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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How Theresa May laid a trap for herself on the immigration target

When Home Secretary, she insisted on keeping foreign students in the figures – causing a headache for herself today.

When Home Secretary, Theresa May insisted that foreign students should continue to be counted in the overall immigration figures. Some cabinet colleagues, including then Business Secretary Vince Cable and Chancellor George Osborne wanted to reverse this. It was economically illiterate. Current ministers, like the Foreign Secretary Boris Johnson, Chancellor Philip Hammond and Home Secretary Amber Rudd, also want foreign students exempted from the total.

David Cameron’s government aimed to cut immigration figures – including overseas students in that aim meant trying to limit one of the UK’s crucial financial resources. They are worth £25bn to the UK economy, and their fees make up 14 per cent of total university income. And the impact is not just financial – welcoming foreign students is diplomatically and culturally key to Britain’s reputation and its relationship with the rest of the world too. Even more important now Brexit is on its way.

But they stayed in the figures – a situation that, along with counterproductive visa restrictions also introduced by May’s old department, put a lot of foreign students off studying here. For example, there has been a 44 per cent decrease in the number of Indian students coming to Britain to study in the last five years.

Now May’s stubbornness on the migration figures appears to have caught up with her. The Times has revealed that the Prime Minister is ready to “soften her longstanding opposition to taking foreign students out of immigration totals”. It reports that she will offer to change the way the numbers are calculated.

Why the u-turn? No 10 says the concession is to ensure the Higher and Research Bill, key university legislation, can pass due to a Lords amendment urging the government not to count students as “long-term migrants” for “public policy purposes”.

But it will also be a factor in May’s manifesto pledge (and continuation of Cameron’s promise) to cut immigration to the “tens of thousands”. Until today, ministers had been unclear about whether this would be in the manifesto.

Now her u-turn on student figures is being seized upon by opposition parties as “massaging” the migration figures to meet her target. An accusation for which May only has herself, and her steadfast politicising of immigration, to blame.

Anoosh Chakelian is senior writer at the New Statesman.

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