Dr Bernard. Photo: TIMOTHY A. CLARY/AFP/Getty Images
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NHS scandals, markets in health care – and why a dog is often just as good as a doctor

"If you’re too depressed to put your pants on in the morning, they’ll lick your testicles. When did you have that much fun with a doctor?"

I was honoured to be asked to speak at the People’s March for the NHS when it rolled into Bristol and hundreds of NHS staff and supporters shouted out for a properly funded, publicly owned health service that is not for profit or sale. At a previous stop in Nye Bevan’s birthplace, Tredegar, the actor Michael Sheen had grabbed global attention, imploring politicians to, “by God, believe in something”. It was a hard act to follow but it focused the mind.

I believe in the NHS because its principles bind us together as a humane society; loving and caring for people according to their needs, not their ability to pay. I don’t believe in putting whole services out to ­tender to companies that are obliged to make a profit for shareholders. Markets often fail to deliver humane health care because it’s far easier to make money from those who need less care, at the expense of those who need it most. This insidious vested interest plays havoc with professional judgement. And if you can’t make a profit, you bail out . . . leaving the NHS to pick up the pieces.

 

Political footballs

I believe in the NHS but I also believe it could be even better. The Commonwealth Fund ranks it as the top performing health service in the world but, as a Private Eye journalist for 23 years, I’ve seen how it can treat those who try to speak up about poor care. In 1991, I met Ian Hislop in the toilet at a BBC Radio light entertainment Christmas party. I asked him for a column in Private Eye. He asked me not to stand quite so close. But he gave me a break and, in 1992, I unearthed a dark secret about child heart surgery in my home city of Bristol. Far more babies were dying or suffering brain damage in Bristol than they would have done had they gone to neighbouring units.

I broke the story in the Eye that year but it took seven years for it to become what was then the largest public inquiry in ­British history. The whistleblower, Stephen Bolsin, paid for his bravery with his career and was never able to work in the NHS again. Fast-forward 23 years and child heart surgery in the NHS still hasn’t been safely reorganised and whistleblowers are still being destroyed for trying to protect patients from harm. For all the good it does, a politicised NHS can still be very brutal when it comes to burying bad news.

 

Crash test dummies

Journalists need to have values and I’ve slowly learned that understanding is more likely to improve the NHS than brutal exposure. Imagine you’re a surgeon trying to do the hardest job in the world – operate on babies’ hearts the size of a plum – and you find that what you thought was a confidential audit of your results has appeared in a satirical magazine, along with the revelation that doctors in your own hospital have dubbed your unit “the Killing Fields”. What would your response be? When hospitals are so brutally exposed, they tend to pull up the drawbridge and shred the evidence. Disastrous operations in Bristol continued for three years after I broke the story.

The solution I came up with in 1999, based on the ideas of a visionary doctor called Bill Pickering, was for an airline-investigation-style team for the NHS, to go in quickly when serious concerns have been raised by patients, carers or front-line staff. The team needs to be clinical – so it has access to all the medical records – but independent from the professional and NHS “brotherhoods”. It could root out vexatious complaints as well as nip further harm in the bud. Its reports would be published in full.

Bill Pickering died in February, too soon to see that one recommendation of the recent Kirkup review into the avoidable deaths at an NHS maternity unit was . . . an NHS “crash investigation team”.

 

Patient explanations

Can patients and carers do anything to survive in an NHS stretched to breaking point? It’s a question I’ve been struggling with since I was asked to write a book called Staying Alive: How to Get the Best from the NHS. It’s very rare that a publisher asks you to write anything, so I said yes. Then I got stuck for months trying not to fall into the trap of a doctor who has never been ill telling people how to behave when they are. My “aha” moment came when I realised that I needed to do what the NHS needs to do: listen to patients. So, I collected stories and suggestions from patients and carers, many of whom had had excellent care in the NHS – and a few of whom hadn’t and wanted to ensure that others weren’t harmed. What struck me was that they all said that great care was founded on compassion, collaboration, competence and communication; and that once you’ve recovered from the shock of a serious diagnosis you need to speak up and stay on top of your care.

It’s easier said than done but as Edward R Murrow observed: “Difficulty is the excuse history never accepts.” I’m hoping that readers will be inspired and emboldened by those who have bounced back from extraordinary hardship and unfairness and want to share their ­experiences and expertise.

