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The Mid Staffs scandal was inevitable from the day Bevan created the NHS The Mid Staffs scandal was inevitable from the day Bevan created the NHS
(7 months later)
Last Saturday's Guardian ran two articles that made a fascinating if unhappy contrast. Danny Boyle was interviewed about, among other things, his Olympics opening ceremony last summer, with its nurses holding up NHS placards and "bouncing children on NHS beds". Then one could turn to Roger Taylor's outstanding long essay entitled We love the NHS too much to make it better.Last Saturday's Guardian ran two articles that made a fascinating if unhappy contrast. Danny Boyle was interviewed about, among other things, his Olympics opening ceremony last summer, with its nurses holding up NHS placards and "bouncing children on NHS beds". Then one could turn to Roger Taylor's outstanding long essay entitled We love the NHS too much to make it better.
Well before reading Taylor, I had been thinking again about the opening ceremony, and wondering how it must have felt watching that mawkish pageant if you had been one of the victims – one of the survivors, that is – of Stafford hospital. Is it possible that some degree of embarrassment about the egregious failings of this health service that we love too much explains why the full, almost indescribable horror of that scandal seems not to have fully sunk in?Well before reading Taylor, I had been thinking again about the opening ceremony, and wondering how it must have felt watching that mawkish pageant if you had been one of the victims – one of the survivors, that is – of Stafford hospital. Is it possible that some degree of embarrassment about the egregious failings of this health service that we love too much explains why the full, almost indescribable horror of that scandal seems not to have fully sunk in?
Innumerable patients, most of them elderly, were left to suffer untended and ignored in their own excrement and vomit. The details are nearly too repulsive to read. This is much worse than almost any other crime attributable to the British government – which is after all ultimately responsible for the NHS – for decades past. The 1,100 or more needless deaths at Mid Staffs outnumber the combined total for the Bloody Sunday shootings, the Belgrano, the Hatfield rail crash, and numerous other episodes that have aroused so much indignation.Innumerable patients, most of them elderly, were left to suffer untended and ignored in their own excrement and vomit. The details are nearly too repulsive to read. This is much worse than almost any other crime attributable to the British government – which is after all ultimately responsible for the NHS – for decades past. The 1,100 or more needless deaths at Mid Staffs outnumber the combined total for the Bloody Sunday shootings, the Belgrano, the Hatfield rail crash, and numerous other episodes that have aroused so much indignation.
But we love the NHS too much to make it better, or criticise its obvious systemic flaws, or ask what their origin might be. If one does ask, part of the answer might be the way the NHS was created.But we love the NHS too much to make it better, or criticise its obvious systemic flaws, or ask what their origin might be. If one does ask, part of the answer might be the way the NHS was created.
It's hard to believe that the NHS's founding father, Aneurin Bevan, would have felt anything other than shame if he had seen the Mid Staffs report. But would he have guessed how that hateful story stemmed from his own mistakes and misapprehensions?It's hard to believe that the NHS's founding father, Aneurin Bevan, would have felt anything other than shame if he had seen the Mid Staffs report. But would he have guessed how that hateful story stemmed from his own mistakes and misapprehensions?
At the 1945 election, Labour had promised universal healthcare regardless of means, but in broad and unspecific terms. After the landslide victory it was Bevan, the fiery orator and hero of the left, who became minister of health, and it was only then that detailed plans were drawn up. When he took them to the prime minister, Clement Attlee said in astonishment: "But you're going to nationalise the hospitals!"At the 1945 election, Labour had promised universal healthcare regardless of means, but in broad and unspecific terms. After the landslide victory it was Bevan, the fiery orator and hero of the left, who became minister of health, and it was only then that detailed plans were drawn up. When he took them to the prime minister, Clement Attlee said in astonishment: "But you're going to nationalise the hospitals!"
And so he was. It was the spirit of the age. In the aftermath of total war, that spirit was infused by a belief in the benevolence and efficacy of an all-powerful state, in the desirability of planning and "controls", and in the superior wisdom of the gentleman in Whitehall who really did know what was good for the people better than the people knew themselves, as one of Bevan's Labour colleagues so memorably put it.And so he was. It was the spirit of the age. In the aftermath of total war, that spirit was infused by a belief in the benevolence and efficacy of an all-powerful state, in the desirability of planning and "controls", and in the superior wisdom of the gentleman in Whitehall who really did know what was good for the people better than the people knew themselves, as one of Bevan's Labour colleagues so memorably put it.
To understand the nature of the problem even now, recall that at the time Bevan insisted that the NHS would cost less with every year that passed. That showed his utter incomprehension of the question. He naively supposed that, as the populace received better medical care, they would grow healthier and need less treatment. Neither the great increase in life expectancy nor the explosive development of medical treatment seems to have occurred to him as a possibility.To understand the nature of the problem even now, recall that at the time Bevan insisted that the NHS would cost less with every year that passed. That showed his utter incomprehension of the question. He naively supposed that, as the populace received better medical care, they would grow healthier and need less treatment. Neither the great increase in life expectancy nor the explosive development of medical treatment seems to have occurred to him as a possibility.
