God Bless the NHS: the Truth Behind the Current Crisis
Faber & Faber, 336pp, £9.99
Set against the background of the Francis inquiry into the terrible events at Stafford Hospital, this book is a fast-paced, thorough and entertaining explanation of the dilemmas, tensions, advances, trends and uncertainties that affect both modern medicine and the delivery of health care pretty much anywhere in the world, including in the National Health Service.
I should start with a declaration of interest. Roger Taylor and I worked briefly together at the Financial Times in the days when he was pharmaceutical correspondent and I was public policy editor. We got along fine but did not always see eye to eye. So I started this book with some trepidation.
Roger went off to be a co-founder of Dr Foster, the health-care data company whose best-known public work is the Hospital Guide but that does much more to exploit a wide variety of data on the results of treatment and death rates in an attempt to improve the quality of care and to identify those hospitals (or parts of hospitals) that are failing.
I feared that God Bless the NHS might be little more than a covert piece of advertising for the value of the standardised hospital mortality rate and how studying it is the key to improvement in the NHS. Far from it. There is indeed a substantial chunk on how such data can best be used and its huge potential for improving care but the limitations, difficulties and current weaknesses of such an approach, as well as its undoubted strengths, are also acknowledged. And God Bless the NHS is about much more than that.
The events at Stafford Hospital are used as a broad framing narrative for a balanced, often very nuanced, exploration of many of the main debates about how to improve the care of patients and how to achieve a service that delivers quality cost-effectively in a cashconstrained, tax-funded system.
Thirty years after the cardiologist John Hampton declared, “Clinical freedom is dead and no one need regret its passing,” the book explores how evidence and evidencebased medicine have restricted doctors’ autonomy and increasingly brought a demand that they manage resources, not just the patient in front of them, with all the tensions that brings.
Taylor looks at the pressures – which will not go away – to reshape hospital services, with smaller accident and emergency departments closing and with specialist care increasingly concentrated in specialist centres. He considers the arguments for and against the use of the private sector in the NHS, casting a suitably sceptical eye over the views of both sets of protagonists. He also gets into the rationing of health care and asks why the default position of politicians when it comes to the NHS is to reorganise it. And he repeatedly points out that there are no black and white answers to seemingly simple questions such as: “Is my hospital safe?”
In short, this is a fine primer to pretty much everything that is going on in the NHS and one that gets across the sheer complexity of the issues and the uncertainties around many of them.
It is written, at times, with the zest of the best tabloid journalism, its arguments illustrated with portraits of people and patients. Yet it nonetheless manages to grapple with remarkable clarity with some of the most difficult issues in modern health care. It has a sense of history and an international reach. And you don’t have to agree with everyone of Taylor’s arguments, judgements and conclusions to finish it better informed about the modern NHS than when you started.
For anyone faced with the prospect of their local hospital’s services closing or being reshaped, or wanting an account of what went wrong at Stafford Hospital shorter than the 2,000-odd pages of the Francis report, or wondering how we should go about ensuring high-quality care for all, this book is a stimulating read.
Nicholas Timmins is a senior fellow at the Institute for Government and the King’s Fund