We are in danger of loving the NHS to death

Universal healthcare is the least citizens should expect. To make the NHS better for patients, politicians, press and public alike need to cultivate a healthly scepticism towards it, not give it unlimited adulation.

When Gary Walker broke the terms of a non-disclosure agreement to reveal the impact on patients of excessive target-setting at the United Lincolnshire Health Trust over which he used to preside, he revealed a great deal more. Most obviously, he lifted the lid on a culture of fear of that still pervades much of the NHS, a culture in which whistle-blowers stand to lose reputations and careers, in which silence is commonly bought through the use of legal gagging clauses that break the spirit and perhaps the letter of the Public Interest Disclosure Act. It's significant that when the BBC put Walker's allegations to the NHS, the response of the trust's lawyers was to write to the former manager threatening him with the loss of his £500,000 severance package, rather than to deal with the substance of his allegations.

But what's equally striking is that the story was presented as one about whistle-blowing, about the morality and legality of non-disclosure agreements, rather than about the horrendous overcrowding and patient neglect that caused Walker to blow his whistle. The fact that United Lincolnshire is one of fourteen NHS trusts currently under investigation for hundreds of excess deaths seemed of less significance than a debate about management practices. And of course it is important. A corporate culture that discourages and punishes whistle-blowing is one in which failures and abuses go unchallenged, one that breeds complacency and in which those responsible are rarely held to account. What is truly shocking, however, is that vulnerable people in our hospitals are spending their last days in squalor and dying needless deaths through dehydration and neglect.

At least it should be shocking. But perhaps, following years of revelations about dirt, mistreatment and neglect in hospitals - elderly patients left wallowing in their own waste, deprived of food and water while staff are sitting in offices filling in forms, beds parked in corridors while their occupants are treated with contempt - such tales have ceased to shock.

It's now two weeks since the release of the second report by Robert Francis into Mid Staffordshire hospital trust, where almost 1,200 excess deaths occurred between 1996 and 2008, years when the Labour government was pumping unprecedented amounts of cash into the NHS and boasting loudly about having transformed standards of treatment. By any standards, this is one of the biggest scandals of recent years - bigger than Savile, bigger than MPs' expenses, certainly bigger than the horsemeat saga that has largely relegated Mid Staffs to the inside pages. Bankers can steal your money, the press can invade your privacy, but only the NHS can kill you. Yet no-one has been forced to resign, and at this stage criminal charges seem an unlikely prospect. Yes, there have been ritual expressions of regret. But where is the outrage, where is the raw anger?

The Labour party, which was in government in the period covered by the Francis reports, prefers to talk about the Coalition's forthcoming reforms (or about horsemeat). The Conservatives, for whom Mid Staffs ought to represent an open goal, if only as evidence that their radical measures are needed, have been if anything even more reticent. David Cameron has contented himself with expressing his full confidence in Sir David Nicholson, the bureaucrat who presided over the Mid Staffs debacle and who now runs the entire NHS, dismissing calls for his resignation as "scapegoating."

For both main parties, where the NHS is concerned there's a fear of treading on sacred ground. It's especially acute for the Tories, fearful of detoxifying the brand by saying anything that might be construed as critical of the NHS. For Labour, meanwhile, the NHS is the great shibboleth. The Labour attitude is an unfortunate combination of sentimentality and a defensive sense of ownership. Its problems can be acknowledged only as unrepresentative and untypical; the only possible cure, more funding.

As for the public? The picture here, I suspect, is rather more mixed than often assumed by politicians or the press. The NHS regularly tops surveys of the things that make people proud to be British. At the same time, whenever the topic of hospital treatment features on a radio phone-in there's a huge response from people with bad experiences to share.  A talk by Christina Patterson on Radio 4 about the poor quality of nursing care she experienced while in hospital resonated hugely with audiences. Last summer, even as Danny Boyle brought a patriotic tear to many an eye with his vision of dancing nurses a survey recorded the biggest ever drop in public satisfaction with the NHS.

Few, though, are yet willing to contemplate any alternative. The former chancellor Nigel Lawson once said that the NHS was the closest thing this country has to a national religion. And indeed, the reverence with which the NHS continues to be treated is not entirely rational. Its devotees believe in the NHS despite all the evidence to the contrary, because to do so is an act of faith. The idea of state provision, "free at the point of need" (even while, much of the time, it isn't) is a powerful sustaining myth, a moral ideal whose purity negates the inconvenient fact that the provision itself is frequently worse than it is in countries with mixed systems. Belief in the goodness and inevitability NHS persists alongside the grumbling, alongside the equally widely held belief that the NHS is "failing", underfunded and fraying at the seams.

Universal healthcare isn't just a noble ideal, it is the least that citizens of an advanced society should expect. But there are many ways of providing it. When it was first established after the Second World War, the NHS one of the world's first experiments in nationalised medical care. It's still often said that the NHS is "the envy of the world"; but few other countries have copied it, and while it compares well with other systems in terms of cost efficiency it does much less well in terms of outcomes. Cancer survival rates, for example, are among the worst in the developed world.

What other countries took from the pioneering British example was the idea that universal health coverage was possible, and desirable; and they proceeded to build their systems in their own way, usually by mixing private insurance with public provision, ensuring that the most vulnerable didn't slip through the net.

