Last summer, the

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Last summer, the was awarded the George Cross by .In a handwritten personal message, she said: ‘Over more than seven decades, and especially in recent times, you have supported the people of our country with courage, compassion and dedication, demonstrating the highest standards of public service.’

Most people would agree with this sentiment, particularly in light of the heroic response of frontline workers to the pandemic.

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Curiously, in a development that says much about Britain’s relationship with its favourite institution, the perception that we had a deteriorating health service appeared to be turned on its head during the pandemic itself.The bleaker things got, the greater people’s adulation.

The NHS is often compared to a national religion. Even without a global health crisis, it perennially tops voters’ concerns, which makes the debate over how it is run and funded extremely sensitive.

Sadly, politicians and many of those who run the NHS wilfully deceive the public about the quality of service they receive. 

The aim of our new book is to strip away such spin and paint a picture of the NHS as it really is: the good, the bad and the ugly.

It is only by knowing the truth that the country can demand better.

Even without a global health crisis, the NHS perennially tops voters' concerns, which makes the debate over how it is run and funded extremely sensitive

Even without a global health crisis, the NHS perennially tops voters’ concerns, which makes the debate over how it is run and funded extremely sensitive

Extensive research among focus groups at the outset of the pandemic in March 2020, and again last November when the crisis eased, showed that people were impressed by the way the service had responded to an unprecedented situation. Nonetheless, most (rightly) believed the NHS is in a worse state than it was before the crisis began.

In our polling and focus groups, the prevailing view was that the pandemic had exacerbated existing problems – chiefly waiting times and differing standards of care between different parts of the country – and that things were unlikely to improve any time soon.

All this is true, as Health Secretary Sajid Javid recently acknowledged when he set out the extraordinary number of people who now face very long waits for hospital care.

The majority of the NHS staff work tirelessly.Undoubtedly, millions of patients receive care that is good, and thousands receive care that is outstanding, every single day.

The trouble is that millions of others do not, and the number of those who are failed is growing at the same time as taxpayers are pouring billions more into the system.

When the NHS was established in 1948, it had an annual budget of today’s equivalent of about £15 billion. Average life expectancy for men was 66 years, while women could expect to live to the age of 70.

Today, NHS England has a budget of £129.7 billion and rising, but male life expectancy is just under 80, while female life expectancy is almost 83 years.In 1948, the UK population was about 50 million. Today, it’s just under 70 million.

The heroic response of frontline workers to the coronavirus pandemic was extraordinary but it also underlined major problems with the service

The heroic response of frontline workers to the coronavirus pandemic was extraordinary but it also underlined major problems with the service

Pre-coronavirus, the NHS was dealing with more than a million patients every 36 hours, with more than 17 million hospital admissions and about 96 million outpatient attendances every year.

Much of that demand went unmet during the pandemic.Now the situation is very much worse. This is a whole new ball game. Maintaining the standard of care that everyone who works for the NHS would like to provide is becoming ever more challenging. Sometimes, it is impossible.

The public’s devotion to the service and its principles – that it’s available to everyone and free at the point of use – means ideas for reform are always met with suspicion. Crucially, we do not believe there is any case for diverging from the founding principles. 

Even if this were desirable, no political party will do so.But change is necessary, and for the right change to be identified, we first need to define where we are. 

To provide some depth, we carried out a special investigation into the state of health services in one particular part of the country.Prompted by disturbing evidence about standards of care, we selected the Isle of Wight.

Until very recently, the island was one of the worst-performing NHS Trusts in England and a dangerous place to be seriously sick.

An assessment by the Care Quality Commission (the independent regulator of health and social care services) in 2017 concluded that the trust was failing on multiple levels and was guilty of an array of safety breaches.Inspectors ruled that there were insufficient staff; medical care was inadequate; end-of-life care was ‘dire’.

Under a new chief executive, much has improved. But that is of cold comfort to relatives of the many patients who meet an untimely end in the island’s St Mary’s Hospital and many more who receive sub-optimal care.

During official investigations into 35 unexpected deaths in 2018/19, several themes cropped up with depressing regularity.

They included overcrowding; breaching A&E waiting-time targets; doctor shortages; use of agency nurses; poor staff communication; poor medical record-keeping; inexperienced doctors; clinical staff shortages; and inadequate IT systems.

These epitomise the sort of low-level bad care that takes place every day in the NHS alongside care that is fair, good or outstanding (often all in the same place).

Taken individually, the lapses are not very dramatic.Combined, they point to an organisation that lacks the basic systems and structures to guarantee a decent standard of care.

More sinister, in May 2019, the trust admitted to ‘failing terribly’ in not disclosing abnormalities over the deaths of patients.

The island’s coroner, Caroline Sumeray, said the trust failed to inform her of 20 serious incident investigations before the bodies were cremated, meaning the truth about how patients died, and the hospital’s role in their demise, could not be uncovered.After a period in special measures, the hospital’s official mortality figures are thankfully now in line with the rest of England.

However, many of the themes that contributed to the terrible failures at St Mary’s – including, shockingly, the reflex to cover up errors and distort the true picture – recur throughout the NHS.

It was while watching a woman having a life-threatening seizure that the then Health Secretary Matt Hancock was prompted to try to sort out Information Technology systems in the NHS.He was shadowing a team of nurses when an alarm went off at a bed, signalling a medical emergency.

