The silence from the political left is deafening. Of course there has been the usual horror and condemnation, and calls for heads to roll. But this wasn’t just a case of lax professional standards, which can be sorted out with a bit of culture training, it was complete system failure from cleaner up to Prime Minister.
Furthermore the report produced a dense fog of recommendations, which badly needs a clear sense of vision to set priorities. This goes to the heart of political policy on the NHS. Little more than a year ago we were deluged by experts criticising the Coalition government’s NHS reform bill. Where are those voices now? The failure is conspicuous enough on the Labour side, but the Lib Dems are hardly exempt. On Lib Dem Voice there has been just one posting on the affair, from Norman Lamb, which attracted just five comments. People preferred to talk about equal marriage.
What makes this worrying is that if the left has nothing of substance to say about reforming the NHS, the field is left open to the half-baked ideas of the right. We have already seen this in education. It is not enough to just cheer the good and condemn the bad. Reform gets ugly.
I have personal experience of the good in the NHS. As a recent heart attack victim, the medical treatment I received was first rate. If the nurses were harassed at times, the sorts of things that happened at Mid Staffs were unthinkable. The much maligned care assistants were a real help in keeping the show on the road. The service may have been a bit rough at the edges , but the basics were excellent – and that is the job we ask the NHS to do. And there are many, many more such positive experiences. But it’s not near enough.
Because the bad is still very much with us. At the same time as I was experiencing good care, a friend’s elderly mother was getting treatment that can only be described as callous, as she was pushed onto the Liverpool Pathway without any proper process of consultation. Mid Staffs is only exceptional because the lack of care was allowed to get so extreme. It’s no use blaming Labour’s regime of strict targets either. Before those targets were introduced the NHS was much worse: doctors and managers just seemed to shrug at appalling waiting times. Would those waiting times have been tackled just by increasing budgets?
And so to the ugly. To implement any kind of change in the NHS means challenging a whole mass of entrenched hierarchies, demarcations and working practices. It hurts; whatever you do a number of highly articulate people will resist. But we can’t root out the bad if it’s not done; and given the tide of demographic change, the service will collapse without reform. It’s no use relying on the warm feelings engendered by Danny Boyle’s Olympic extravaganza, or a throwing in cuddly words like, “collaboration”, “caring culture”, “patient centred” or even the latest favourite “integration”. Somewhere there has to be a big stick. And that’s ugly.
As liberals we should be thinking of ways of empowering individual patients, and especially those that are vulnerable. And the ugly truth about that is that it means challenging the entrenched, top-down instincts of most NHS professionals. Do we have the stomach for that?
* Matthew is a Lib Dem activist who blogs at thinkingliberal.co uk