Hospital dramas

Who said these wise words in the House of Commons? "In this spirit of great caring, dredging up personal cases of misery to try to find the one case that has gone badly in the NHS and overlooking all the reforms and successes that we have had, they have resorted to the lowest form of political debate." Was that Tony Blair this week? No, it was Tory shadow health spokesman Dr Liam Fox, in his maiden speech on May 12 1992. He spoke in the wake of the Jennifer's Ear debacle during the 1992 election, when Labour had used a child's case in an emotive party political broadcast and - as these things do - it blew up in their face. Dr Fox was dead right.

That story too descended into farce as Jennifer's semi-separated parents rowed in public and it turned out that her mother was a Tory council candidate while her Labour-inclined father offered up her case to the party campaign machine. Families, we all know, are messy confused affairs with all kinds of internal dynamics and surprises. Now the family of Rose Addis have (unwisely) offered themselves up for public inspection by going straight to the Evening Standard with their version of their grandmother's treatment at the Whittington Hospital. The hospital's chief executive rightly sprang to the defence of his staff with a robust letter refuting every point of the family's complaint.

Then all hell broke loose in the Commons as Iain Duncan Smith made the beginner's mistake of not triple-checking the facts. (The Tories are still green about cases that turn into political landmines.) Blair was genuinely angry and Duncan Smith lashed out, sensing that he may have fallen into an elephant trap. Things went from bad to worse as the hospital - the angriest of all - spelled out that the old lady refused to be undressed by black nurses. They gave Duncan Smith a furious walloping for raising a case without calling them first, demanding an apology. But nothing ever looks crystal clear. The hospital's hint that the old lady refused to be touched by black hands may have raised doubts about whether a confused 94-year-old was dumped by angry, offended nurses. Allow real life into political debate and things turn foggy.

An independent witness spoke to me yesterday, outraged at the allegations against the Whittington. Jean Christodoulo was in the next door cubicle to Rose Addis, and she saw and listened to her most of the day. "She was very confused and the doctors and nurses were in to see her all the time, gave her a cardiogram and were very good with her," Jean Christodoulo said. "She refused to be cared for by a black nurse. She was in a terrible state and they were trying to clean her up but she would not let them. Sometimes she did not know where she was and kept calling out that she had lost her keys, very distraught, but they were really patient and caring. I was incensed when I saw her grandson on television saying she was not racist. I heard her shouting 'I don't want you touching me!' to a black nurse. I know those nurses and they are very nice, but maybe she was just confused. They couldn't have been more caring to her or to me. It's all political."

The hospital's medical director, Professor James Malone-Lee (a Labour activist, it turns out) said what every family in the country must have thought when he suggested that Mrs Addis's relatives "had not helped at all" by failing to visit her for two days. "I regret to say it is not unusual for it to take such a long time for the family of elderly patients to visit." But families are not simple: who knows what their relationship is?

The family put themselves up for such speculation by making the public allegations about Mrs Addis's treatment when they were not there to see for themselves. They could have used the Whittington's very good complaints procedure, but preferred the Evening Standard, newly edited by an apparatchik from the Mail which specialises in these frontpage NHS shockers. With breathtaking cheek - and surely some political motive - the grandson is now protesting about Downing Street: "I think it is an absolute disgrace they have committed such an intrusion. They may have breached codes of practice." He was considering legal action.

Now the saga is unravelling, the entire Tory press has spun the story on its head and thundered into attacks on Labour for breaching patient confidentiality, as if Labour brought the case of this sad old lady to public attention. Does that mean the opposition and their press can use any case and no one can defend either hospital or government? Labour only repeated what the hospital had already said in an open letter. The peculiar question is whether doctors are allowed to use key patient information in public to clear themselves from calumny.

Department of Health guidelines and BMA advice suggest that where a family puts information in the public domain, doctors are allowed to answer allegations with their version of the facts. The government should rush to sign today's BMA call for all parties to pledge no breaches in confidentiality, and all facts to be checked first. Will the Tories sign too?

Who won? Labour, on points. But did they really? Most people only have half an eye on the news, so all that remains of poor Rose's 15 minutes of fame may be an old lady badly treated. In Rose's wake, came a stream of "My A&E hell" stories, many probably true. A&E may be getting better - most refurbished with another £100m just announced, 600 more nurses and targets to admit-or-discharge all within four hours by 2004.

But "better" will never be 100%. This most public face of the NHS will still alarm on inner-city Saturday nights when eight out of 10 patients arrive with alcohol-related injuries and 65,000 staff were assaulted last year. That's why Casualty makes good TV drama.

How can the NHS escape death by a thousand anecdotes? The Kings Fund, an independent health thinktank, yesterday called for ministers to withdraw to arm's length, giving real independence to each hospital. If only. The government already has similar plans but no seasoned observer imagines that it will ever be possible - here or in any other democracy - to stop health and its dramas being used as potent political ammunition by every opposition. How the Tory government blustered during Jennifer's Ear, accusing Labour of "shroud-weaving" and "sick NHS stunts". The best hope is that sharp and angry rebuttal by NHS staff themselves each time will see off political predators bent on proving that the NHS is unsustainable.