Andrew Lansley opened his account as Secretary of State for Health with a statement of intent: ‘We need a cultural shift in the NHS. From a culture responsive mainly to orders from the top-down, to one responsive to patients, in which patient safety is put first.’ The problem is the same words could have been taken from the lips of pretty much every health minister since Aneurin Bevan.
A deeper problem is that this, arguably, is not the biggest cultural issue when it comes to the NHS. Rather, it is the aura surrounding ‘the NHS’ itself as something approaching an untouchable.
There is, of course, a level on which this is entirely justified. Many of the values the NHS embodies should always be part of the framework of a civilised society. Universal, comprehensive, health care is something that should always be defended. It is as the architect of the welfare state, William Beveridge, intended: in return for everyone accepting a responsibility to contribute in their working lives, ‘medical treatment covering all requirements will be provided for all’.
But, in embracing the additional post-war ideal of nationalised provision, the NHS has also taken on a mantra of being a part of a ‘greater good’. In one sense this provides some much needed civic glue. It has also been used in too many quarters as an excuse for inertia, complacency and false attachment to the status quo.
Three examples present themselves. One, there is an uproar almost every time a commissioning organisation proposes pulling a service out of a hospital or awarding a contract to a voluntary, private or even other NHS provider. Yet, if another organisation can offer a better service, at lower cost, all we are doing is denying patients and the public better health care and better value for money.
Two, the aura around the NHS inculcates a broader, and damaging, ‘us versus them’ attitude between the NHS and private/voluntary sectors, that at times puts patient care in real jeopardy. Yet, as King’s College Hospital NHS Foundation Trust have proved with their recent joint venture with Serco in pathology services, patients could gain much from a partnership of talents.
Three, in stifling the competition that Labour attempted to inject into the health service, NHS providers have collectively enabled services offering a poor deal for patients to keep running, and isolated surgeons, in particular, from pressure to up their game. One medical director described a shocking story of how surgeons take two and a half hours to perform an operation in the NHS that they do safely in 45 minutes in a private hospital.
In his 1942 report, Beveridge was at pains to emphasise that ‘in organising security the state should not stifle incentive, opportunity and responsibility’. The NHS as currently thought of is doing just this.
It is time for the coalition government to focus less on endless structural change as a solution to the NHS’s woes and concentrate instead on introducing a new public consciousness: not of the NHS as a culturally revered system of provision, but as a service that supports civil society through enabling all to access the highest quality health care.
Who provides it should not matter: instead all providers should compete on the quality of their service offering. Above all else, we need new entrants with new ideas to support us through tight financial times.
James Gubb is director of the Civitas Health Unit and the co-author of Refusing treatment: the NHS and market-based reform, published today by Civitas
