Why has real health scandal been swept under the carpet?

Columnist

Monday 18 February 2013

You may have noticed in passing, even if you don't pay close attention to the news, that everything you've eaten in the past five years, from fish fingers to penny chews, was actually made from horse.

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Or something along those lines.

Perhaps you were reassured by the fact that lots of people eat horses without any apparent ill effects other than being French. Indeed, horsemeat is higher in protein and lower in fat than beef. But then some science types popped up on the television to tell us about phenylbutazone – which, heedless of the damage they are doing to the tourist economy of Rothesay, they call "bute".

I have not consulted my friend Colonel Blood (not his real name), who is a haematologist, but I am led to believe – by numerous newspaper reports – that bute may be connected with aplastic anaemia. I worried a bit less, though, when I discovered when bute was used as a medicine for humans it caused dangerous side effects in only one in every 30,000 patients. And I worried a lot less when I discovered the residue of bute in the horsemeat which has been discovered is less than one-thousandth of that human therapeutic dose. But if, despite the thousands of column inches and hours of airtime devoted to this story, it turns out there is a vanishingly small risk of anyone dying, the authorities have nonetheless stressed – quite properly – that they intend to track down those responsible for this scandal, which can only be described as criminal, whether that be through negligence or (as seems likely) downright fraud. People will lose their jobs. People will go to jail. All that is as it should be. So why, I wonder, has the media been so comparatively quiet about a scandal which actually has killed hundreds of people? The report into Stafford Hospital produced by Robert Francis QC, which estimated that up to 1200 people died unnecessarily because of errors there between 2005 and 2009, appeared about 10 days ago. And where are the resignations, the sackings, the arrests which one imagines must inevitably follow from such a damning verdict? There haven't been any. Indeed, Sir David Nicholson, who was directly in charge of the West Midlands NHS during this period, is now in charge of the NHS for all of England (in which capacity he is paid more than £200,000, with benefits in kind of about £37,000 and expenses which, a couple of years ago, added another £50,000). He doesn't see any reason why he should resign. But, far from pursuing this outrageous scandal, the media lost interest in it almost at once. A probably non-existent health threat involving horsemeat merits blanket coverage, but the NHS actually killing people off is a non-starter as a story. The only possible reason for this is the ridiculously sacrosanct status the NHS enjoys in the UK's political discourse and public imagination. When it is pointed out that guns kill nearly 9000 Americans a year, people launch campaigns for gun control. When the London School of Hygiene and Tropical Medicine concluded last year the NHS was responsible for 1000 preventable deaths every month, hardly anyone batted an eyelid. I don't want to defend or advocate any particular system of healthcare, nor am I disputing for a second there are many able and caring people working in the NHS. I don't even suppose the minor differences in administration north and south of the Border matter all that much. I have no axe to grind, either in favour of or against, Andrew Lansley's changes to the NHS in England (the Mid-Staffs disaster, for example, pre-dates this Government). I simply wonder whether, if this were any other organisation, there would not be urgent and rigorous questions about what went wrong. The sentimental insistence that the NHS is "the envy of the world", a suitable centrepiece for the Olympic opening ceremony, staffed by angels and unimprovable in every way, is just not sustainable. If it were the case, other countries would have rushed to emulate us. Only Cuba, North Korea and Canada have a similar system. What's more, there's nothing very special or important about how one funds health provision. It is not an article of faith, or political dogma. It is just a mechanism for paying for it. Every European nation has a healthcare system which is effectively free at the point of use, but none of them centralises their provision as we do. And we very often have worse clinical outcomes than those countries – UK cancer survival rates, for example, are the worst of leading Western nations. As it happens, I'm fairly sceptical about the efficiency of insurance-based systems (a voucher system, of the sort used in Singapore, is probably better). But it is piffle to claim that in countries which operate them – ie, most European nations, most of which have had centre-Left governments for the majority of the period we have had the NHS – people are left to die in the street, or have their credit card checked before the paramedics get the defibrillator out. The NHS, let us not forget, was set up (in the teeth of fierce opposition from the medical profession) for the convenience of the state, in the period when it was assumed that centralised bureaucracies were the most efficient way of running anything and that managers and the man in Whitehall knew best. But as we know, the man in Whitehall is an idiot, and bureaucracies are usually the least efficient way of running anything. What's more, any very large organisation – and the NHS is the fourth or fifth biggest employer in the world – has a tendency to begin to operate for the benefit of those who work in it, rather than those it is intended to serve. As long as it remains free at the point of use, I don't actually care very much how the NHS is administered. I simply object to the myopic insistence that its funding, or its status as a public institution, is the important issue. That is surely secondary to the question which no-one seems to have any interest in pursuing, which is whether it does its job well. I am sure that it often does. But I can't think of any firm or industry that could be said to be doing especially well if it is causing the unnecessary deaths of 1000 people a month. Calling the NHS Britain's greatest institution while it has that record is like calling a horse a cow, but considerably more dangerous.

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Why has real health scandal been swept under the carpet?

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