The Health Bill isn’t the death of the NHS, but it will delay recovery.

As expected, the controversial Health and Social Care Bill is now set to become law within the next few weeks. The UK press have sensed that the public are fairly bored with the protracted political wranglings and in the wake of the Chancellor of the Exchequer’s budget announcements yesterday, the Health bill passed the finishing line with little ceremony.

Only one newspaper, Daily Mirror, seemed to prioritise the story and dedicated its front page to the NHS reforms with a picture of a tombstone headline ‘RIP NHS 1948 – 2012’

As Mark Twain (very much alive at the time) said after seeing his obituary prematurely published ‘Reports of my death are greatly exaggerated’, this is not the death of the NHS. But it’s certainly not very well. The comedian Spike Milligan’s grave stone reads ‘I told you I was ill’ (really – it does!) and this would have been a more appropriate headline for any newspaper. It isn’t competition that will do the most harm, it’s giving GPs too much money, too much responsibility and too much power. It’s ignoring the importance of quality nursing care and the value of performance based targets for both staff and clinical regimes. It’s the loss of priceless expertise in Strategic Health Authorities and Primary Care Trusts and introducing new layers of beaurocracy, despite claims to the contrary.

We know that it’s not just the patients in our hospitals and health centres who need treatment, we know that the health system needs fixing. No-one argues with this fact. This Bill won’t kill the NHS but although Andrew Lansley’s diagnosis was right, his recommended treatment and his unrealistic prognosis is way off course.

The NHS Reform sitcom - in homage to Blackadder goes forth

This week there’s been yet another debate on NHS Reform in the commons, BBC’s Newsnight programme did a Healthbill special, and just about every political programme continues to follow the tale of misinformation, misery and mayhem. Yes the Health and Social Care Bill is taking on the persona of a confusing sitcom, with three of the key players, The PM, Deputy PM and Health Secretary sticking true to character throughout.

The Health Bill sitcom scripts aren’t great and the characters not particularly appealing but I can see some similarities to the brilliant satire, Blackadder, especially series 4, based in the trenches during the first world war. Captain Blackadder, a battle weary, worldly wise leader struggles to keep his troops in line, fighting a war he doesn’t understand and facing a particular battle that he knows he is unlikely to survive unscathed. Captain Darling, similar in rank but lacking is good sense and paying lip service to his paymasters away from the front line is an unwelcome but compulsory presence in the trenches. And then there’s the unpalatable batman, Private Baldric – who has his own warped version of reality - diligent, loyal but, to be frank, living on a different planet to his colleagues. A good example of Baldric’s ‘brilliance’ is to shoot a pigeon so that Blackadder will have meat for supper. The only problem is – he shot the carrier pigeon used to relay vital information to and from the command post…

I shall leave you to decide who should play each character in my version of this tale…

Blackadder: ‘We need to improve the NHS – it’s too expensive, badly run and unsustainable. I have pledged that there will be no top down reform but we need to improve services and efficiency’

Baldric: ‘It’s OK Captain Blackadder – I have a cunning plan…’
Blackadder: ‘Good – I’ll leave it to you then.’
Baldric: ‘The patient will be at the heart of everything we do. The lion share budget will go to GPs. Nothing about me without me…’
Blackadder is distracted and doesn’t really listen - ‘Good, good …. Carry on…’

 A year passes and the troops don’t seem to like the Health Bill very much. They decide to try a new tack..

Blackadder: ‘No-one knows more about the NHS than Baldric’

Darling: ‘No-one knows more about the NHS than Baldric’

That doesn’t seem to rally the troops – in fact – it seems to irritate them.

Blackadder: ‘Baldric – this doesn’t seem to be going very well – most of the NHS staff, the medical colleges and even GP’s themselves don’t seem to be very keen, even your cunning plan of pausing and reflecting doesn’t seem to have distracted the troops enough, there might even be some desertions – what do you have to say?’

Baldric: ‘…many, many GP’s I’ve spoken to support the Bill…’
Blackadder: ‘Great! Where are they…?’
Baldric: ‘…nothing about me without me…. The patient at the heart of everything we do….’
Darling: ‘Can I help?’
Blackadder and Baldric look round to see where the noise has come from and at last realise that it’s Darling who doesn’t really say or do very much in the trenches.
Darling: ‘Why don’t I write a letter to all my troops and advise that I want a few more amendments and then we can discuss the Bill again in the commons and then I can pledge my support for the Bill and…’

That plan, which was carried out this week, didn’t work very well either.

The series ends with our three heroes preparing to go over the top to fight a major battle. As haunting music accompanies freeze frame shots of our characters leading their troops into the abyss we know how this is going to end….

Badly.

Ministers behaving badly must go.

I try to keep this blog apolitical and would struggle if pushed to give an allegiance to one party. So I am writing this post as an independent observer disappointed with three of her majesty’s government ministers. I am also writing as a healthcare evangelist – and it is impossible to separate health and politics right now.

I won’t delve too deep into today’s resignation of Liam Fox, the Minister for Defence, as there is blanket coverage already available. At best – he showed very poor judgement - at worst, broke the mistrial code regarding conflict of interest. But either way – you don’t take your mates to work with you – do you? Ministers are, or should be, leaders. And leadership can be a lonely role. I must confess that when I was an employed director I would have quite liked to have a friend in tow – even my Mum sometimes! But it’s simply not done.

Then – even more bizarrely – we have the case of Cabinet Office Minister Oliver Letwin disposing of sensitive government documents in a park litter bin on five separate occasions. What?? I’m not a particularly over cautious individual but I shred any bill with my details on it and burn client information of it’s no longer needed. I would never, ever, ever dispose of anything remotely private in a public bin! Letwin is guilty of extreme stupidity. If his judgment is so poor on something as fundamental as confidentiality – Heaven knows what other imbecilic things he gets up to. He has to go

And finally – oh dear. Andrew Lansley – the beleaguered Health Minister. I have no doubt that Lansley is an honourable and intelligent man who genuinely believes that his reforms are the right way forward. But for nearly a year now he has consistently ignored the views of the experts in health – the consultants, nurses, GPs, therapists and managers who all tell him that the Health and Social Care Bill isn’t the way to solve the NHS woes. He is fixated on a solution that does not actually address the problem and this intransigence is now actively damaging the state provision.

But the killer blow for me was Lansley’s performance at BBC’s flagship discussion programme, Question Time. Questions are posed by a public audience to a panel of politicians and ‘thought leaders’ and the audience have an opportunity to join in the debate. With Lansley on the panel, of course health came up. The question logically enough was something along the lines of ‘when so many medical institutions and clinicians are against the NHS reforms, is it wise to go ahead?’ Lansley’s response was measured. Then a member of the audience, a health worker, very calmly and eloquently gave her opinion, finishing with ‘Mr Lansley, I don’t trust you’. I’m not sure if Lansley knew the camera was on him – but he sneered at this woman with undisguised contempt.

It was actually quite chilling. Twitter went ballistic demonstrating very clearly that I wasn’t the only person to notice that the one thing NHS staff and Andrew Lansley have in common is a mutual and reciprocal dislike and disrespect. In that split second, 8 million viewers saw what Lansley thinks of many of the 1.5 million NHS workers for whom he has a responsibility. He is so disconnected from this population and apparently dismissive of their views that he didn’t even hide his feelings.

If a CEO of a large corporation loses the respect of his staff and ploughs a furrow not in the best interest of that organisation – the board would normally dismiss him. And so it is with the UK Secretary of State for Health.

It’s time for Andrew Lansley to go.