Today MPs are debating a matter of conscience, invoking their personal religious beliefs as they examine the same sex marriage bill. The debate has largely remained remarkably respectful thus far. But tomorrow the Prime Minister will give a statement on another matter that stirs similar religious fervour: the NHS.
It will be David Cameron who delivers the government’s response to the Francis Report on the failings of the Mid Staffordshire NHS Trust, not the Health Secretary. The Prime Minister manages these occasions well: we saw that with the Bloody Sunday and Hillsborough statements.
British voters might, according to the latest census data, be losing their religion. But when it comes to the NHS, they remain faithful. Health policy is named by 36 per cent of voters as an important issue influencing their 2015 vote, below only the economy and immigration. And Labour currently enjoys a 16-point poll lead over the Tories on the NHS, with 34 per cent of voters naming Labour as the party they trust the most on the NHS, 18 per cent picking the Tories, and 32 per cent saying they trust none of the main parties.
Andy Burnham managed to get away with the line that the Tories were destroying the NHS with the Health and Social Care Bill because of the emotional response it elicits. Everyone – myself included – has their own story of wonders performed by this country’s free at the point of access health service. It is almost a miracle worthy of a religious shrine that this behemoth organisation exists in this country. Its icons provoke the same adulation as statues of the saints: Danny Boyle knew that when he wrote the health service section of his Olympic opening ceremony.
But this means that those who question this great religion of signs and wonders are denounced as heretics. The I ♥ the NHS avatar badges on Twitter accounts, those personal stories of the excellent cancer unit, the GP who spotted the irregular heart rhythm, all smother those heresies. The whistleblowers in the Mid Staffs case received hate mail. Even politicians criticising the NHS must caveat it with their own praise of its treatment of their mother or son. But take any group of doctors away from the heretics, and out come the same stories: the failings of hospital administrators, the wards they wouldn’t trust to treat their grandmothers because of the poor quality of the nursing staff, the disparity between the quality of care in different specialties.
So how can Cameron take the recommendations of the Francis report tomorrow as a catalyst for change? His party’s standing in the polls when it comes to the NHS could easily tempt him to take the easy route, simply telling MPs tomorrow that ‘lessons will be learned’. But this scandal demands more than that. As our leading article argued last week, there will be ‘an awful lot of talk about the need to “tighten up procedures”‘ and changes to targets, not overarching changes to increase accountability in the NHS. This is where independent providers have a role, not because they are intrinsically better than public providers (sometimes they are, sometimes they aren’t), but because they not only experience the anxiety of losing a contract as a result of poor performance, but encourage anxiety in the public sector providers too rather than the complacency that arises from being the only game in town.
On a political point, Cameron may not enjoy a poll lead on the NHS, but he can take heart from the polling on the standards in the NHS. YouGov’s polling at the end of last week found 45 per cent of voters thought standards of care in the NHS had got worse, with 26 per cent saying they’d stayed the same, and 18 per cent believing standards had risen. While voters were relatively evenly split between believing doctors and nurses were less caring today than they were 10 or 20 years ago, and believing they were as caring as they used to be, 41 per cent said ‘most nurses prioritise hitting targets over caring for patients’. Similarly, the report is likely to attack the trust’s slavish adherence to targets set by the Labour government: this is not a failing of the nasty anti-NHS Tories.
This gives Cameron a cause to be bold and to encourage faithful followers of the NHS not to lose their religion, but to shun blind belief in favour of proper scrutiny. That way the NHS can be something worth worshipping wholeheartedly.