The threat is external, not least from a poisonous press
Another day, another front page NHS horror story. London's billboards were ablaze this week with an evening paper tale - "94-year-old abandoned in casualty". It was a good blood-boiler - a frail old lady who had fallen and concussed herself was left alone "caked in blood" and forgotten for three days in A and E for lack of a hospital bed. Except it wasn't true. There were beds, but she was kept under observation, moved to a room of her own and only sent to a ward when well enough. But despite the hospital's vigorous denials the story still appeared, repeated in the Daily Mail, deeply implanting in a million minds yet another nasty NHS snapshot.
The NHS is in grave danger - not from internal failure but from external attack. A war of anecdotes has replaced most attempts at careful analysis. It is more fun to write "My hospital hell", or "My hospital heaven in a much better Spanish hospital", "My wonderful NHS birth experience", or "My neighbour's 10-hour wait for his son's cut finger". Journalists who do not usually write about health feel quite at liberty to expound their own sudden brushes with medicine, good and bad, as if this were "evidence" of the state of the NHS, taking leave of the objective analysis they would apply to other subjects. Since I write about health, I am bombarded with friends' and colleagues' NHS sagas - good and bad - as if these were triumphant "proof" of anything. A head of a TV news service told me the other day that he now "knew" the NHS could not survive: his wife had a bad NHS birth. Actually it was because the hospital at the time was undergoing a major maternity ward renovation, one of more than 200 around the country, costing £100m. To be sure the temporary decanting process had been abominably managed, but this was not the sign he took it to be that now we must reach for some radical privatising alternative.
Health stories are dynamite. Inordinate gleeful space and TV time is given to any medical calamity - last week's corker happened to come from a private hospital where a young mother died. As the NHS treats a million people a day, there will never be a shortage of such tales, as indeed, there never is in "better" Europe where just such horror stories of killer surgeons or fatal injections fill their tabloid pages too. In TV news rooms I see how pushy health correspondents, competing to get their faces on screen, can always elbow their way into the running order with some souped-up NHS crisis. Only 100% perfect medicine will do now, with zero mistakes and zero below-average treatment (a statistical impossibility). Without statistics, any bad anecdote lets the press ring the death knell for a non-viable, non-survivable health service.
No such excited attention greeted the first annual report of the NHS modernisation board, the body which oversees the government's 10-year plan, on which sit leaders of the royal colleges of doctors and nurses, trade unions, managers and the independent Kings Fund. Barely reported, (not at all in most papers), here is the first annual assessment of what is actually happening. This is no New Labour spin machine, for on this board sit those who shout loudest when things get bad: they have no vested interest in glossing the facts, especially as many are in the middle of tricky NHS contract negotiations.
Their report charts progress so far, not startling, but progress: 597 new critical care beds, 714 new general beds, 500 more secure mental beds, 10,000 more nurses, four new medical schools to double doctors in training, 10 new major hospitals, free nursing care for people in nursing homes, 150 new rapid access chest pain clinics, 797 GPs surgeries modernised, 42 new high street walk-in health centres, 5.75m patients using the new NHS Direct telephone advice service, and more. But some of the "successes" only serve to remind us how far there is still to go: 60% of GP surgeries now see patients within 48 hours, (hardly a triumph). The number of people waiting more than 15 months for their operation fell by a third but was still 8,100 (to be eliminated by 2005). Meanwhile, seven out of 10 were treated within three months. It is not much of a boast that no hospital now has "red" alert status for dirt, while more are still "yellow" than top class "green" clean. But the money is at last flowing in - 21 new MRI scanners, 52 CT scanners and so on.
For all that, the killer anecdote will always win. Meanwhile consider the absence of some old stories. Leading NHS figures, like Lord Winston, are no longer blowing the whistle, as they rightly did on Labour's disastrous first two low-spending years. So far, for the second year running there has been no winter beds crisis. The NHS dog is no longer barking, even if it is too early to start wagging its tail.
However good the NHS may become, the front pages of the 75% Conservative press will still proclaim it is getting worse. Tory hopes are pinned on persuading voters this failed "Stalinist" institution can only be saved by a dose of privatisation. As a tactic it works: Labour did the same with its own outrageous "24 hours to save the NHS" slogan at the 1997 election. It is lethal for public trust in the NHS, but all politicians kick it about recklessly for their own self-interest. The recent Telegraph poll showed how voters are swayed: two thirds think the NHS is in bad shape. Yet asked about their personal experience, 86% are happy with their GP and 77% happy with their hospital treatment. What can the NHS do when people believe the Daily Mail more than the evidence of their own lives?
The answer has to come from within the NHS itself. Those doctors and nurses who speak out in bad times must get used to the idea of publicly defending it in good times against its predators. Tory ideas are flowing fast: Iain Duncan Smith posits getting people to pay to visit GPs. Professor Tim Congdon, Tory economic guru, this week publishes a pamphlet calling for state spending to shrink from 40% to 25% of GDP, cutting public services to a rump with minimal vouchers for health and education to be cashed in private facilities. "Over time extra expenditure would have to be financed by parents, patients and citizens, as they saw fit." It is not just the usual Tory extremists who now play around with the idea that the NHS is beyond repair, a 1940s outfit unfit for the 21st century and the like.