 

Hair of the dog

For 90 per cent of symptoms, you’re better off with a dog than a doctor. Hug one and it reduces your blood pressure. A dog also reduces your cholesterol . . . by eating your food. Dogs are always happy to see you. Dogs give you unconditional love. Dogs don’t mind if you get their name wrong. Dogs don’t mind if you’re drunk. Dogs don’t mind if you don’t take your tablets. Dogs are delighted if you forget to wash. They particularly love it when you bring a sample. Dogs always have longer than ten minutes. Dogs look you in the eye – and they keep looking at you until you take them out for a walk. You can wrestle on the carpet with a dog without getting arrested. And if you’re too depressed to put your pants on in the morning, they’ll lick your testicles. When did you have that much fun with a doctor?

Dr Phil Hammond is an NHS doctor, journa­list and comedian. “Staying Alive” (Quercus) is published on 2 April

This article first appeared in the 19 March 2015 issue of the New Statesman, British politics is broken

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Leader: Trump and an age of disorder

Mr Trump’s disregard for domestic and international norms represents an unprecedented challenge to established institutions.

The US presidency has not always been held by men of distinction and honour, but Donald Trump is by some distance its least qualified occupant. The leader of the world’s sole superpower has no record of political or military service and is ignorant of foreign affairs. Throughout his campaign, he repeatedly showed himself to be a racist, a misogynist, a braggart and a narcissist.

The naive hope that Mr Trump’s victory would herald a great moderation was dispelled by his conduct during the transition. He compared his country’s intelligence services to those of Nazi Germany and repeatedly denied Russian interference in the election. He derided Nato as “obsolete” and predicted the demise of the European Union. He reaffirmed his commitment to dismantling Obamacare and to overturning Roe v Wade. He doled out jobs to white nationalists, protectionists and family members. He denounced US citizens for demonstrating against him. Asked whether he regretted any part of his vulgar campaign, he replied: “No, I won.”

Of all his predilections, Mr Trump’s affection for Vladimir Putin is perhaps the most troubling. When the 2012 Republican presidential nominee, Mitt Romney, warned that Russia was the “number one geopolitical foe” of the US, he was mocked by Barack Obama. Yet his remark proved prescient. Rather than regarding Mr Putin as a foe, however, Mr Trump fetes him as a friend. The Russian president aims to use the US president’s goodwill to secure the removal of American sanctions, recognition of Russia’s annexation of Crimea and respect for the murderous reign of the Syrian president, Bashar al-Assad. He has a worryingly high chance of success.

Whether or not Mr Trump has personal motives for his fealty (as a lurid security dossier alleges), he and Mr Putin share a political outlook. Both men desire a world in which “strongmen” are free to abuse their citizens’ human rights without fear of external rebuke. Mr Trump’s refusal to commit to Nato’s principle of collective defence provides Mr Putin with every incentive to pursue his expansionist desires. The historic achievement of peace and stability in eastern Europe is in danger.

As he seeks reconciliation with Russia, Mr Trump is simultaneously pursuing conflict with China. He broke with precedent by speaking on the telephone with the Taiwanese president, Tsai Ing-wen, and used Twitter to berate the Chinese government. Rex Tillerson, Mr Trump’s secretary of state nominee, has threatened an American blockade of the South China Sea islands.

Mr Trump’s disregard for domestic and international norms represents an unprecedented challenge to established institutions. The US constitution, with its separation of powers, was designed to restrain autocrats such as the new president. Yet, in addition to the White House, the Republicans also control Congress and two-thirds of governorships and state houses. Mr Trump’s first Supreme Court appointment will ensure a conservative judicial majority. The decline of established print titles and the growth of “fake news” weaken another source of accountability.

In these circumstances, there is a heightened responsibility on the US’s allies to challenge, rather than to indulge, Mr Trump. Angela Merkel’s warning that co-operation was conditional on his respect for liberal and democratic values was a model of the former. Michael Gove’s obsequious interview with Mr Trump was a dismal example of the latter.

Theresa May has rightly rebuked the president for his treatment of women and has toughened Britain’s stance against Russian revanchism. Yet, although the UK must maintain working relations with the US, she should not allow the prospect of a future trade deal to skew her attitude towards Mr Trump. Any agreement is years away and the president’s protectionist proclivities could yet thwart British hopes of a beneficial outcome.

The diplomatic and political conventions embodied by the “special relationship” have endured for more than seven decades. However, Mr Trump’s election may necessitate their demise. It was the belief that the UK must stand “shoulder to shoulder” with the US that led Tony Blair into the ruinous Iraq War. In this new age of disorder, Western leaders must avoid being willing accomplices to Mr Trump’s agenda. Intense scepticism, rather than sycophancy, should define their response.

This article first appeared in the 19 January 2016 issue of the New Statesman, The Trump era