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The State Can’t Manage Healthcare

The level of outrage shown in response to the Francis Report belies one fact: that so much has been known about widespread failures of NHS care for a very long time. Will this, the latest report, lead to the systemic failure being tackled, rather than treating it as yet another local failure. As far back as 2009 I drew attention to the NHS’s own Ombudsmen who described aspects of NHS care as “an indictment of our society” in my Politeia study on the direction health policy should take, A Premium on Patients (Politeia 2009). I described the NHS as technically efficient, but socially deficient. Francis, too, points to a long and alarming catalogue of past reports of shameful treatment of patients despite a “plethora” of preventative checks and balances. It shows just how poor the state is at managing healthcare that one of the causes of the disaster of Stafford Hospital was the hospital’s ultimately successful pursuit of Foundation Trust status; so-called “earned autonomy”.

It is almost inconceivable for a state monopoly to provide that focus on the patient to which both Francis and the Prime Minister aspire. Indeed partly in recognition of this, Andrew Lansley sought to bring more competition into the supply of NHS-funded care and to release the system from Ministerial control. Whether the Francis Report will lead others to the same conclusion has yet to be seen, but previous such catastrophes have led to greater central control rather than less. The Prime Minister’s emphasis on a demand for hourly ward rounds does not augur well, suggesting yet more of the same. What in the first instance is needed are nursing staff who are dedicated to their patients not to their paperwork, or as Anne Clwyd said, who will care enough to hold the bowl if the ill need to vomit.

*Tony Hockley is Director of the Policy Analysis Centre. He has been an adviser to two health ministers and teaches in the Social Policy Department at the LSE. He is author of Politeia study A Premium on Patients.

Dr Tony Hockley

Dr Tony Hockley is a Visiting Senior Fellow at the Department of Social Policy at the London School of Economics & Political Science. He is Director of Policy Analysis Centre Ltd and the co-author of Politeia’s Working Systems: Towards Safer NHS Nursing (2014) and A Premium on Patients: Funding the Future NHS (2010).

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