The danger in criticising the state of the National Health Service is to forget where it has come from.
It is easy to lose sight of the state it was in under the Conservatives and in the first three years of the Labour government.
People still complain about dirty wards or not seeing their GP when they want. But that is to forget years-long waiting lists, too few doctors, even fewer nurses, diabolical food, buildings that were disintegrating before patients’ eyes and a low level of expectation.
Now waiting lists are at a record low, spending a record high, there are more doctors and nurses, the crumbling edifices that were the nation’s hospitals have been revamped or rebuilt, and the food is edible.
Yet all is not well, no matter what ministers say.
Take the recent resignations of some of the most senior NHS officials, including the chief executive of the NHS and permanent secretary at the Department of Health, Sir Nigel Crisp, and the DoH’s workforce director Andrew Foster.
Last week, it was the turn of the director of clinical governance, Professor Aidan Halligan, who accused ministers of ‘deceit over reform’ and of not overhauling the NHS while pouring in billions of pounds.
Foster also resigned with some stinging words, claiming that the past 15 months had seen an increasing sense of dislocation between the NHS and the DoH and a growing lack of confidence in the department’s leadership.
There have been murmurings over the past year of trouble at the top within Richmond House, not least because of ministers’ increasing dissatisfaction that all their money and bright ideas were not winning the plaudits that they felt they deserved.
That it has all boiled over is not surprising, especially with everybody bracing themselves for the final deficit figures — figures that should have been released by now. The last unaudited estimate was £620m net — so £1.2bn seems a fair guess.
The pressure on the civil servants is more than it has ever been and the departing words of Halligan and Foster paint a picture of mandarins caught between the fury of Milburn/Reid/Hewitt and hospital managers juggling with ever-increasing demands and limited budgets.
The underlying issue, of course, comes back to expectation — that with all this extra funding, patients should be receiving gold-standard treatment.
But patients are not receiving the treatment they could have expected under Labour. It feels as bad as it did in the mid-1990s when Conservative ministers were under almost daily attack because, for example, one woman living in Somerset was being given a breast cancer drug that another, across the county line in Wiltshire, was not receiving.
Let us not forget that Labour came into power promising to remove the postcode lottery. It even set up the National Institute for Health and Clinical Excellence.
But tell that to Paul Bould, who has lung cancer. His local Morecambe Bay Primary Care Trust will not pay for Tarceva, the drug his consultant said he needed. He was offered a Fiat Punto worth £9,000 as a disability vehicle but he said he would rather increase his life expectancy.
Tell that to Dr Tess McPherson in Oxford, who has been told by her PCT that she cannot have Herceptin because there are no ‘exceptional circumstances’. A 34-year-old dermatologist and mother of two who is expecting her third child, she objects to being described as 'unexceptional'.
Her oncologist has said that he would like her to start Herceptin in early July, after her baby is born. Despite last week’s licensing of the drug for early breast cancer, Oxford PCT has not yet changed its mind.
Across the country, patients are being refused Macugen, a drug for age-related macular degeneration. The bowel cancer screening programme has been delayed, mental health services are being cut back, and midwife-led maternity units are under threat.
I do not believe the Royal College of Nursing claims last month of 14,000 job losses. When I checked with some of the trusts they quoted, they did not know where the figures specific to them had come from.
Nor do I believe the dire warnings of redundancies. Most of the job losses appear to be from posts already frozen.
The chief executive of the NHS Confederation, Dame Gill Morgan, might have been correct when she said hospitals could afford to lose even more beds, on top of the third lost over the past 20 years.
But to say it somehow feels tactless, and to miss the point, when the postcode lottery still affects so many people around the country.
