It's the weekend, so it must be time for another Lunch with the FT. A full page spread in the Life & Arts section, it is a weekly format that gives a house journalist a chance to break fancy bread with a politician, official or some other public figure or author whom often shares the FT's soft-left vision of the world. The participants get to chow down on things like "Heritage beets" "Iberian leaves" and "New England cod with shallot and caper infused almond milk jus". Sometimes they indulge themselves with a glass of Sancerre; but this being a serious paper, alcoholic drinks are frequently (and as ostentatiously) spurned. The bill for two invariably comes to an amount which folk might incur for a delicious banquet meal for six, with Cobra beer, in their local Bangladeshi restaurant.
At the end of July, it was the turn of the outgoing head of NHS England, Sir Simon Stevens, to be so honoured. Naturally, it wouldn't really have done for him to be seen expensively packing his pouch at some high-end restaurant with 5.3m citizens on NHS waiting lists, so lunch took place in the "gritty Elephant & Castle district of south London" at Kaieteur Kitchen Original, whose "ebullient Guyanese owner, Faye Gomes, greets Stevens as an old friend". The bill for an "array of subtly spiced dishes...served family style" and free drinks (the alcoholic content of which is unstated) came to £33.50. Bafflingly, the FT lady left a rather ungenerous $5 tip for poor Faye, presumably a note left over from the expense account of the FT's last scoff-fest in the USA.
But never mind. Sir Simon had good reason to be pleased as the UK presently has one of the highest vaccination rates in the world, with over 70% of the adult population now fully inoculated against the disease. The combined efforts of virologists, pharmaceutical companies and Kate Bingham's tiny UK Vaccine Task Force may have discovered, developed, manufactured and procured vaccinations in double quick time, but it is Sir Simon's outfit that has done the jabbing. The situation in Scotland (where Nicola Sturgeon, by way of an explanation for her failure to hit the target of actual "jagging", has said that her program was merely to "offer" vaccination), is of course a little more nuanced.
Lunch with the FT is not really about the elucidation of important matters so much as the promotion of the interviewee. Sir Simon is shortly to join the ranks of their lordships in the Upper House, and if ever you want to speak to someone again for your paper, you don't ask them out to lunch only to give them a proper hosing down. But despite Sir Simon's "force of intellect and sinuous political skills", and the halo that has settled on the NHS, not even the FT could refrain from pointing out that the organisation "has missed performance targets by ever wider margins on his (7 year) watch".
Happily, this will have been the only part of the article that will have caused a post-prandial burp from Sir Simon for he was hardly pressed at all on other matters such as the pandemic. As to why the UK (as at the end of July 2021) had one of the highest mortality rates from Covid in the developed western world, despite having a "national" health service, Sir Simon essayed that it was probably because were are all too fat and have an "obesogenic food environment". But he wasn't asked why the UK had nearly double the rate of deaths and infection rates per million as the Netherlands, which has an almost identical level of population density and similar issues with plumpness. Nor why the NHS forced the government to spend £15bn on PPE, £2bn worth of it unusable, and most of the rest now piled high and untouched in various warehouses. Nor why the NHS failed to exploit the pop-up Nightingale hospitals or the expensively requisitioned private sector bed space to ease the strain of the pandemic on the existing NHS estate. Nor why the NHS connived to discharge hundreds of infected elderly patients into un-protected care homes at the start of the pandemic. Nor why over 250,000 people have been on NHS waiting lists for over a year, and over 3,000 for more than two. Nor why GP referrals declined by nearly a third in 2020, despite the NHS being "open". Nor how the NHS is going to deal with any of this, beyond spending ever huger amounts of taxpayer money (to which Steven's refers as the post-Covid "dividend").
Hearing it from Sir Simon, the UK government led by David Cameron was jolly lucky to have secured his services back in 2014 at all, and clearly he is not a man given to much self - doubt, an important quality when speaking for an organisation which in all its parts employs over 1.5m people. Apparently, his "signature solution" for a service that has defied all attempts to make it more accountable, responsive and efficient, was the establishment of "integrated care systems". Naturally, Stevens did not offer any evidence that this approach (whatever it is) was working and certainly his claim to have successfully made the NHS more joined up will come as a surprise to that champion of medical vested interest, the BMA. Neither did he explain why the government now wants to remove the operational independence of the NHS to make it more responsive to ministers.
