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Leading article

Bad care

2 February 2013

9:00 AM

2 February 2013

9:00 AM

When the letters ‘NHS’ appeared to the world above the dancing nurses at the Olympic opening ceremony, many in Britain will have imagined two darker words hovering alongside: ‘Mid Staffs’. Few of those affected will have been able to forget what now seems to be one of the greatest scandals in the history of British health care. Its horrific details will be laid out in full next week when Robert Francis QC publishes his report into Mid Staffordshire NHS Foundation Trust.

What we already know about the level of care at the Trust is shocking — and goes far beyond patients left in soiled bedclothes. There was the case of the elderly patient left to bleed to death because a nurse failed to act upon the telltale signs of rising heart rate and falling blood pressure. The hospital seems to have recorded between 400 and 1,200 more deaths than would have been expected over a three-year period.

Had this happened in a private hospital, it would be described as one of our worst peacetime disasters: worse than Lockerbie, Hillsborough, Hatfield and Potters Bar put together. Margaret Hodge, chairman of the Commons Public Accounts Committee, would emerge as the lead inquisitor. Union leader upon union leader would reject the notion of ‘system failure’ and call for jail sentences — perhaps accusing shareholders of having blood on their hands. The government, too, would feel obliged to take action, terminating the contracts of other, perfectly good hospitals.

Yet when the Francis report is published on Wednesday, no one will call for the NHS to be closed down. No one will call for charges of ‘corporate manslaughter’. No one will argue that the disaster was the inevitable result of human laziness, recklessness or greed. There will instead be an awful lot of talk about the need to ‘tighten up procedures’.

Compare and contrast with the case of Winterbourne View, the privately run Bristol hospital for patients with learning difficulties, where staff were filmed physically abusing patients by an undercover BBC reporter. The hospital was closed. Six staff were jailed. And Norman Lamb, a health minister, announced that 3,400 patients in similar hospitals would be reassessed with a view to moving them into NHS accommodation. The implication is that all private providers are suspect. The Cameron government tries to encourage independent providers into the system, but did nothing to defend them.

It ought to be plain to anyone that bad doctors and nurses, like bad professionals of all kinds, lurk in the public and private sectors alike. A Bupa nurse is every bit as much a public servant as an NHS nurse. And for every cowboy surgeon implanting dodgy breasts in a private clinic, there is an NHS doctor botching treatments. There is nothing that can be learnt from picking out the extreme examples of bad apples and trying to make conclusions about the public and private barrels in general.

But the futility of trying to use the occasional negligence and wrongdoing of private companies to attack capitalism in general will not stop the likes of Ms Hodge. Last year A4E, one of the companies involved in running welfare-to-work programmes, found that some of its staff had been fraudulently massaging figures to increase payments, and reported the matter to the police. Hodge did not even try to hide the fact that she was on a crusade against the involvement of private companies in public services, declaring: ‘The profits you make come from the taxes that ordinary, hard-working people pay.’

Far from providing a damning judgment on private companies who provide public services, the case pointed to something quite different: that private companies are far better at weeding out wrongdoing. Studies suggest fraud is significantly more likely to be detected in the private sector than in the public sector. Consider the case of the Whitehall civil servant who concocted invoices to divert £246,000 of public funds to his own account. He was caught only after his suspicious bank manager made inquiries, and even then the case was never reported in the press. Had this been carried out by an accountant in one of Michael Gove’s free schools, Labour would probably have called for every one of them to be closed down.

Lies, book-fiddling and blunders are inevitable in every walk of life. The question is how quickly they are detected and dealt with. There is a striking contrast between A4E, which moved rapidly to deal with the fraud it uncovered, and the Mid Staffordshire NHS Trust, which dismissed and then tried to discredit statistics which suggested it had a worryingly high death rate. To those operating in a competitive environment, reputation is everything. There is nothing more fatal than being seen to act recklessly or to try to brush aside public concerns: just ask BP’s shareholders, who were taken to the cleaners after the Deepwater Horizon disaster.

The Stafford Hospital scandal is a painful reminder that things can and do go horribly wrong in the NHS — but, worse, due to its ponderous bureaucracy, the problems can go undetected for a long time. If it wasn’t clear before the Mid Staffs scandal that the NHS can benefit from more independent providers, it should be now.

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