NHS consensus is a British weakness

Tony Hockley, 20 June 2013

A deep-rooted fear of upsetting the “consensus” on the NHS lies at the heart of the pervasive care scandals and cover-ups that are now seeing the light of day. The British health system is producer-led by design. Over the past 30 years successive governments have offered small elements of consumerism in order to maintain the consensus, whilst support for other state industries has disappeared and been long forgotten. NHS leaders shuffle effortlessly from one job to another as problems are addressed by such actions. Agencies are endlessly renamed and reinvented. Ministers constantly search for the next “safe pair of hands” to address each crisis. Time and again they later seem to be tainted hands, however, as the trickle of evidence emerges from the NHS citadel.

In response to the Francis Report, a scandal on a scale that would have led to the breakdown of any institution other than the NHS, ministers made an attempt to look further afield for help, but alighted nevertheless upon another safe pair of hands that would not shake the peculiar British health system. The new safety czar, Don Berwick, had long been a fan of the NHS, describing himself six years ago as “romantic” in his love for the institution, fuelled by his dismay with healthcare in his own country. He also has an unshakeable belief in the effectiveness of central, national agencies; the bigger and stronger, the better. It is ironic that after a controversial set of reforms to decentralise and “liberate” the NHS, the direction of travel seems to be quite different.

Now the NHS is looking for a new Chief Executive, and despite claims of a global search for the right person, the leading candidates seem once again to be system insiders, all associated with past reforms and contracts for which patients are now paying the price. The NHS needs a fresh, sceptical outsider to give it the wake-up call that it needs. Not a romantic of a system still recognisable from 1948, and not someone on first name terms with those who have led it into and through the latest series of scandals. A patient-centred health system simply cannot be created from taking the safe option time and time again.

My own recent paper for Civitas showed how we have fostered a system within which those who shout the loudest get the best care. Those who do not or cannot make a big noise suffer in silence regardless of the severity of their need. This is not a system to be romantic about. If 30 years of consumer-based adjustment has not broken its producer capture, then more of the same will not do so. The NHS consensus is the problem, not the answer.