The shocking conclusions of the inquiry into the bad treatment and cruelty which became the hallmark of the Stafford Hospital should prove a wake up call to the nation, which is so emotionally attached to the NHS, that it refuses to accept what an inefficient and ham fisted organisation it has become. True in a crisis it saves lives and works miracles. The problem is that most medical treatment is care, not crisis, driven. It is routine and procedure based. For the most part it does not work miracles; rather it helps the patient to recover if not to full health, to a reasonable quality of life. It is in this routine mass of daily care that cruelty is rife and incompetence common. Three things need to happen.
The first is that the quasi-independent structure of trusts, which are now called commissioning bodies are, however they are organised, re-organised, re-titled, re-constituted or re-arranged, not fit for purpose and will never work. This is a public organisation paid for out of taxation for the general benefit of everyone. It is not a private utility, nor is it at arms length from the government of the day. The government should stop being responsible for reorganisations and instead take responsibility for the performance of the NHS as a whole. The Minister must take responsibility and exercise it through single local managers publicly empowered to lead all and held accountable for everything. Maybe this person should be elected like the new police commissioners.
Second, all the Royal Colleges and the British Medical Association need to up their game and change their allegiance from protecting their members to protecting the patients. To these must be added the General Medical Council. This is a partial and ineffectual organisation engaged in systematic whitewash of medical failure. It acts only in the most flagrant cases and lets the others off the hook. If it cannot reform it should be shut down and replaced with a government inspectorate which really will go after the guilty and bring them to book.
Finally it is time to accept that you cannot provide an infinite and expanding service with ever increasing capacity to heal and cure, coupled to ever increasing demand for this service, from a finite budget plucked from general taxation, even less one frozen or reducing. It is no longer possible to provide world class healthcare from this financial model. The cash must grow with usage, like any other economic activity. It is time to look at a new model which is partially or fully insured. Whatever the emotional trauma this causes, no other proposal will deal with the root problem of trying to do too much with too little.
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