What is wrong with Government policy for the Health Service?

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I would not like it to be thought that I disagree with all the Government’s recent policy announcements for the Health Service. Some aspects of health policy should be determined at national, or even international, level, and Government decisions on these, such as to focus on reducing deaths from the major killer diseases and to approve for regular use nationwide treatments that have been demonstrated to be effective, are generally sound. There are however, examples of where the Government has failed to act, or where it has been too prescriptive on matters that ought to be decided by individuals or by local communities.

• Apart from general practice, most NHS services are administered by chief executives appointed by NHS trusts whose members are appointed by ministers. When a chief executive acts improperly towards patients, staff or the community, or when a trust has different policies from other trusts (often described as "postcode prescribing"), it is not satisfactory for ministers to shelter behind the trusts. If the trusts had been accountable to local residents, it would be a different matter, as the residents would be able to vote the members off the trusts.
• The medical profession regulates itself. Other professions, such as accountants, architects and lawyers, also regard themselves as self-regulating. But where there activities impact on citizens, governments have been willing to impose duties and restrictions on their members. Governments seem to have no more influence now on medical ethics than they did before the NHS was formed. Initially this was a compromise to get consultants’ acceptance of the NHS, but this does not excuse the continuance of Government indifference to medical ethics half a century (or more than two professional generations) later.
  
  The most extreme example of this is in the deliberate killing of patients. Since the courts permitted the removal of a drip feed from a man who had been unconscious for ten years after the Hillsborough football disaster, medically assisted death , often without the patient’s or relatives’ consent, has become routine. The British Medical Association has issued guidance that patients or relatives should be consulted, but that doctors should make the final decision.. The High Court ruled that relatives could not lawfully stop a child being killed in hospital, and imprisoned them for forcibly taking him away. A head teacher instructed a school nurse to kill a pupil and dismissed her for refusing. She failed to win reinstatement.
  
  Resuscitation for patients suffering heart failure during treatment is often withheld without consultation for reasons that are not specified, based on prejudice about a patient’s "quality of life", or because of arbitrary age limits which in some hospitals can be as young as sixty.
  
  The case law has removed important safeguards protecting vulnerable patients. The Government has stood back. It opposed the Medical Treatment (Prevention of Euthanasia) Bill, which would have made it illegal to withdraw treatment with the purpose of killing a patient. It has done nothing to prevent the abuses that seem to be a daily occurrence.

• Comparative statistics on health and detailed performance standards for hospitals are very important for identifying weaknesses needing local attention. They are less useful for national decision-making. When hospitals are targeted according to a single indicator, the effect is damaging.
  
  In the first few years of the present Government, the focus was on reducing waiting lists, and chief executives were threatened with dismissal if they did not reduce waiting lists. As a result, patients needing quick treatments for non-urgent conditions were rushed through, while patients needing more complicated treatment for life-threatening conditions had to wait. Patients were rejected to keep them off the waiting list, or given stop-gap treatments.
  
  Recently hospitals have been given star ratings based on easily measurable indicators. While this may be useful to identify badly managed hospitals (and my local hospital trust serving Rugby and Coventry has been rightly criticised in the press for several years), it is very misleading to give high star ratings to hospitals when the standards of medical treatment are not measured. Hospitals that fail to diagnose dangerous conditions or kill patients in sub-standard operations can still have the top star rating.
  
  Comparative performance indicators need to be debated and interpreted locally. And the hospitals need to be accountable for how they try to improve performance to their residents, not to over-simplifying ministers.
• The Government needs to recognise that its experts are not trusted. There are good reasons for this. In central government official secrecy has been endemic. Health risks have been covered up at the whim of individual ministers because effective action against them was seen as expensive, either to taxpayers or to powerful lobbies. So the risks from BSE and the ineffectiveness of safeguards to stop people eating infected meat were played down for many years.
  
  When there are public doubts about the safety of medical procedures, such as MMR vaccine, assertions that the procedures are safe, even if the assertions are objectively sound, will not be trusted. The Government needs to offer choice to people who distrust the assurances, and not to stick to policies that have lost public confidence.
  
  Longer term the Government should repudiate the culture of secrecy and ensure that their experts’ evidence and advice, including any differences of opinion, are published. Then the community will be able to assess the evidence with more confidence and will be better able to trust the integrity of any assurances of safety.

Campaign for Health Service Democracy.
Sheila Porter-Williams,
Green Haven,
Halfway Lane,
Dunchurch,
Rugby,
Warwickshire,
CV22 6RD.
http://www.healthdemocracy.org.uk
email sheila@healthdemocracy.org.uk

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Sheila Porter-Williams
Campaign for Health Service Democracy
Green Haven, Halfway Lane
Dunchurch
Rugby, Warwickshire CV22 6RD
sheilaCHSD@porter-williams.freeserve.co.uk