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

Photo: Getty
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The rise of the green mayor – Sadiq Khan and the politics of clean energy

At an event at Tate Modern, Sadiq Khan pledged to clean up London's act.

On Thursday night, deep in the bowls of Tate Modern’s turbine hall, London Mayor Sadiq Khan renewed his promise to make the capital a world leader in clean energy and air. Yet his focus was as much on people as power plants – in particular, the need for local authorities to lead where central governments will not.

Khan was there to introduce the screening of a new documentary, From the Ashes, about the demise of the American coal industry. As he noted, Britain continues to battle against the legacy of fossil fuels: “In London today we burn very little coal but we are facing new air pollution challenges brought about for different reasons." 

At a time when the world's leaders are struggling to keep international agreements on climate change afloat, what can mayors do? Khan has pledged to buy only hybrid and zero-emissions buses from next year, and is working towards London becoming a zero carbon city.

Khan has, of course, also gained heroic status for being a bête noire of climate-change-denier-in-chief Donald Trump. On the US president's withdrawal from the Paris Agreement, Khan quipped: “If only he had withdrawn from Twitter.” He had more favourable things to say about the former mayor of New York and climate change activist Michael Bloomberg, who Khan said hailed from “the second greatest city in the world.”

Yet behind his humour was a serious point. Local authorities are having to pick up where both countries' central governments are leaving a void – in improving our air and supporting renewable technology and jobs. Most concerning of all, perhaps, is the way that interest groups representing business are slashing away at the regulations which protect public health, and claiming it as a virtue.

In the UK, documents leaked to Greenpeace’s energy desk show that a government-backed initiative considered proposals for reducing EU rules on fire-safety on the very day of the Grenfell Tower fire. The director of this Red Tape Initiative, Nick Tyrone, told the Guardian that these proposals were rejected. Yet government attempts to water down other EU regulations, such as the energy efficiency directive, still stand.

In America, this blame-game is even more highly charged. Republicans have sworn to replace what they describe as Obama’s “war on coal” with a war on regulation. “I am taking historic steps to lift the restrictions on American energy, to reverse government intrusion, and to cancel job-killing regulations,” Trump announced in March. While he has vowed “to promote clean air and clear water,” he has almost simultaneously signed an order to unravel the Clean Water Rule.

This rhetoric is hurting the very people it claims to protect: miners. From the Ashes shows the many ways that the industry harms wider public health, from water contamination, to air pollution. It also makes a strong case that the American coal industry is in terminal decline, regardless of possibile interventions from government or carbon capture.

Charities like Bloomberg can only do so much to pick up the pieces. The foundation, which helped fund the film, now not only helps support job training programs in coal communities after the Trump administration pulled their funding, but in recent weeks it also promised $15m to UN efforts to tackle climate change – again to help cover Trump's withdrawal from Paris Agreement. “I'm a bit worried about how many cards we're going to have to keep adding to the end of the film”, joked Antha Williams, a Bloomberg representative at the screening, with gallows humour.

Hope also lies with local governments and mayors. The publication of the mayor’s own environment strategy is coming “soon”. Speaking in panel discussion after the film, his deputy mayor for environment and energy, Shirley Rodrigues, described the move to a cleaner future as "an inevitable transition".

Confronting the troubled legacies of our fossil fuel past will not be easy. "We have our own experiences here of our coal mining communities being devastated by the closure of their mines," said Khan. But clean air begins with clean politics; maintaining old ways at the price of health is not one any government must pay. 

'From The Ashes' will premiere on National Geograhpic in the United Kingdom at 9pm on Tuesday, June 27th.

India Bourke is an environment writer and editorial assistant at the New Statesman.

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