big taxes has come to a full stop.
We, in our islands, do not see things quite the same way. Perhaps it is time for us to take another look.