A couple of years ago, on the 74th anniversary of the founding of the NHS, the phone rang in my office. It was NHS England calling to complain about research we’d put out showing the number of people dying while on waiting lists. They weren’t calling to complain about the accuracy of the story or tell us about their plan to do something about it. They called to complain that we had spoilt the NHS’s birthday.
It was Nigel Lawson who described the NHS as the closest thing the English have to a national religion, with those who practise it regarding themselves as a priesthood.
As I’ve been arguing for more than two years now, the NHS is a service not a shrine. What matters is what it does, not what it is.
What the NHS has done in relation to contaminated blood, the biggest scandal in its history, is truly shameful. The cover-up was as bad as the crime, inflicting injury upon injury.
I mention the phone call because it is a morbid symptom of a cultural rot that places protecting the reputation of the NHS above protecting the public.
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Of all the challenges we face if we win the next general election, it’s the culture that worries me most. We have too often seen NHS leaders become defensive or even blind to its serious shortcomings. Not just historic injustice, but ongoing scandals — from failing maternity units to monsters like Lucy Letby. Recognising failures shouldn’t be regarded as heresy. Yet brave whistleblowers are hounded out, bullied and silenced as heretics.
I know this will be hard for some people to hear. I am a cancer survivor who owes his life to the NHS and the people who work in it, who are overwhelmingly motivated by service and compassion. When my nan died last year, her district nurse was at her funeral. It is so personal to so many of us.
There is an understandable pride in the achievements of the NHS over the last 75 years: most fundamentally the equitable principle that whenever you fall ill, you need not worry about the bill. But when Nye Bevan introduced the NHS Bill to parliament, he said: “Not only is it available to the whole population freely, but it is intended … to generalise the best health advice and treatment.”
No one can honestly say that the NHS is offering the best care today. The millions of patients forced to go private are testament to that. As are the frontline staff, trying their best, but sustaining severe moral injury because they can see their best isn’t enough — they are crying out for change.
So, it’s not just reform of the NHS we must embark on, but reformation of the national religion.
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This must start with a policy of radical candour. The first step on the road to recovery is admitting you have a problem. It’s why I’ve been so blunt about the failings of the NHS today. I want staff and patients to know we’ve noticed, and NHS leaders to know that the status quo will be unacceptable to an incoming Labour government.
Those who blow the whistle on wrongdoing must be protected and listened to. Managers who silence and cover up whistleblowing will be sacked and never allowed to work in the NHS again.
Culture is set from the top. The denialism of the crisis in the NHS starts with the health secretary and prime minister. A few days into this general election campaign, it’s already clear the Conservatives don’t want to talk about health at all.
They can’t even bring themselves to admit that the service is broken. But there is no other possible diagnosis of 250 patients dying needlessly in emergency departments each week, or stroke and heart attack patients routinely waiting an hour and a half for an ambulance.
When a man whose wife had been on a waiting list for three years confronted him last week, Rishi Sunak blamed NHS strikes. But she will have been waiting 18 months before any strikes began. Patients deserve solutions, not scapegoats.
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It’ll be the mission of Keir Starmer’s government to get the NHS back on its feet and make it fit for the future. The first step will be 40,000 extra appointments every week through out-of-hours clinics — extra investment, but also reform to make proper use of NHS capacity on evenings and weekends. Every bit of investment we make in the NHS will be tied to reform, as we undertake a decade of change and modernisation.
For the scale of change and modernisation required, the NHS needs opening up, a culture of transparency and a reforming mindset. We will give power to the patient, so they can easily judge providers by league tables, be told what they should expect from the service, and choose to switch if they want to. Where performance is poor, we will send in turnaround teams of the best performing leaders to improve care.
More trust must be placed in staff to try new ways of working, including partnering with the private sector and civil society. Frontline staff will be in the driving seat of the reform agenda — this can’t be done from Whitehall alone.
The election will provide the next government with a mandate for the future of the NHS. If the Conservatives win, it’ll be a mandate to continue as we are. Nothing will change, the NHS crisis will only get worse. Labour is being upfront about the need for fundamental reform of the NHS, because we want permission to turn the service on its head. I’m appealing to Sunday Times readers to give us that mandate for change.
