There is a scene near the beginning of the film, Casablanca, where a crime takes place and, in response, the chief of police commands, “Round up the usual suspects!”
He knows this will not reveal the culprit. Doubtless his staff knows, too. Everybody knows. But at least he can say that he is taking action.
The response to the horrific events at Stafford Hospital is not wholly different.
David Cameron has announced that a Chief Inspector of Hospitals is going to be appointed. The author of the report, Robert Francis QC, made no fewer than 290 recommendations. All this might be convincing if we had not been around this course many times before. Ever since the NHS was created – by the most Left-wing minister in the post-war Labour government – there have been serious problems followed by reforms that were meant to solve everything.
In the 1970s, one government thought that re-organisation as recommended by the firm McKinsey would make things better. More recently the introduction of ‘professional management’ was going to improve it. Then targets were the answer. In fact, targets were probably part of the reason why Stafford treated its patients so badly. I remember speaking to a surgeon who was incandescent after a weekend in which he had been instructed to operate on people with minor problems while others who had just broken their hips and lay in great misery and discomfort had to wait until Monday. Why? To meet targets.
Over the past year and a half, I have visited eleven countries looking at their welfare states. Among other things, I was trying to discover the best possible healthcare system. I would not claim to have found the perfect answer but one thing is starkly clear: the NHS is not it. In fact the NHS has claims to being the worst healthcare system in the advanced world.
If you look at almost most sensible measures, the UK comes out badly. Breast cancer survival rates? One of the worst. Colorectal cancer survival rates. One of the worst again. Number of MRI scanners per capita? One of the lowest. Number of CT scanners? Same again.
The OECD did a study to work out which of its member countries got the best healthcare in relation to the amount of money spent. The British NHS was one of the worst. It is not even good value.
There is no need to reform the NHS. It needs to be abolished. I should emphasise that I mean no disrespect to those doctors, nurses and others in the NHS who work in extremely difficult conditions to the best of their ability. Their efforts are all the more admirable if they persist in discouraging circumstances. Incidentally it is worth remembering that doctors were against the original creation of the NHS.
The essential flaw is that is fact that it is a monopoly. When providers know you might take your custom elsewhere, they shape up. That is what is lacking. Choice and competition exist in practically every other system in the advanced world. In the Netherlands and Switzerland you can choose your insurer. In France, you can choose your doctor and can go straight to a consultant without visiting a GP. In Singapore everybody has a health savings account and can use the money in it to pay for their healthcare.
People will say, “Oh but the British love the NHS. It even featured in the Olympics opening ceremony.” Actually the love is skin-deep. A few years ago I took part in a BBC Radio 4 programme in which I advocated the abolition of the NHS. When I told others I was doing this, they were surprised and some were even shocked at first. But then typically they would pause and say something like, “Actually, I remember when my father was in hospital. He was left alone for hours, disoriented and ignored.”
During the programme itself, I was challenged by experts in the studio and members of the public phoning in. Afterwards the producer looked astonished as he told me that the calls and texts had broken clearly in favour of people agreeing with me.
The deaths at Stafford were not an aberration. They were the tip of an iceberg. Most NHS deaths, such as from cancer treated too late or with out-of-date drugs or not at all, go unrecorded. How many people have to die unnecessarily before we accept that the NHS – a state monopoly – is inherently a bad system? For the sake of those we love and for ourselves, it must go.
This is the original draft of an article which appears in today’s edition of City AM. The link is here but it is better to copy and paste it rather than click on it. http://www.cityam.com/forum/there-are-alternatives-the-nhs-we-must-face-its-failure