NHS: the Blair years
BMJ 2007; 334 doi: https://doi.org/10.1136/bmj.39210.492188.AD (Published 17 May 2007) Cite this as: BMJ 2007;334:1030
All rapid responses
I am no admirer of Tony Blair. Indeed, I believe that he is the worst
Prime Minister that Britain has ever had and it is truly remarkable that
he has held office for such a disastrously long time. If his ineptitude
index (circa 80%) is multiplied by his ten years in office, yielding a
disaster score of 800, his title as our worst PM is guaranteed beyond
doubt.
Polly Toynbee's article is a useful if brief review of the
tribulations of the NHS between 1997 and 2007. She rightly states that
things are not as uniformly bad as the press and Unison like to point out,
and that some genuine improvements have been made. Her observation that
"voters don't do gratitude" is very true indeed. Despite the slightly
optimistic nature of her article, it is a fact that the NHS has been
bedevilled by multiple reorganisations, a succession of incompetent
Ministers, ghastly and costly blunders - for example in information
technology, and the egregious habit of calling any change a "reform".
Although the article is on the whole fair, the same cannot be said
about the accompanying illustration. The PM is depicted against the
background of an apocalyptic explosion. He appears to have triggered this
with his mobile phone, and is overjoyed by the result. The depiction is
reminiscent of Blofeld or other FIHS's (Fiends in Human Shape)of the James
Bond films. One suspects that the picture is the contrivance of digital
photography and does not represent a real event. This might be admissible
for Private Eye, but certainly not for a distinguished scientific journal
such as the BMJ.
Competing interests:
None declared
Competing interests: No competing interests
I’m not sure what Rod Storring means when he says it is “obvious” why
NHS staff and voters are convinced that everything is worse. Polly Toynbee
describes the two big paradoxes: that overall satisfaction with the
personal NHS is high, yet “the NHS” is condemned as failing; and that by
many measures we are doing much better, but nobody remembers how much
worse it was. So how is it “obvious”? One could say that the reason it is
failing is that it is doomed to fail forever, because medical treatments
advance and there will never be the resources. Anyone who thinks that the
frustrations of the NHS, both the doctors’ and the politicians’, are
anything new, should read Rudolf Klein’s “The new politics of the NHS”,
now in its fifth edition. All Blair did really was to speed up the
reorganisation cycle time.
It is interesting that Toynbee concludes “Tony Blair leaves with the
NHS as his Iraq on the home front.” Another angle on that is to ask to
what extent Blair is held to have failed with the NHS because of Iraq,
because one’s view of the man is forever tainted.
Competing interests:
None declared
Competing interests: No competing interests
Polly Toynbee asks why NHS staff and voters think the NHS is worse despite the Blair record apparently being good.1 A problem is the way in which progress is reported to government, so that an overly positive gloss is presented rather than a balanced realistic perspective.
For example, the National Director for Mental Health's report on the ten year progress on mental health care reform, although recognising that problems remain, did not describe any of these problems, except to suggest they often reflect previous neglect of the service before the last ten years.2 Instead an emphasis was placed on an increase in staffing, the increased use of the newer atypical antipsychotic drugs, specialisation of community services, the improved physical environment of acute wards and the reduction in national suicide rate. No mention was made of the fragmentation of services because of increased specialisation, the blame culture in mental health services, the need for training to make services more therapeutic and supportive, and the scandal of exporting difficult to manage psychiatric patients out of the NHS to expensive private care.
Gordon Brown has signalled a shift from spin to substance in government with a priority on the NHS. How well health tsars deal with issues must be measured by more than presentation.
- Toynbee P. NHS: the Blair years. BMJ 2007; 334: 1030-1031 [Full text]
- Appleby. L. Mental health ten years on: progress on mental health care reform. Department of Health, 2007 [Full text]
Competing interests:
None declared
Competing interests: No competing interests
Polly Toynbee asks,as does the government repeatedly,why are NHS
staff and voters convinced that everything is worse.The answer is
obvious,and to do with the ever deepening frutration of NHS workers trying
to do a good job,together with the endless experiences of patients who in
a supposedly patient-centered and seemless service do not feel that their
problems are even recognised,never mind sorted.
I would like to suggest a remedy,a target no less,but only one.
Each NHS Trust has an annual staff satisfaction survey.Many of these are
poor,some are appalling.
A commonsense thought would suggest that if staff felt that they were
doing a good job,they would return a good staff satisfaction score.
The single target for each Trust therefore that I would suggest,is an
adequate staff satisfaction score.Not only would this improve patient
care,but it would convert a top-down dysfunctional organistion which is
today's NHS,into a bottom-up arrangement which will be more efficient,and
therefore less costly.A further thought is that this arrangement could
result in the Secretary of Health post no longer being seen as the short
straw.
Competing interests:
None declared
Competing interests: No competing interests
Winston Churchill's N.H.S.
Polly Toynbee gives much praise to Nye Bevan yet none to Winston
Churchill. It was he who introduced the NHS Bill in 1943 with Sir Wiliam
Beveridge's "Social Security Scheme". It was what he had always wanted.
Sir Kingsley Wood at the time warned of the "open-ended" nature of the
scheme and that it could be costly.
Social Security and Industrial Injury and Sickness Benefit had always been
uppermost in Sir Winston's mind since before the First World War though
his Old Age Pension scheme of that time got hi-jacked by Lloyd George.
Likewise did Aneurin "Nye" Bevan, who was Winston's lone opposition
during his Government in the last war, get all the acclaim when the scheme
eventually came into force in 1948.
Indeed he encouraged patients to "go to their doctor and ask, demand" what
they wanted.
Cheaper by far if the Government then and now had just agreed to pay each
doctor's bill for services rendered.
Competing interests:
None declared
Competing interests: No competing interests