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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On Brexit, David Cameron knows exactly what he's doing

It's not a dead cat - it's about disarming the Leave campaign. 

If you’re explaining, you’re losing. That’s the calculation behind David Cameron’s latest entry into the In-Out (or Remain-Leave in new money) battle. The Prime Minister has warned that were Britain to leave the European Union, the migrant camp at Calais – popularly known as “the Jungle” – could move to Britain. But Eurosceptic campaigners have angrily denounced the remarks, saying that there’s little chance of it happening either way.  

Who’s right? My colleague Henry Zefferman has written a handy explainer of the ins and outs of the row, but the short version is: the Eurosceptic campaigners are broadly right.

But the remarks are very far from a gaffe by Downing Street or Cameron, and they aren’t a “dead cat” strategy – where you say something offensive, prompting a debate about that instead of another, trickier issue – either.

Campaigners for Remain have long been aware that immigration remains their glass jaw. The line wheeled out by Cameron has been long-planned. Late last year, senior members of the In campaign discussed what they saw as the danger points for the campaign. The first was a renegotiation that managed to roll back workplace rights, imperilling the support of the Labour party and the trade unions was one – happily avoided by Cameron’s piecemeal deal.

That the deal would be raked over in the press is not considered a risk point. Stronger In has long known that its path to victory does not run through a sympathetic media. The expectation has long been that even substantial concessions would doubtless have been denounced by the Mail, Telegraph and Sun – and no-one seriously expected that Cameron would emerge with a transformative deal. Since well before the general election, the Prime Minister has been gradually scaling back his demands. The aim has always been to secure as many concessions as possible in order to get an In vote – but Downing Street’s focus has always been on the “as possible” part rather than the “securing concessions” bit.

Today’s row isn’t about deflecting attention from a less-than-stellar deal, but about defanging another “risk point” for the In campaign: border control.

Campaign strategists believe they can throw the issue into neutral by casting doubt on Leave’s ability to control borders any better. One top aide said: “Our line is this: if we vote to leave, the border moves from Calais to Dover, it’s that simple.” They are also keen to make more of the fact that Norway has equally high levels of migration from the European Union as the United Kingdom. While In will never “own” the issue of immigration, they believe they can make the battle sufficiently murky that voters will turn to the areas that favour a Remain vote – national security, economic stability, and keeping people in their jobs.

What the row exposes, rather than a Prime Minister under pressure is a politician who knows exactly what he’s doing – and just how vulnerable the lack of a serious heavyweight at the top makes the Leave campaign(s). Most people won't make a judgement based on reading up the minutinae of European treaties, but on a "sniff test" of which side they think is more trustworthy. It's not a fight about the facts - it's a fight about who is more trusted by the public: David Cameron, or Iain Duncan Smith, Chris Grayling or Priti Patel? As one minister said to me: "I like Priti, but the idea that she can go against the PM as far as voters are concerned is ridiculous. Most people haven't heard of her." 

Leave finds itself in a position uncomfortably like that of Labour in the run-up to the election: with Cameron able to paint himself as the only option guaranteeing stability, against a chaotic and muddled alternative. Without a politician, a business figure or even a prominent celebrity who can provide credibility on the level of the Prime Minister, any row about whether or not Brexit increases the chances of more migrants on Britain’s doorsteps helps Remain – and Cameron. 

Stephen Bush is editor of the Staggers, the New Statesman’s political blog. He usually writes about politics.