In less than an hour we have Health Secretary Alan Johnson speaking here on public health. I’m responding and his speech has just arrived so I will be brief.
I wonder whether we will get any questions on the terrible revelations about Stafford Hospital? When something goes wrong like this there is a tendency to look for system failures and to blame the Government. Sometimes this is justified, but in this case I’m not sure. Four points:
1. There is little doubt that overall the NHS is in a better state than ever before. If you don’t want to take my word for it read this leader in the Times from Monday (published hours before the Stafford revelations). The big question is how dependent these improvements have been on extra money and what will happen now the money is running out. Mary Riddell is pessimistic in today’s Telegraph.
2. The NHS is a huge system. This alone means that at any one time something will be going wrong somewhere. Just think of any large organisation you’ve worked in. To draw conclusions about a whole system from the worst performer is as invalid as drawing conclusions from the star performer.
3. Setting and enforcing targets is a complicated business. It is easy to get them wrong. Policy makers try to avoid perverse incentives and outcomes, sometimes by generating even more targets. Any enforced target will be vulnerable to people either trying to rig the results or over-rigidly adhering to the target against common sense or compassion (this seems to be what happened in Stafford) But the fact that targets have these problems doesn’t mean they should be abolished. Again we have to look at the system overall and here the evidence is that targets have contributed to genuine improvements in patient care and accountability.
4. The best way to avoid disasters like Stafford is to make it easier for patients themselves to blow the whistle on bad care. The Government is doing this. It was a theme of last weeks' public service reform document. So hopefully, in future, scandals like this will be publicly exposed in months rather than years.
And we should beware those who use Stafford to call for a return to the good old days when doctors did what they wanted and were accountable only to each other. There is a piece in the Guardian along these lines this morning. An anonymous doctor blames Stafford squarely on targets and central interference. Among the many things in the piece that don’t add up is the statement that the NHS was much better when it relied on doctors’ goodwill followed immediately by the allegation that targets are driving doctors to choose to let sick patients die in order to care for the less ill. So we are required to believe on the one hand that doctors used always to be driven by only the best motives and then a paragraph later that it takes only a target for these same doctors to abandon their Hippocratic Oath.
Not everything is perfect in the NHS, tough questions should be asked of those who claimed to have inspected Stafford Hospital not to mention thsoe who awarded it Foundation status. But debate needs to be based on proper analysis not knee jerk response.
Public services, commercial corporations and spontaneous social movements: what's the power they all lack? How might public service reform not flounder through shoehorning dynamism into a universalist and planned approach? How might businesses become genuinely socially responsible rather than merely intoning fine sounding rhetoric?