Dr Bernard. Photo: TIMOTHY A. CLARY/AFP/Getty Images
Show Hide image

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 Images
Show Hide image

How can Britain become a nation of homeowners?

David Cameron must unlock the spirit of his postwar predecessors to get the housing market back on track. 

In the 1955 election, Anthony Eden described turning Britain into a “property-owning democracy” as his – and by extension, the Conservative Party’s – overarching mission.

60 years later, what’s changed? Then, as now, an Old Etonian sits in Downing Street. Then, as now, Labour are badly riven between left and right, with their last stay in government widely believed – by their activists at least – to have been a disappointment. Then as now, few commentators seriously believe the Tories will be out of power any time soon.

But as for a property-owning democracy? That’s going less well.

When Eden won in 1955, around a third of people owned their own homes. By the time the Conservative government gave way to Harold Wilson in 1964, 42 per cent of households were owner-occupiers.

That kicked off a long period – from the mid-50s right until the fall of the Berlin Wall – in which home ownership increased, before staying roughly flat at 70 per cent of the population from 1991 to 2001.

But over the course of the next decade, for the first time in over a hundred years, the proportion of owner-occupiers went to into reverse. Just 64 percent of households were owner-occupier in 2011. No-one seriously believes that number will have gone anywhere other than down by the time of the next census in 2021. Most troublingly, in London – which, for the most part, gives us a fairly accurate idea of what the demographics of Britain as a whole will be in 30 years’ time – more than half of households are now renters.

What’s gone wrong?

In short, property prices have shot out of reach of increasing numbers of people. The British housing market increasingly gets a failing grade at “Social Contract 101”: could someone, without a backstop of parental or family capital, entering the workforce today, working full-time, seriously hope to retire in 50 years in their own home with their mortgage paid off?

It’s useful to compare and contrast the policy levers of those two Old Etonians, Eden and Cameron. Cameron, so far, has favoured demand-side solutions: Help to Buy and the new Help to Buy ISA.

To take the second, newer of those two policy innovations first: the Help to Buy ISA. Does it work?

Well, if you are a pre-existing saver – you can’t use the Help to Buy ISA for another tax year. And you have to stop putting money into any existing ISAs. So anyone putting a little aside at the moment – not going to feel the benefit of a Help to Buy ISA.

And anyone solely reliant on a Help to Buy ISA – the most you can benefit from, if you are single, it is an extra three grand from the government. This is not going to shift any houses any time soon.

What it is is a bung for the only working-age demographic to have done well out of the Coalition: dual-earner couples with no children earning above average income.

What about Help to Buy itself? At the margins, Help to Buy is helping some people achieve completions – while driving up the big disincentive to home ownership in the shape of prices – and creating sub-prime style risks for the taxpayer in future.

Eden, in contrast, preferred supply-side policies: his government, like every peacetime government from Baldwin until Thatcher’s it was a housebuilding government.

Why are house prices so high? Because there aren’t enough of them. The sector is over-regulated, underprovided, there isn’t enough housing either for social lets or for buyers. And until today’s Conservatives rediscover the spirit of Eden, that is unlikely to change.

I was at a Conservative party fringe (I was on the far left, both in terms of seating and politics).This is what I said, minus the ums, the ahs, and the moment my screensaver kicked in.

Stephen Bush is editor of the Staggers, the New Statesman’s political blog.