19 September 2019

Omar Salem was right – the NHS needs radical reform


I am not a huge fan of politicians. Most of them have an insurmountable temptation to do things – to meddle, to spend more of our money, to impose more laws on us. When listening to them in Parliament or being interviewed in the media, they often don’t come across as being particularly intelligent. This makes their  conceit in wishing to boss us around all the more exasperating.

But the complaint that politicians are “out of touch” is one of the less valid charges levelled against them. That is because even the Prime Minister remains a constituency MP. In Ancient Rome, a slave would continuously whisper ‘Remember you are mortal’ in the ears of victorious generals as they were paraded through the streets after coming home, triumphant, from battle. After the Falklands War, or the Berlin Wall coming down, or a landslide election victory only a few days would have passed before Margaret Thatcher was off to Finchley and given some “casework” to pursue with Barnet Council over some constituents difficulty with a housing repair.

Increasingly politicians knock on doors to canvass the electorate routinely, not only during election campaigns. Theresa May often spent her Saturday mornings doing this even when she was Prime Minister.

It is a strength of our system, much better than having a President, cut off from the public they represent. Our politicians do get out and about – far more so than journalists, who are much more inclined to spend time talking to each other.

Yet the perception of aloofness gave added drama to the confrontation between Omar Salem and Boris Johnson at Whipps Cross University Hospital in north-east London yesterday. Salem explained that his new-born daughter is “gravely ill”. He complained that “there are not enough people on this ward, there are not enough doctors, there’s not enough nurses, it’s not well organised enough”. There was a political slant to some of his comments with a claims that “the NHS has been destroyed” and that the Prime Minister had “come here for a press opportunity”.

It soon emerged that Salem is a Labour activist. But to dismiss his concerns on those grounds would have been a cheap shot and was one Boris Johnson avoided, writing on Twitter that “I’ve been PM for 57 days, part of my job is to talk to people on the ground and listen to what they tell me about the big problems. It doesn’t matter if they agree with me”.

After all, it’s hardly likely that Salem would have invented the problems his daughter faces. Indeed the hospital confirmed that “an unexpected emergency” on another ward did result in “temporary pressure”. The distress and anger were surely genuine.

With such anger bubbling away, would Salem have put his allegiance to one side and attacked a Labour Prime Minister in the same way? If Salem had been in a Welsh, would the First Minister Mark Drakeford have experience a similar confrontation, given that health is a devolved matter? Who knows. What is clear is that with the system in place the difficulties will continue regardless of which party is in government. Those of us with long memories can remember Tony Blair on a hospital visit in 2001 encountering a furious Sharon Storer. (“No, you are not very sorry. Because if you were you would do something about it…”)

Each year we see billions of pounds spent on the NHS, and hear statistics churned out about new hospitals, more doctors, more nurses. This deluge of positive talk can sound complacent when faced with sometimes scandalously poor treatment, and serves to further enrage those on the receiving end of it. It is questionable, to say the least, if a Corbyn Government would be able to increase NHS spending at a faster rate. That is because such an undertaking would not be compatible with crashing the economy, as John McDonnell seems intent on doing. But even if it was, that would not solve the problem.

What is required is to maintain the principle of free, universal health care but to embark on radical reform to increase choice and competition. Rather than apologising for the growing role of the private health sector – both within and outside the NHS – it should be morally championed for its contribution to reducing illness and saving lives. Businesses that provide health insurance for their staff are not villains, they are good and responsible employers.

Such opportunities should be widened so they are available to the poor as well as the rich, should they so wish. There is huge health inequality at present – in Herefordshire the average disability-free life expectancy is 71 years in Tower Hamlets the disability-free life expectancy is 55 years. It is a great indictment of the NHS that health inequality has widened since it was founded.

When health outcomes are compared with other western European countries the UK comes out poorly. If cancer patients had the same survival rates as achieved in Germany, Belgium or the Netherlands thousands of lives would be saved a year. Why are we less likely to survive a heart attack or a stroke after being admitted to a hospital here than those admitted to hospitals on the continent?

If the NHS really is the “envy of the world” why hasn’t the rest of the world copied us?

We all have anecdotes about wonderful doctors and nurses. But if you talk to them they will know better than anyone about inefficiency and poor value for money in the system. This year spending on the NHS will be over £134 billion. The cost of admin is extraordinary. Getting a pack of paracetamol on the NHS costs the taxpayer 10x what it would do if just bought over the counter. That example could be replicated across the service.

Since 2010 the state schools in our country have been transformed. The reforms have been a success. Some progress has been made with the NHS. There is greater choice over which GP you use.

When Jeremy Hunt was Health Secretary he was brave in championing transparency so that failings ceased to be covered up. But overall the standard of health care is unacceptably low, based on the reasonable measures of what is achieved in other developed countries.

That does not mean the situation will continue forever. The public is becoming less deferential and more internationally minded. More data is becoming available and it is becoming better understood. Even when we don’t directly pay for a service a consumerist mentality is replacing passive acceptance.

Politicians are well aware of the dissatisfaction. They take up such cases every day. But they are also aware of the deep emotional commitment felt towards the NHS as an institution. Thus it continues with periodic reorganisation and managerial upheaval but without the fundamental reform that would empower the patient. That is why, in refusing to accept the deficient care his daughter received, Omar Salem gives voice to patients of the future.

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Harry Phibbs is a freelance journalist