Sunday, May 03, 2020

The sick man of Europe

When this terrible crisis is over, I sincerely hope the National Health Service will not come out of it unchanged.
We have all been full of admiration for the doctors, nurses and other health workers who risk their own lives to care for others.
This should not blind us to the terrible failings in the NHS. Its organisation, management and infrastructure should not be allowed to survive unscathed.
For individual workers, this may well have been their finest hour. Never was so much owed by so many.
But this has not been the NHS’s finest hour. The selfless heroism of many health workers should not blind us to the bureaucracy’s fatal - literally fatal - ineptitude.
From before the crisis became a crisis, the NHS bureaucracy in all its bewildering variety has proved itself time after time to be inefficient, bungling, complacent, aimless and incompetent.
Of course, supporters of the status quo will argue first that the NHS has been a victim of cuts and austerity for so long it’s no wonder it wasn’t prepared. They will then claim the crucial decisions were made by politicians, as if that lets the bureaucrats off the hook.
The truth is, funding for the NHS has rocketed while efficiency has plummeted. Every extra £1 spent on the health service these days yields about 10p’s worth of improved services.
On almost all measures, we have one of the worst health services in the developed world.
Yet in the past few months Boris Johnson’s Government has been led entirely by the advice it receives from experts who work in the NHS directly or in one of its many service industries like Imperial College, London.
And that advice has been mixed, to say the least. First, there was no cause for alarm. Then there was a policy of herd immunity. Then there was lockdown.
These contradictory policies were based on flawed and contradictory expert advice. As a result we must endure the devastation of the British economy, with petrifying long-term consequences.
Meanwhile cancer patients and others with potentially fatal illnesses don’t even get to see a GP.
We were told testing was the ‘game changer’. Once we knew who had suffered the illness and who hadn’t, all would be well.
It turned out there were few reliable tests and the NHS had centralised the entire system in one location thus ensuring it would take forever to get any results.
To make matters worse, private companies and universities queued up offering help and were ignored. Possibly this was because of the inadequacy of the NHS bureaucracy, possibly because of a doctrinaire refusal to deal with ‘the private sector’ but, most likely, it was the result of a collective instinct to command and control everything even if it cost lives.
The slow and inadequate testing regime was blamed on Ministers yet they have given the NHS a blank cheque and complete freedom to deal with it. The failures lie at the door of the NHS’s overpaid executives.
The same applies to shortages of personal protection equipment. Why were there shortages?
It is more understandable the NHS might be tripped up by a shortage of intensive-care respirators but its attempts to acquire more were chaotic. Ministers, aware of the need, appealed to private businesses to make them. Many responded. Alas, again, the NHS failed to react.
Where, you might ask, were the highly-paid executives responsible for NHS procurement?
The health service employs more than 4,000 people in purchasing jobs, some of them being paid well over £100,000. Why did these executives fail to secure an adequate supply of PPE for their colleagues?
Of course, part of the problem with the NHS is the way jobs are dished out to superannuated politicians who get to sit on trust boards and pocket hefty salaries for doing nothing but attend a few board meetings to rubber-stamp the decisions of their managers. And the managers themselves have little or no experience of managing anything outside the health service.
That means they are often quite incapable of behaving in a businesslike fashion and plod on without imagination, ingenuity, creativity or any real interest in medical or financial improvements.
The entire lockdown was thrust upon us not so much to protect us from the virus as to protect the NHS from being overwhelmed with sick patients.
That’s understandable up to a point but, as a result, thousands of people with other illnesses are being neglected and driven to an early grave.
An adequate health service would ensure the cure does not cause more fatalities than the disease. Thanks to NHS failures, it is quite possible lockdown will eventually be seen as the greater of two evils.
At the moment, the whole country is in love with the NHS. We applaud and thank its workers every Thursday evening. We donate money. We admire health workers for putting their lives at risk to save ours (though the Covid-19 mortality rate among NHS staff is actually a quarter of what it is for the population as a whole).
But if and when this is all over, we must not be afraid to criticise the NHS. It led us into this war without adequate weapons to fight it and thousands of lives have been sacrificed as a result.
That is not the result of ‘austerity’ or ‘the cuts’. It is due to a whole catalogue of issues including, let us not forget, the health service’s success in keeping us all alive for longer than at any time in human history.
But the organisation has failed its staff and patients throughout the coronavirus crisis. If things get back to near-normal, we need to learn from our mistakes.
Above all, given we have one of the worst coronavirus mortality rates in the world, that means learning from other countries which do things better than us.
However much we revere it, the terrible truth is the NHS is the sick man of Europe.

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