ZERO: Eliminating unnecessary deaths in a post-pandemic NHS by Jeremy Hunt
“He who would do good to another must do it in Minute Particulars,” William Blake wrote. “General good is the plea of the scoundrel, hypocrite and flatterer.”
Yet politicians find themselves obliged to talk about the general good. They have to make speeches and issue manifestos about what they will do to make things better for the whole country, or even the whole world.
Although they often have no real idea about how to solve or improve some problem, they have to pretend that they do. How easy, in these circumstances, to degenerate into a scoundrel, hypocrite and flatterer.
Once a politician aspires to, say, the presidency or the prime ministership, speeches and manifestos are no longer enough. A book is required.
Words like “future” and “hope” often appear in the title of this volume, which is unreadable.
Jeremy Hunt is aware of these pitfalls, and has sought with immense conscientiousness to avoid them. He knows that particular cases are more interesting than general moralizing.
At the start of the book, he relates a thought which occurred to him a year into his six years as Health Secretary, at Margaret Thatcher’s funeral in 2013, as he listened to the eulogy delivered by Richard Chartres, the Bishop of London:
“He read out a letter she had received from a nine-year-old boy called David, to which she had replied personally. I sat there, and thought: In my seven months as Health Secretary I haven’t read a single letter from an NHS patient. If Margaret Thatcher had found the time to do personal replies as Prime Minister, couldn’t I?”
The Department of Health received more letters than any other government department. It employed 50 officials in the correspondence unit to draft replies, and to protect ministers “from the highly personal and emotional missives received from people who had experienced problems with their care”.
Hunt asked to see one letter a day to which he would write a personal reply:
“I didn’t know it at the time, but this request sent the department into a spin. Sir Humphrey-like meetings were held behind my back to work out if they could dissuade me from such a thoroughly dangerous idea. They saw their job as shielding me from such letters, not exposing me to them.”
He at length received a letter which said: “I am just writing to thank you for the fantastic NHS care I received…”
This, of course, was not the point, and at length he started getting some proper letters of complaint, which were “eye-opening and sometimes horrifying”.
Hunt reckons the problem is that when error is admitted, a search begins for someone to blame. This means mistakes are covered up, nothing is learned from them, and often the same mistake is repeated over and over again before anyone does anything about it.
Hence the horror of the Mid Staffs hospital scandal, which continued unchecked for four years. The whole system is designed to pretend things are better than they actually are.
All this can be stated quite briefly, and is already generally accepted. Atul Gawande, mentioned by Hunt, and others have written about the need, as in the airline industry, for mistakes to be reported, not hushed up.
Once Hunt manages to get a letter a day of complaint presented to him by the department, he drafts a personal reply to it. And he uses some of these letters to introduce each of the 15 chapters in his book by him: his method by him is to recount some monstrous case of neglect, before drawing some general conclusions about the need for a culture change within the NHS.
No normal reader is likely to have the stamina to read through all these cases. One soon feels one has supped too full of horrors, and has also had enough of clunky, inconclusive passages like this one:
“I put in place an ambition to halve neonatal deaths, stillbirths, maternal deaths and severe injuries which was very ably led by leading obstetrician Matthew Jolly and chief midwife Jacqueline Dunkley-Bent, which contributed to neonatal deaths dropping by over a third and stillbirths by a quarter over the last decade. I also set up a maternity scheme modeled on what happens in Sweden, to allow instant access to a settlement in maternity cases where the NHS knows a mistake has been made. It was designed to bring faster closure for families and prevent the frustration of long court processes. To my frustration, it was not up and running before I left my role and ended up being cancelled, presumably on cost grounds.”
When I was a child in the 1960s, I knew who my NHS doctor was, and he would visit me at home when I was ill. Dr Price was a comfort both to me and to my parents.
He behaved, so far as I can tell at this distance and through a cloud of the usual childhood ailments, as he would have done before 1948, when the NHS was founded. That was the tradition in which he had been trained.
Does anyone now know the name of their doctor? Hunt works round to this question, and on page 173 it states:
“We need a decisive change in the model of care offered by the NHS, so that patients always have one doctor or nurse clearly responsible for their care. In normal circumstances that should be a patient’s GP, although for frail elderly patients it might be a district nurse.”
How right he is, but can such an outcome be attained by Hunt, or some other well-intentioned Health Secretary, declaring that it ought to be attained?
In the absence of a single doctor or nurse who takes responsibility for a patient’s care, the family try to act as champions, desperately trying to see that relevant notes from the past are presented to doctors new to the case, and to provide whatever the harassed nurses are unable to provide in the way of care.
But what a supplicant one feels as one goes about this task of asking the nurses whether they could possibly provide this or that, or simply tell one, on the telephone, what sort of a night the patient has had.
The melancholy paradox must be stated that to survive a stay in hospital, one needs to be feeling more than usually fit, even though one has been taken in because one is more than usually weak.
Hunt is full of good intentions. If he appeared at one’s bedside, he would be wonderfully sympathetic. It would do one good to see his furrowed brow. One would be sure he really cares. One might even think that if he was in charge, the world would be a better place.
But as Health Secretary, he too was reduced to the role of supplicant. And his dreary, well-informed, well-meaning book of him will make not one jot of difference to anything.