Nor have his claims resonated with Rachel Clarke, an NHS palliative care doctor given half a page in the Sunday Times on 25th July to explain why the NHS cannot "survive much longer". Hers was the usual and movingly manipulative story of the distress of those awaiting treatment or even attention, the anger of relatives and the "burn-out" of practitioners as they struggled to deliver the appropriate level of intervention in a service which is at the point of "bursting". Not even the lock-down of the entire population to Save the NHS has had much effect, according to Clarke. Instead, "the electorate drifts - eyes wide shut - into a de facto two-tier system in which the NHS provides a limited rump of core and emergency services while the rest is rationed to oblivion unless you can pay. Only someone lucky enough not to be, or to know, a patient can't see it (sic). The only question is how much we care." She may not have noticed it, but we arrived at the destination she describes a long time ago: the NHS is already a two - tier system with producer interests on one side and the patient on the other; care has always been "rationed"; the practice of triage in emergencies is routine, and we are all paying through the nose.
The gulf between the failed management consultancy leadership approach of Stevens and the evident collapse of morale of those at the coal face surely demands a re-evaluation of the strategy of the NHS, at the very least. Indeed, the evident crisis suggests that the whole purpose of an organisation struggling to meet unlimited and increasing demand "free at the point of use" needs to be re-examined, both philosophically as well as practically. Neither the strategy of Stevens (managerial sclerosis) nor the diagnosis of Clarke (the only real limit on the NHS is our compassion) have much if any credibility, and both have been serially undermined by the weight of experience.
There is no other country on the planet, whatever the prevailing politics, that has chosen to replicate or even emulate "our" NHS. Yet Stevens has neither used his seven years of operational independence to reflect upon why this might be so, nor to bring forward credible solutions. Rather, he has sought to re-frame the problem, the better to disguise the lack of progress he and his colleagues, both professional and political, have made. The key thing now, he says, is to deliver "anticipatory" care rather than "reactive" or "episodic" care: today the mission of the NHS is (apparently) to keep people well over decades, especially those with multiple long term conditions. The way Stevens tells it, one could be forgiven for thinking that the lacunae at the heart of the care of the steadily increasing cohort of the elderly or the mentally unwell are things that have only just appeared on the NHS radar.
Yet two episodes will suffice to show the real nature of the challenge to the NHS. In the first, there is an 83 year old man, an overweight ex smoker with a heart condition and the onset of early stage dementia. The man (who lives on his own) was admitted to an Edinburgh hospital with Covid in the Spring. His dim recollection of puffing on a cigarette probably helped to save him as hospital staff managed the very tricky task of getting him on a ventilator. With this and other effective treatment, the man recovered from Covid. Three months later, he is still in hospital as his other ailments means he is in no fit state to be discharged into his home. He has become a "bed blocker".
The second is the episode portrayed by Doctor Clarke in her Times article. Here she recounts the abuse received from, of all people, an ambulance paramedic, who is beside himself with anxiety about his frail and elderly mother with metastatic cancer who has been discharged from hospital three times in a fortnight and whom he has discovered collapsed and dehydrated at her home. Quite understandably, he wants action this day, but the hospital has been "cleared" to make way for other patients. They do not know when she will be re-admitted.
These are real people, not spreadsheet items, yet neither of these tales is really about medical means and ends. Nor are they really about the different ways in which two hospitals, one Scottish, one English, choose to treat octogenarians. They are really about aims and expectations.
While there is an increasingly shrill and ongoing debate about the right to die, there has been virtually no public debate worth the name about the practice of keeping people alive long past their point of natural expiry with an increasing array of drugs. Nor has there been an acknowledgement that in an high expectation consumer society, where individuals want things dealt with NOW and to their complete satisfaction, offering something as critical as healthcare for free is simply unsustainable. It is no exaggeration to say that the current generation of healthcare consumers has been conditioned to expect not only immediate freedom from pain, but also freedom from the imminence of death, a conceit ludicrously encouraged by the demented attempts not only to supress Covid but also to eliminate it.
The infantile veneration of a deeply flawed NHS has been one of the most depressing features of the Covid crisis. The citizenry has endured over 18 months of restrictions in order to shield the NHS, but we still being told that it is on the verge of collapse. This is a very heavy price to pay for an organisation which is apparently central to the social solidarity of the UK until someone actually has to use it, at which point it becomes a complete lottery. Yet Sir Simon is a smart enough operator to know that the witness of those like Doctor Clarke will, paradoxically, save him from too much embarrassment at any future enquiry into the UK's official handling of the pandemic. With the help of others like Sir Jeremy Farrar (who has landed his blow early in his highly selective book Spike), the lumpen apparat will attempt to shift most the blame onto the "choices" made by politicians. The rest of us will continue to suffer.
Boris may not get it yet, but the NHS is going to be to his party what Home Rule for Ireland was to the 19th century Liberals. It became an issue that eventually destroyed them. Before then, "global" Britain will also likely discover that when an "independent" country continues to pursue unique and unlimited policies which cost a lot of money, but which do not work, the global markets normally make it very expensive for it to continue. The NHS is a losing hand. It's time to throw it in.
