Bernard Ingham: NHS should put in the hours to win back our confidence

For the past month I have monitored references to the NHS in the national press. Bad marks have averaged one a day – and I have allowed only one reference to the Mid Staffordshire hospital scandal and the row over Leeds General Infirmary’s heart baby unit in my count.

The reported lack of confidence by NHS staff in their very own hospital’s service is shocking. So is the shortage of specialists at nights and weekends. Worse still was the Royal College of Nursing survey that found two-thirds of nurses had raised concerns about inadequate patient care but 25 per cent had been told to forget it because of the NHS’s “culture of fear and intimidation”.

Danny Boyle may have celebrated the NHS as one of the modern wonders of the world at the opening of the London Olympic Games last year but the past month has made it sound, if not exactly a branch of Ravensbruck, a thoroughly unhealthy place to be.

At least for some.

We are also told that 7,800 NHS managers and consultants earn more than £100,000 – and one-third of them more than 
the Prime Minister’s £142,000 – “while nurses are run ragged because of dangerously low staffing levels”.

This – and the sum total of public criticism voiced this past month – suggest it is thoroughly badly managed. So what’s new? Margaret Thatcher’s problem of securing an efficient and caring NHS with a chance of coping with rising costs from an ageing population and exponential advances in medical science remains unsolved.

The difference now is that the old background hymn of praise from patients and their relatives for the treatment dispensed by the NHS is being drowned out by the steady drum of criticism and condemnation. It must be horribly sapping of the morale of decent, hardworking medical professionals who really care.

In saying all this, I was not born yesterday. I fully recognise that the current fashion is to slate the NHS. This can lead to exaggeration. Nor must we forget that good news in media terms is bad news. Frightening people is more commercial than making them feel comfortable. There is also the possibility of buck-passing inside the NHS.

But I find it difficult to ignore the continuing wide variations in the outcome of treatments and survival rates and all the harrowing tales about the NHS experience of the elderly. This suggests that leadership is sadly lacking. There is not a blind bit of use – or fairness – in attacking nurses at the workface if the environment in which they work is wrong. It is clearly not right.

This raises three questions: Are there still far too many layers of managers? Are current administrative units too large? And does the chain of command clearly identify the individual responsible for the system? I know only too well how bureaucracies can hide or 
dilute personal responsibility. It would, for example, be helpful to know who is David Cameron’s chief press secretary. Whatever I think of Alastair Campbell – and it is not much – he was at least identifiably responsible for the Blair government’s presentation.

But I digress. One useful reform would be for all ranks in the NHS to work hard again. I refer particularly to GPs. It is a measure of the system’s chronic incompetence that first Gordon Brown threw money at them while allowing them to withdraw a 24-hour service and now Cameron has not required round the clock care from them in putting them in charge of the bulk of the NHS’s budget.

Yet Health Secretary Jeremy Hunt has just laid the lengthening queues in many A&E departments squarely at their feet by not providing a proper out-of-hours service. It should surely be obvious that today’s group practices are equipped to provide it in contrast to the lone GP of old who nonetheless somehow dispensed medicine, checks and solace day and night.

I do not kid myself that a 
harder working NHS, leaving aside those nurses being “run ragged”, is all that is required. But it would help to demonstrate that this arthritic, creaking and possibly complacent 65 year-old system knows it needs to sort itself out if ancients like me are to repose any confidence in it. As it is, it is a worry pensioners could do without.