Putting real power back in the hands of patients
As a former government adviser, I can attest to the huge difficulty in trying to make the NHS in any serious way more accountable to ordinary people. Ask it to be more open to a greater choice of providers of treatment, or to more scrutiny about the results doctors achieve, and a Praetorian Guard of NHS elites, trade unions and stuffy medical organisations links arms in stubborn resistance.
It is why I despair at the current debate around the scandal of hidden deaths caused by neglect on the wards of Mid Stafford hospital. This is one of the biggest cover-ups in public service history. It should inspire real anger among all the NHS talking heads appearing in the media. Yet they offer only sterile platitudes: “it’s all very sad; we must learn lessons and move on” and so on. There is no challenge at all to the medical establishment whose grip on the NHS is the root cause of the problem.
And this is quite probably what the Francis Report – the independent inquiry into Mid Stafford’s failings – will dish up too. The experts have already predicted that the recommended action will be more transparency, tougher regulation over nursing standards, protection for whistleblowers, etcetera; administrative measures the medical profession must themselves weave into the existing NHS culture.
The raw truth is that such measures serve only to communicate that ‘the system’ has listened to people’s worries and that action is being taken. The real need is to take on the system itself with far more disruptive and progressive reform. It is the only way to achieve lasting change.
We must challenge the whole power base governing our NHS. From the dinosaurs running the medical unions to the very most senior ranks in our civil service, the top of our NHS is essentially as an insiders’ club serving the interests of powerful elites, rather than the ordinary people the service was set up for. Their authority must be smashed.
To really make the NHS more open and accountable, we must rid it of the stranglehold of the outdated medical Royal Colleges, the deeply reactionary trade unions and the old-boys network of top clinicians and bureaucrats. Their power must be swept back in a revolution to put choice and control firmly in the hands of patients. The servants must be the masters now.
This means our NHS should remain an open gateway to free care – but who provides that care, including private providers if they can do so at the right quality and cost, should be the free choice of people & families, with no veto by medical bureaucrats.
We must also challenge the scandalous fact that there is still absolutely no provision of decent information that ordinary patients can use to compare different NHS services. I recall in government the endless work to try to extract simple league tables for GP practices from the NHS establishment – efforts I believe are still ongoing. The resistance is due largely to fear of the huge variation in results it will expose.
Opening the NHS to new providers and the free choices of ordinary patients will be transformative. Poor performance, like that at Mid Stafford, will not only be deemed totally unacceptable, it will fatally penalise those offering it because patients will be much more likely to vote with their feet and switch to better providers. People’s free choices will always be way more powerful a catalyst for improvement than any system-led administrative change.
The Coalition is, of course, attempting to implement a version of bringing competition into the NHS to expand choice for people, but the passage of even that progressive reform was bitterly contested by public sector elites, completely at odds with the mass of evidence that shows ordinary people want this change. Patients demand much more choice, control, openness and accountability in the NHS. The brazen disregard by NHS elites for this is astonishing.
The sad fact, however, is that many of the politicians we should be relying on to back patients show timidity in standing up to NHS bureaucrats. They mistake controversy over reform that is largely manufactured by media-savvy trade unions for public opposition to change. The NHS establishment flexes its muscle and the politicians shy away.
The fact is that politicians have for years fawned over the NHS for cheap votes, regardless of how it treats real people. It is largely a great institution and a wonderful service, but very few have ever dared say anything critical where it goes bad. And they should have.
This is even more reason to put much more power into the hands of patients. By configuring the NHS around people’s free choices of any provider that wishes to enter the market, we break down the old monopolies run by the trade union top brass and stuffed shirts in the Royal College dining rooms. Our NHS becomes much more open, accountable and delivers better results for people – and we can truly start to consign the spectre of failures like those at Mid Stafford to the history books.