The woman needed immediate attention or she would die. Yet critical minutes were lost in a frantic scramble to locate her medical notes.In scenes that would have been farcical had it not been a life-or-death situation, someone eventually arrived with the necessary records in a big box, which was wheeled into the ward on a trolley.

As the patient fought for breath, a female consultant stood on a chair and read out the notes to the assembled medical team, occasionally struggling to decipher the handwriting.Nobody except the Health Secretary seemed fazed.

The incident could have occurred in any NHS hospital. The truth is that hospitals are still working with hopelessly patchy, unreliable and outdated computer systems, leaving doctors and nurses making critical clinical decisions in the dark.

Health Secretary Sajid Javid set out the extraordinary number of people who now face very long waits for hospital care

Health Secretary Sajid Javid set out the extraordinary number of people who now face very long waits for hospital care

Unfortunately, Hancock’s efforts to digitise the entire NHS were somewhat derailed by coronavirus – though the pandemic showed how fast and effectively the machine can move in an emergency.The NHS app was rapidly improved and (for better or worse) online consultations became mainstream.

Nonetheless, parts of the NHS remain in the digital Dark Age, particularly when it comes to patient records. In the early 2000s, efforts to modernise the system ended notoriously in what a parliamentary committee called ‘one of the worst and most expensive contracting fiascos in the history of the public sector’.

Today, across the NHS, huge sums are squandered procuring software that is unfit for purpose and must then be upgraded, repaired or changed, usually by the same company that failed to provide what was required in the first place.

Mark Gordon, who spent years working as an interim chief operating officer in troubled NHS trusts, says the NHS ‘continually’ makes strategic errors commissioning the wrong systems or failing to train staff in how to use new software.

During his time at St George’s Hospital in Tooting, South-West London, the introduction of a system known as Cerner descended into chaos because people did not understand Percetakan Brosur how it worked.

Gordon claims that as many as two million patient records were lost during the fiasco in 2017.As they pieced everything together, he says the trust identified a high volume of cases in which patients may have been put at risk or harmed as a result of failures to follow up clinical investigations or act on test results.

He says: ‘We started to find 300 patients a week who were potentially harmed, and that was only out of a sample of 650,000 of two million lost records.’

Following a ‘clinical harm review’ of 646 patients potentially affected by the debacle, St George’s admitted that 15 had suffered ‘severe harm’ – meaning ‘permanent or long-term damage’ – and four more had suffered ‘moderate’ harm, but Gordon is certain the real figure is far higher.’There were thousands of patients whose prognosis was either worsened or who were dead. It has been hugely covered up,’ he says.

Those in positions of responsibility have a legal ‘duty of candour’. In reality, a deeply disturbing culture of omerta continues to permeate the health service, especially in hospital trusts, meaning errors, abuses and failings are routinely covered up, and staff are fearful of speaking out.

Whether little or large, cover-ups are the norm.

Professor Sir Brian Jarman OBE is an 88-year-old academic who probably knows more about hospital mortality than anyone else in the world.

Now an emeritus professor at the School of Public Health, Faculty of Medicine at Imperial College London, he is best known for developing a way of measuring whether hospitals have higher or lower death rates than expected.

Jarman’s methodology adjusts patient data for factors such as age, gender, deprivation levels and whether patients were admitted to hospital as an emergency.The aim is to create a reasonable measure of the quality of care. 

With depressing predictability, managers soon figured out that if they gave more patients a ‘palliative care’ code – meaning those patients were assumed to have come to hospital to die, and thus the hospital could not be criticised for failing to save them – they could dramatically reduce official death rates.

In another fiddle, hospitals found that they could reduce death rates by discharging dying patients to hospices.

Health Secretary Matt Hancock tried to sort out Information Technology systems in the NHS

Health Secretary Matt Hancock tried to sort out Information Technology systems in the NHS

Jarman claims that the Department of Health has been lackadaisical about rooting out such ruses.He says: ‘When I first developed the [high mortality rate] alert system with chief executives and medical directors of various trusts, the Department of Health did not want to receive it. The attitude was, ‘Please don’t tell us what’s wrong!”

In hospitals, the most widely used patient safety database is called Datix.It relies on staff inputting information about safety incidents. 

It is a big database of guilty secrets, revealing the blunders and oversights, accidents and abuses, communication failures and confusions that take place every day in NHS trusts.

Every month, in almost every hospital, there are errors with anaesthetics; cancer diagnoses that come too late; mistakes with drug dosages and medicines given to the wrong patients; botched gynaecological operations; injuries to mothers during childbirth; blunders with blood transfusions; and lapses in infection control.

Taken together, these paint a worrying picture of management failures and poor standards of care.

A Freedom of Information (FOI) request to all NHS trusts asking for Datix records from 2016 to 2019 received a comprehensive response from about half of those approached.

In all, the trusts that provided figures recorded just under 1.6 million Datix incidents in 2018/19; 173,890 more than in 2016/17, in a 12.2 per cent increase.

<div class="art-ins mol-factbox news floatRHS" data-version="2" id="mol-e6ea4360-9746-11ec-8c34-69e4dc6d3b7d" website ASHCROFT & ISABEL OAKESHOTT: NHS needs radical reform to save it