8 July 2021

Not every part of the NHS deserves a medal


A day after the NHS was given the George Cross, a report found that two in five maternity services in England are not safe enough for mothers and babies. So that’s a gallantry award for East Kent NHS Trust, which plead guilty to causing the “wholly avoidable” death of baby Harry Ritchford at just seven days old. A medal for Morecambe Bay, where an independent report found a “lethal mix” of failures lead to the deaths of at least 11 babies. A gong for Shrewsbury and Telford, where 1,862 potentially preventable maternal and neonatal deaths are currently being investigated.

I do not mean to detract from the heroism of all staff – from consultants to cleaners – who risked infection to fight Covid. Simply to point out that giving such an award to the entire institution, parts of which have fallen well below its own standards, is specious at best and at worst undermines individual bravery.

But it’s hard to begrudge this battered country an empty gesture if it makes us feel better after a terrible year. What I do worry about is the way this fact-defying country’s devotion to the NHS stands in the way of improving it. As Hannah Ord has written on these pages, our love for the health service blinds us to its faults.

The NHS isn’t perfect, nor is it even exceptional by international standards. Comparing health services is tricky, but a detailed IFS report from 2018 concluded that “the NHS performs neither as well as its supporters sometimes claim nor as badly as its critics often allege.” It’s good at procuring cheap medicines for example, and it’s the best in the world at providing care to people when they need it on a totally equal basis. Its main weakness however is outcomes – that is, actually keeping you alive. The NHS performs worse than its peers in treating many of the most common and deadly conditions, including breast cancer, lung cancer, heart attack, stroke and birth.

Nor is its performance in the pandemic above criticism. Of course, it has saved countless lives, not just caring for patients, but discovering new treatments like Dexamethasone and vaccinating millions. But the health service must bear some responsibility for the fact we’ve had more excess deaths in the past year than many similar countries, including for example, Spain which spends less on healthcare than we do. Meanwhile so many non-Covid patients were left untreated that the backlog could take five years to clear. The truth is for all our sacrifices we didn’t protect the NHS – it was overwhelmed and the forthcoming Health and Care Bill will need to deliver serious reform to get it back on its feet.

But that’s a daunting task when criticising the NHS is widely regarded as blasphemy. The usual retorts about ‘Tory cuts’ and ‘underfunding’ miss the point. At around 10% of GDP, Britain’s health spending is fairly average for an OECD country. Given the priority so many people place on health spending and the pressing need for a solution to social care, that may well go up. But the question should be: are we spending this money in the right places and spending it well?

The Health Select Committee report into maternity services identified two areas that need urgent change. The first is staffing – we need 1,932 more midwives and 496 more obstetric consultants to make maternity wards safe. This is a problem that’s reflected across the NHS. Despite spending about the same, Britain has fewer doctors per 1000 people than comparable countries and is particularly reliant on healthcare workers from overseas. There are around 100,000 vacancies in the NHS, representing a staff shortfall of 8.1%. The NHS is one of the largest employers in the world, but only a third of the workforce is made up of doctors, nurses and midwives – are we sure this is the right balance?

Related to these staffing challenges is the fact that the NHS is often not a very nice place to work. The Select Committee found that Trusts repeatedly failed to learn lessons from their mistakes and instead tried to pin blame on individuals – even bereaved parents. This culture of blame means staff are scared to speak up when things go wrong and failures keep happening. Even before the pandemic 44% of NHS workers reported feeling unwell from stress. Low well-being leads many doctors and nurses to leave the service or retire early, contributing to the staffing shortages and increasing the workload of those who remain. It also inhibits their ability to give patients the best possible care. For all the clapping and rainbows and fairy tales, many of the people who work for the NHS are miserable.

So it’s hardly surprising that their unions are calling for pay rises beyond the 1% the Government has offered. But ministers must take a more strategic view. It might be tempting to give in to the Royal College of Nursing’s demands for an extra 12.5% – even when pay is frozen across the public sector, the private sector has taken a hammering, and the lowest paid health workers – those in social care – aren’t even getting the 1%. But that won’t solve the longer-term problem of how you recruit, train and retain the doctors and nurses of the future.

The new Health Secretary might hope that sympathy for high earning consultants will wane if they make good on their threat of going on strike when they’ve got waiting lists 5m people long. But given the level of adoration for ‘our NHS’ I wouldn’t bet on it.

King George VI created the George’s Cross at the height of the Blitz to recognise “acts of the greatest heroism or of the most courage in extreme danger”. It will take a courageous Government to sweep aside the rhetoric, see off the danger of industrial action, and make sure the NHS lives up to the hero worship.

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Alys Denby is Deputy Editor of CapX.