All systems have their drawbacks. With the NHS, the main problem is lack of transparency, which allows abuses such as those in Mid Staffordshire and United Lincolnshire to fester. I see a direct connection between the lack of transparency and the NHS's sacrosanct place national life, certainly in political debate. Other countries may provide more of the people, more of the time, with better healthcare; they may protect the vulnerable more effectively, and be less unequal; they may keep more patients alive. But they will never be loved, as the NHS is loved. People who can see a connection between their financial contribution and the care they receive don't have this same superstitious reverence for their healthcare system, so in other countries it has been easier to introduce reforms.

"Each man kills the thing he loves," as Oscar Wilde once wrote. The NHS is in danger of being loved to death, by politicians, press and public alike. We should not love the NHS, any more than we should hate the NHS. We should, rather, cultivate a healthy scepticism about the NHS. We should appreciate that, however great the NHS's achievements in the past, it was built for a different age, an age of far greater social conformity and far less sophisticated (and thus expensive) medical care, when "one size fits all" represented a liberation not a straightjacket. We should try to separate the institutions and bureaucracy from the many tremendous people who work in it - who would, after all, continue to care for the sick and injured under whatever system happened to exist. And we should remember that, in the end, the patients are the only people who matter.

 

Danny Boyle's Olympics opening ceremony coincided with a survey recording the biggest ever drop in public satisfaction with the NHS. Photograph: Getty Images
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France’s burkini ban could not come at a worse time

Yet more legislation against veiled women can only further divide an already divided nation.

Since mayor of Cannes David Lisnard banned the full-body burkini from his town’s beaches, as many as 15 French resorts have followed suit. Arguments defending the bans fall into three main categories. First, it is about defending the French state’s secularism (laïcité). Second, that the costume represents a misogynistic doctrine that sees female bodies as shameful. And finally, that the burkini is cited as a threat to public order.

None of these arguments satisfactorily refute the claims of civil rights activists that the bans are fundamentally Islamophobic.

The niceties of laïcité

The Cannes decree explicitly invokes secular values. It prohibits anyone “not dressed in a fashion respectful of laïcité” from accessing public beaches. However, the French state has only banned “ostentatious” religious symbols in schools and for government employees as part of laïcité (the strict separation between the state and religious society). And in public spaces, laïcité claims to respect religious plurality. Indeed, the Laïcité Commission has tweeted that the ban, therefore, “cannot be based upon the principle of laïcité”.

While veils covering the entire face such as the burqa or niqab are illegal, this is not to protect laïcité; it is a security matter. The legal justification is that these clothes make it impossible to identify the person underneath – which is not the case for the burkini.

 

By falling back on laïcité to police Muslim women in this way, the Cannes authorities are fuelling the argument that “fundamentalist secularism” has become a means of excluding Muslims from French society.

Colonial attitudes

Others, such as Laurence Rossignol, the minister for women’s rights, hold that the burkini represents a “profoundly archaic view of a woman’s place in society”, disregarding Muslim women who claim to wear their burkini voluntarily.

This typifies an enduring colonial attitude among many non-Muslim French politicians, who feel entitled to dictate to Muslim women what is in their best interests. Rossignol has in the past compared women who wear headscarves through choice to American “negroes” who supported slavery.

Far from supporting women’s rights, banning the burkini will only leave the women who wear it feeling persecuted. Even those with no choice in the matter are not helped by the ban. This legal measure does nothing to challenge patriarchal authority over female bodies in the home. Instead, it further restricts the lives of veiled women by replacing it with state authority in public.

Open Islamophobia

Supporters of the ban have also claimed that, with racial tensions high after recent terrorist attacks, it is provocative to wear this form of Muslim clothing. Such an argument was made by Pierre-Ange Vivoni, mayor of Sisco in Corsica, when he banned the burkini in his commune. Early reports suggested a violent clash between local residents and non-locals of Moroccan origin was triggered when strangers photographed a burkini-wearing woman in the latter group, which angered her male companions. Vivoni claimed that banning the costume protected the security of local people, including those of North African descent.

Those reports have transpired to be false: none of the women in question were even wearing a burkini at the time of the incident. Nonetheless, the ban has stood in Sisco and elsewhere.

To be “provoked” by the burkini is to be provoked by the visibility of Muslims. Banning it on this basis punishes Muslim women for other people’s prejudice. It also disregards the burkini’s potential to promote social cohesion by giving veiled women access to the same spaces as their non-Muslim compatriots.

Appeals to public order have, occasionally, been openly Islamophobic. Thierry Migoule, head of municipal services in Cannes, claimed that the burkini “refers to an allegiance to terrorist movements”, conveniently ignoring the Muslim victims of recent attacks. Barely a month after Muslims paying their respects to friends and family killed in Nice were racially abused, such comments are both distasteful and irresponsible.

Increased divisions

Feiza Ben Mohammed, spokesperson for the Federation of Southern Muslims, fears that stigmatising Muslims in this way will play into the hands of IS recruiters. That fear seems well-founded: researchers cite a sense of exclusion as a factor behind the radicalisation of a minority of French Muslims. Measures like this can only exacerbate that problem. Indeed, provoking repressive measures against European Muslims to cultivate such a sentiment is part of the IS strategy.

Meanwhile, the day after the incident in Sisco, riot police were needed in nearby Bastia to prevent a 200-strong crowd chanting “this is our home” from entering a neighbourhood with many residents of North African descent. Given the recent warning from France’s head of internal security of the risk of a confrontation between “the extreme right and the Muslim world”, such scenes are equally concerning.

Now more than ever, France needs unity. Yet more legislation against veiled women can only further divide an already divided nation.

The Conversation

Fraser McQueen, PhD Candidate, University of Stirling

This article was originally published on The Conversation. Read the original article.