There is more to it. Although Bevan was a genuine democrat who disliked the Soviet tyranny of secret police and show trials, he was a convinced state socialist who believed, and said, until the end of his life in 1960, that the communist east was bound to overtake the west economically. It was axiomatic to Bevan that a centrally planned command economy must be more efficient and productive than the ramshackle free market.There is more to it. Although Bevan was a genuine democrat who disliked the Soviet tyranny of secret police and show trials, he was a convinced state socialist who believed, and said, until the end of his life in 1960, that the communist east was bound to overtake the west economically. It was axiomatic to Bevan that a centrally planned command economy must be more efficient and productive than the ramshackle free market.
That belief underlaid the creation of the NHS. Bevan confused the desirability of healthcare available to all, which few advanced countries (apart from the United States) today dispute, with the need for a vast Leninist monolith, the most centralised and bureaucratic health service anywhere, not to say the largest single employer in Europe, as the NHS now is. That belief in central planning was once far from confined to Labour, but has itself been refuted by history, as the more intelligent and reflective left now recognises.That belief underlaid the creation of the NHS. Bevan confused the desirability of healthcare available to all, which few advanced countries (apart from the United States) today dispute, with the need for a vast Leninist monolith, the most centralised and bureaucratic health service anywhere, not to say the largest single employer in Europe, as the NHS now is. That belief in central planning was once far from confined to Labour, but has itself been refuted by history, as the more intelligent and reflective left now recognises.
Though not Danny Boyle. The champion of the people, as Saturday's headline had it, was asked by Jonathan Freedland if his faith in the NHS has been dimmed by the Mid Staffs revelations. "He answers that of course things will always go wrong." Yes they will, won't they? But really, what a contemptible reply. One can imagine Boyle's reaction – or most Guardian readers' – if David Cameron had said the same about Bloody Sunday or Amritsar. Or if a Pentagon official, asked about Abu Ghraib or the killing of children by a drone, had answered with a shrug: "Things will always go wrong."Though not Danny Boyle. The champion of the people, as Saturday's headline had it, was asked by Jonathan Freedland if his faith in the NHS has been dimmed by the Mid Staffs revelations. "He answers that of course things will always go wrong." Yes they will, won't they? But really, what a contemptible reply. One can imagine Boyle's reaction – or most Guardian readers' – if David Cameron had said the same about Bloody Sunday or Amritsar. Or if a Pentagon official, asked about Abu Ghraib or the killing of children by a drone, had answered with a shrug: "Things will always go wrong."
As if my fundamental scepticism about the NHS weren't bad enough, I disliked Isles of Wonder (what a name!), but thought I really must be in a minority of one – until I was relieved to read Uri Avnery, the great Israeli dissenter now in his 90th year. He used the very word that had run through my mind all that evening: Boyle's ceremony was pure kitsch.As if my fundamental scepticism about the NHS weren't bad enough, I disliked Isles of Wonder (what a name!), but thought I really must be in a minority of one – until I was relieved to read Uri Avnery, the great Israeli dissenter now in his 90th year. He used the very word that had run through my mind all that evening: Boyle's ceremony was pure kitsch.
But that's a mere aesthetic point. Far more serious is the connection between the credulous reverence for the holy NHS expressed by those nurses with their placards, and the hideous reality of old women dying in their own filth. In Nigel Lawson's sardonic phrase, the NHS is the nearest thing we have to a national religion, and that phrase also helps explain Mid Staffs, if one thinks of more conventional religion.But that's a mere aesthetic point. Far more serious is the connection between the credulous reverence for the holy NHS expressed by those nurses with their placards, and the hideous reality of old women dying in their own filth. In Nigel Lawson's sardonic phrase, the NHS is the nearest thing we have to a national religion, and that phrase also helps explain Mid Staffs, if one thinks of more conventional religion.
Roman Catholic priests were allowed to abuse so many children for so long, not least because of the reverence in which the church was held by loyal Catholics, and their unquestioning respect for priests. And it's just because we have been indoctrinated to regard the health service with similar superstitious awe that we have never stopped to examine its own innate maladies. Until that is done, there will be more horrors like Mid Staffs, not made easier to take by bouncing children on NHS beds.Roman Catholic priests were allowed to abuse so many children for so long, not least because of the reverence in which the church was held by loyal Catholics, and their unquestioning respect for priests. And it's just because we have been indoctrinated to regard the health service with similar superstitious awe that we have never stopped to examine its own innate maladies. Until that is done, there will be more horrors like Mid Staffs, not made easier to take by bouncing children on NHS beds.
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