The NHS versus the Trusts

Picture of Lucy Wilson, a white woman in her 30s wearing a grey T-shirt, sitting at a wooden table with boxes of tablets in front of her
Lucy Wilson, one of three patients left disabled after botched surgery by Camilo Valero, who continues to work at an NHS hospital in Norwich.

Yesterday Channel 4 broadcast a Dispatches programme presented by Matthew Syed (a long-standing writer for the Times newspaper) titled Clapped Out: Is the NHS Broken?, on the failings of the NHS and whether it lives up to the adulation it has received over the past 18 months of the pandemic. It focussed on specific areas where there are shortages of equipment and staff, most notably radiology, leading to people not receiving diagnoses until their disease has progressed and in some cases has become terminal (including cancers) and in others more seriously disabling than it might otherwise have been (such as a young woman with multiple sclerosis lost the sight in her right eye). It covered the matter of serious medical errors, “never events” which happen hundreds of times a year, surgeons who butcher patients (such as in the case of Lucy Wilson, right) and yet can continue working at the same hospital, and how reviews are held after such events and yet the same mistakes continue to be made. It compared the adversarial system of litigation for medical mistakes and negligence in the UK with that in Sweden, where claims are resolved between the hospital and the patients’ insurer. (Clapped Out is available in the UK for the next 28 days as of this writing.)

Towards the end, Syed suggests that there is a culture by which the reputation of the NHS comes before the interests of the patient. This is an example of a common fallacy; that healthcare institutions such as hospitals and bureaucracies such as commissioning groups and NHS trusts and the NHS are one and the same. In fact, ‘NHS’ is a brand and a funding model. In the past, healthcare was delivered by local authorities; this changed in the 1980s when local health services started to be provided by trusts which were funded by central government. I find it very doubtful that when health trust and hospital managers persecute whistle-blowers and use their resources to contest rightful negligence claims, they are concerned about the reputation of the NHS; rather, they are concerned about their own professional reputations and that of the specific organisation they work for or run, as it could affect their future career prospects. If the NHS were ever privatised, or made dependent on insurers, most of our hospitals would still exist, and the same reputation-protecting measures would be in place to protect the company rather than a state body. (Doctors also have a history of protecting each other, even when they know their colleagues are in the wrong; they are reliant on each other’s favours for subsequent appointments and promotions.)

Rather than moving us to an insurance-based healthcare system, the NHS could have some sort of tribunal to redress claims of negligence or error which is independent of that particular hospital or trust or indeed any particular NHS body. This would, of course, require legislation; the same legislation could reform the coroners’ courts so that NHS and private healthcare bodies could not use legal trickery to reduce the potential to find fault while patients and their families had no access to representation at all. Syed made the point about the large cost to the NHS of claims for injuries caused by medical error, but often the claims are about justice for a relative, often a disabled relative, who died a preventable death. People have faced massive legal bills and had to crowd-fund for legal representation so that they could get a verdict at inquest that reflects what they saw with their own eyes. A no-fault restitution system like Sweden’s could work in some circumstances, but sometimes there is fault — recklessness, prejudice, illegality — and this sometimes needs to be addressed in court.

That we have the NHS is a huge asset and it’s right that there is major opposition to privatising it. In the UK, people do not fear getting ill, or rebuff attempts to rescue them when they are injured because they cannot afford hospital bills. Reforming the way NHS bodies respond to inquiries and to evidence of serious errors that cost people’s lives, the way it responds to whistle blowers, the way it recompenses patients and their families for injuries, can be done with legislation without doing away with the principle of a publicly-funded national health service.

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