The prime minister and Alan Milburn deserve their own share of the blame. It is time to stop floating a clever new NHS wheeze every week. It is time they started to stand up for the basic principles of the NHS, proclaiming its growing strength and encouraging its staff. Nuts and bolts reforms being implemented by the modernisation board are bearing fruit. The more Labour talks up radical ideas using the word "private", the more they undermine trust and confirm the Tory story that an ideological revolution is required: their own facts and figures suggest otherwise.
p.toynbee@guardian.co.uk
The NHS is in grave danger - not from internal failure but from external attack. A war of anecdotes has replaced most attempts at careful analysis. It is more fun to write "My hospital hell", or "My hospital heaven in a much better Spanish hospital", "My wonderful NHS birth experience", or "My neighbour's 10-hour wait for his son's cut finger". Journalists who do not usually write about health feel quite at liberty to expound their own sudden brushes with medicine, good and bad, as if this were "evidence" of the state of the NHS, taking leave of the objective analysis they would apply to other subjects. Since I write about health, I am bombarded with friends' and colleagues' NHS sagas - good and bad - as if these were triumphant "proof" of anything. A head of a TV news service told me the other day that he now "knew" the NHS could not survive: his wife had a bad NHS birth. Actually it was because the hospital at the time was undergoing a major maternity ward renovation, one of more than 200 around the country, costing £100m. To be sure the temporary decanting process had been abominably managed, but this was not the sign he took it to be that now we must reach for some radical privatising alternative.
Health stories are dynamite. Inordinate gleeful space and TV time is given to any medical calamity - last week's corker happened to come from a private hospital where a young mother died. As the NHS treats a million people a day, there will never be a shortage of such tales, as indeed, there never is in "better" Europe where just such horror stories of killer surgeons or fatal injections fill their tabloid pages too. In TV news rooms I see how pushy health correspondents, competing to get their faces on screen, can always elbow their way into the running order with some souped-up NHS crisis. Only 100% perfect medicine will do now, with zero mistakes and zero below-average treatment (a statistical impossibility). Without statistics, any bad anecdote lets the press ring the death knell for a non-viable, non-survivable health service.
No such excited attention greeted the first annual report of the NHS modernisation board, the body which oversees the government's 10-year plan, on which sit leaders of the royal colleges of doctors and nurses, trade unions, managers and the independent Kings Fund. Barely reported, (not at all in most papers), here is the first annual assessment of what is actually happening. This is no New Labour spin machine, for on this board sit those who shout loudest when things get bad: they have no vested interest in glossing the facts, especially as many are in the middle of tricky NHS contract negotiations.
Their report charts progress so far, not startling, but progress: 597 new critical care beds, 714 new general beds, 500 more secure mental beds, 10,000 more nurses, four new medical schools to double doctors in training, 10 new major hospitals, free nursing care for people in nursing homes, 150 new rapid access chest pain clinics, 797 GPs surgeries modernised, 42 new high street walk-in health centres, 5.75m patients using the new NHS Direct telephone advice service, and more. But some of the "successes" only serve to remind us how far there is still to go: 60% of GP surgeries now see patients within 48 hours, (hardly a triumph). The number of people waiting more than 15 months for their operation fell by a third but was still 8,100 (to be eliminated by 2005). Meanwhile, seven out of 10 were treated within three months. It is not much of a boast that no hospital now has "red" alert status for dirt, while more are still "yellow" than top class "green" clean. But the money is at last flowing in - 21 new MRI scanners, 52 CT scanners and so on.
For all that, the killer anecdote will always win. Meanwhile consider the absence of some old stories. Leading NHS figures, like Lord Winston, are no longer blowing the whistle, as they rightly did on Labour's disastrous first two low-spending years. So far, for the second year running there has been no winter beds crisis. The NHS dog is no longer barking, even if it is too early to start wagging its tail.
However good the NHS may become, the front pages of the 75% Conservative press will still proclaim it is getting worse. Tory hopes are pinned on persuading voters this failed "Stalinist" institution can only be saved by a dose of privatisation. As a tactic it works: Labour did the same with its own outrageous "24 hours to save the NHS" slogan at the 1997 election. It is lethal for public trust in the NHS, but all politicians kick it about recklessly for their own self-interest. The recent Telegraph poll showed how voters are swayed: two thirds think the NHS is in bad shape. Yet asked about their personal experience, 86% are happy with their GP and 77% happy with their hospital treatment. What can the NHS do when people believe the Daily Mail more than the evidence of their own lives?
The answer has to come from within the NHS itself. Those doctors and nurses who speak out in bad times must get used to the idea of publicly defending it in good times against its predators. Tory ideas are flowing fast: Iain Duncan Smith posits getting people to pay to visit GPs. Professor Tim Congdon, Tory economic guru, this week publishes a pamphlet calling for state spending to shrink from 40% to 25% of GDP, cutting public services to a rump with minimal vouchers for health and education to be cashed in private facilities. "Over time extra expenditure would have to be financed by parents, patients and citizens, as they saw fit." It is not just the usual Tory extremists who now play around with the idea that the NHS is beyond repair, a 1940s outfit unfit for the 21st century and the like.
The prime minister and Alan Milburn deserve their own share of the blame. It is time to stop floating a clever new NHS wheeze every week. It is time they started to stand up for the basic principles of the NHS, proclaiming its growing strength and encouraging its staff. Nuts and bolts reforms being implemented by the modernisation board are bearing fruit. The more Labour talks up radical ideas using the word "private", the more they undermine trust and confirm the Tory story that an ideological revolution is required: their own facts and figures suggest otherwise.
p.toynbee@guardian.co.uk
Use the feedback form below to submit your comments.
Use the form below to email this article to your friends.
