Patients are failed by the NHS’S blind belief in its own altruism – and no politician can admit it
AJeremy Hunt’s book on lessons learned from the health service’s failings proves why the NHS is so badly placed to care for our nation’s wellbeing
The NHS began – and continues – as a system specifically designed not to respond to patients, but to dictate what it thinks best for them
politician who publishes a book while still active is usually making a career move. In this sense, people are right to see Jeremy Hunt’s new book, Zero, as contributing to a leadership bid.
His book is about the National Health Service, drawing on his experience as the longest-serving health secretary in history (six years). Later, Theresa May promoted him to foreign secretary. Boris Johnson – who beat him for the Tory leadership – deposed him. Mr Hunt is currently working on a book about foreign policy.
Taken together, these two books – the first domestic, the second global – will convey a message: “I have a grasp of these things. I am a serious player.” They imply a second message, one which Mr Hunt is too courteous to make explicit: “Boris is not a serious player.”
The main generalisation the book makes about leadership is: “The best leaders are often not those with the biggest presence. [They] have succeeded… because they are more likely to assemble strong leadership teams around them, rather than being louder characters who tend to be surrounded by yes-men.” That, essentially, is the “Hunt for PM” case. He is entitled to make it.
However, readers more interested in health than politics should not be put off. It is good – and unusual – that an ex-minister cares enough about his former department’s work to want to think about it afterwards. Zero has a specific important subject, expressed in its subtitle, “Eliminating unnecessary deaths in a postpandemic NHS”. This is a good way into the wider problems of the service which many still fondly imagine is “the envy of the world”.
At Lady Thatcher’s funeral, Mr Hunt was inspired by the eulogy delivered by Bishop Richard Chartres, which quoted a letter she had received from a nine-year-old boy to which she had replied personally. “I sat there and thought: In my seven months as health secretary I haven’t read a single letter from an NHS patient.”
He discovered there were no fewer than 50 officials working in his department’s correspondence unit. He asked them to pass him one letter from a member of the public every day. He would then send a handwritten reply.
This gives the book a structure. Each chapter uses the stories in one or two of the letters which Mr Hunt received to look at different aspects of unnecessary deaths. Issues such as short-staffing, hierarchies, targets, litigation and so on are illustrated by real-life – or rather, real-death – examples of what can go wrong.
Some non-death examples are almost comic – the nurse who, when criticised for ignoring call bells and cries for help in her ward, said she had been told it was more important to sit writing out care plans for newly admitted patients than attend to those within earshot.
But many examples are truly shocking. Take Jeff, a lorry driver. He came back from holiday in Lanzarote, where he had had a blockage in his legs, a flesh-eating infection after the operation on it and chronic diarrhoea.
His wife gave the British consultant, the GP and the relevant nurse copies of a detailed explanatory letter from the Spanish doctors. The consultant said he would get it translated, but didn’t. No one ever read it.
For weeks, as the violent diarrhoea continued, the hospital refused to admit Jeff. When it finally did, the vascular surgeon said he couldn’t operate until the diarrhoea was dealt with. After four months back in England, Jeff was taken for a stent to be put in (waiting nine hours in the hospital bed). At the follow-up appointment, the vascular surgeon had simply vanished. The replacement surgeon noticed that Jeff ’s legs were wasting away. A bypass operation for an artery in his leg delayed the bowel operation.
Finally, 11 months after returning from holiday, Jeff had bowel surgery. He was sent home despite severe stomach pain. It got worse, but he was refused immediate admission to a surgical assessment unit. His desperate wife took him to A&E. Eventually sent to the unit, he had to sit upright in a hard chair for hours, soaked by his own faeces. When his bandages were undone, it was found that his bowel had burst. He had an operation to remove his bowel, but the hospital decided he was dying.
Without his wife being told, Jeff was put on the “Liverpool Care Pathway”, which denies you vital fluids. He survived for some weeks, but died at Christmas, over a year after he first collapsed. (If there are any incoherences in this account, forgive me: I have had to shorten it, because the full list of horrendous wrong steps is so long.)
Mr Hunt personally investigated Jeff ’s story at the time. He identified a system in which individuals took responsibility for their own part in the process but “no one was in charge of Jeff”. There was no accountability, no continuity of care.
The book contains many other stories of equal horror, in which the most vulnerable – babies, infants, the old, an autistic youth – suffer the worst.
Mr Hunt’s approach is humane, and although his extreme moderation can be slightly annoying, he is often persuasive. He explains lucidly, for example, why a “blame culture” which singles out an individual for vilification is much less good for health care than a “learning culture”. The shared acknowledgment of error makes it much less likely that mistakes will be repeated.
He is also right that the NHS gains some advantages from its vast scale. There is no other system in the world, for instance, which has a universal system for rating hospitals and therefore for making useful comparisons. I expect that, if his suggestions were generally followed, thousands fewer people would die unnecessarily.
But there is an elephant in every operating theatre, ward and A&E unit whose pachydermous hide Mr Hunt barely touches. The NHS began – and continues – as a system specifically designed not to respond to patients, but to dictate what it thinks best for them. This “producer capture” is replicated in its rigid and overmighty trade unions.
A seductive appeal to the greater good becomes an excuse for the neglect or mistreatment of actual human beings. Mr Hunt says there are 43 “universal” (i.e. tax-funded) healthcare systems in the world. None is so lumbering, unresponsive and preoccupied with its own virtue as ours.
This means that truly appalling scandals are oddly muffled. Between 400 and 1,200 patients died as a result of poor care over four years in the notorious Midstaffs scandal. There certainly was a row about it; but imagine if one branch of Sainsbury’s killed the same proportion by food poisoning, or one large workplace – a big bank, say – by accidentally spreading disease through air-conditioned offices. Such an event would provoke total change. The NHS, however, staggers on, trading on the idea of altruism.
There is an instinctive collusion here between bureaucrats and politicians. Mr Hunt quotes David Nicholson, the ruthless chief executive in charge of the NHS when the Mid-staffs scandal broke. Politicians love being health secretary, Nicholson told Hunt, because the NHS is “the largest toy train set in Europe”. I bet that is true.
In its combination of frivolity, arrogance and power-hunger, his remark provides an almost total explanation for why the NHS is a profoundly wrong way to care for the health of 67million people. It is sad, but necessary, that the public are at last, post-covid, becoming disillusioned.