The NHS is toxic for the Tories and they know it

An increasing number of Conservative MPs are starting to think the unloved health reforms ought some

David Cameron was rattled in the Commons today by an attack on his health reforms - and with good reason. The NHS reorganisation is a disaster on many fronts. It is unloved by doctors, poorly understood by the public and, after a series of mangling amendments in parliament, barely even resembles the vision first outlined by Health Secretary Andrew Lansley. The likeliest outcome from the whole thing is protracted chaos and worse services. This time it will be very hard for the Tories to blame the mess on Labour's legacy.

Opinion polls traditionally show Labour well ahead of Conservatives in terms of who is trusted to look after the NHS. Crucially for Ed Miliband, this is also an issue that is personally associated with David Cameron. The pledge to avoid "top down reorganisations" came from Conservative leader's lips. So did the promise to protect health spending in real terms. That will be very hard to achieve even if inflation comes down - at least not without imposing harsher cuts elsewhere. The Labour front bench think the NHS is one policy area where they might be able to puncture Cameron's famous Teflon coating. I have even heard it said by MPs, and not just from Labour ones, that the NHS alone could cost the Tories a majority at the next election

Crucially, Tory MPs are starting to get worried. They are as baffled as anyone else as to how the government got itself into this mess. Questions are increasingly being asked about Lansley's future. It is recognised that he would have to resign if the reforms were shelved. That is hard to do in practice because some of the structural changes are already under way. But as an exercise in political damage limitation it might still be worth slamming on the brakes and, if need be, losing Lansley. Very senior Tories recognise now that the NHS is their point of greatest vulnerability. So much so, in fact, that one source familiar with the Prime Minister's feelings about the subject recently told me Downing Street wished the Lib Dems had killed the thing off last year instead of insisting on a legislative "pause".

Back then Nick Clegg didn't want to be seen to be too obstructive. The Lib Dem priority was still being seen to make coalition work. With hindsight, Clegg's team now say they should have been bolshier and insisted that the NHS reforms be dropped. It is testimony to how politically toxic the whole thing has come that an increasing number of Tories on front and back benches agree.

Rafael Behr is political columnist at the Guardian and former political editor of the New Statesman

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The overlooked aspect of patient care: why NHS catering needs a revolution

The NHS performs so many miracles every day – in comparison, feeding the sick should be a doddle. 

A friend recently sent me a photo from her hospital bed – not of her newborn baby, sadly, but her dinner. “Pls come and revolutionise the NHS” the accompanying text read, along with a plaintive image of some praying hands. A second arrived the next morning: “Breakfast: cereal, toast or porridge. I asked for porridge. She said porridge would be ‘later’. Never arrived. (sad face).”

Contrast this with the glee with which another friend showed me his menu at a Marie Curie hospice a few weeks later. He seemed to have ticked every box on it, and had written underneath his order for syrup sponge and custard: “extra custard please”. It wasn’t fancy, but freshly cooked, comforting food that residents looked forward to – “like school dinners”, he sighed, “but nice”.

To be fair, though budgets vary significantly between hospital trusts, a reliable estimate suggests £3.45 per patient per day as an average – only slightly more than in Her Majesty’s prisons, though unlike in prisons or schools, there is no legally enforceable set of minimum standards for hospital catering. As Prue Leith writes in the foreword to a 2017 report by the Campaign for Better Hospital Food, “this means hospital food is uniquely vulnerable to a race to the bottom in terms of food quality, and patient care”.

Plate after plate of disappointment is not only demoralising for people who may already be at a low ebb, but overlooks the part food has to play in the recovery process. Balanced, appetising meals are vital to help weaker patients build up strength during their stay, especially as figures released in February suggest the number of hospital deaths from malnutrition is on the rise. According to Department of Health findings last year, 48 per cent of English hospitals failed to comply with food standards intended to be legally binding, with only half screening every admission for malnutrition.

The Campaign for Better Hospital Food’s report, meanwhile, revealed that only 42 per cent of the London hospitals that responded to its survey cooked fresh food for children – even though the largest single cause of admissions in five-to-nine-year-olds is tooth extraction. Less than a third of respondents cooked fresh food for adults.

Once the means to produce fresh meals are in place, they can save trusts money by allowing kitchens to buy ingredients seasonally, when they are cheaper. Michelin-starred chef Phil Howard, recently tasked by the Love British Food organisation to cook their annual lunch on an NHS budget, explained that this, along with using cheaper cuts and pushing vegetables centre stage, allowed him to produce three courses rather than the two he’d been asked for. Delicious they were, too.

Andy Jones, a chef and former chair of the Hospital Caterers Association, who was there championing British food in the NHS, told me the same principles applied in real healthcare environments: Nottingham City Hospital, which prepares meals from scratch, saves £6m annually by buying fresh local ingredients – “I know with more doing, and voices like my small one shouting out, we will see real sea change.”

Unusually, it’s less a question of money than approach. Serving great hospital food takes a kitchen, skilled cooks and quality ingredients. But getting every hospital to this point requires universal legal quality standards, like those already in place in schools, that are independently monitored.

Nutrition should be taken as seriously as any other aspect of care. The NHS performs so many miracles every day – in comparison, feeding the sick should be a doddle. 

Felicity Cloake is the New Statesman’s food columnist. Her latest book is The A-Z of Eating: a Flavour Map for Adventurous Cooks.

This article first appeared in the 18 April 2018 issue of the New Statesman, Enoch Powell’s revenge