The endless tiny errors of the NHS

I wrote recently elsewhere about Jeremy Hunt’s good new book examining unnecessary deaths in the NHS. Someone should write a companion volume about the other end of the scale of seriousness – the literally millions of small mistakes and obstructions effected by ‘the envy of the world’. Since 2014, I have found myself in hospitals many times, though never as a patient. Four close family relations or in-laws have died in hospital in that time, and several living members of my family have received various treatments. This has involved, I think, eight NHS hospitals and dozens of visits. In only one case has a major misdiagnosis contributed to otherwise avoidable death, but almost every encounter has been strewn with error or delay. These include immense waits in A&E, postponement of operations, the loss or muddling of medical notes or X-rays, the cancellation of appointments, non-emergency moves to another hospital conducted in the small hours, shifting the patient between wards for no discernible medical reason, being asked the same questions again and again by different staff, discontinuity of care between doctors with accompanying failure to communicate, and car park machines that are out of order (especially at night). Above all, an overwhelming sense that there is no one in charge – no one with the authority to expedite the whole process, no one whose job it is to consider the whole person’s needs. Much illness involves unavoidable misery, but the NHS, if you use it often, usually adds to the sum of human unhappiness. I have observed so many patients being brave about this and I respect them for not wanting everything to degenerate into constant complaint, and understanding that nurses and doctors have very difficult jobs to do. But when you see it in aggregate, you cannot avoid being angry.

One such issue is weekends. Jeremy Hunt tried to act on this when health secretary, but another great NHS skill is negating in practice whatever directives and reforms come its way. Recently, my wife had to be rushed to hospital for what seemed like a stroke or epileptic attack. Within 48 hours, the doctors established it was neither. They could find no other cause. There was nothing more for them to do. It was by then Saturday, however, and it remains a sacred NHS doctrine that people with the power of decision are not available at weekends. So she had to stay there two more nights, at unnecessary cost to the taxpayer. On the ensuing Monday, the weekend backlog meant no one attended to her until late afternoon. Only then was she discharged. For three of her five days in the ward, she had received almost no medical attention. She could not sleep because of two sad old ladies crying out confusedly and one alcoholic woman trying repeatedly, and eventually successfully, to escape.

Few seem to agree with me – or even to see the point – but there is something bad in the seemingly righteous pursuit of every example of ‘sleaze’ and every accusation of ‘bullying’, ‘abuse’ and ‘toxic behaviour’ in parliament. The error lies behind the now oft-repeated phrase: ‘The House of Commons is a workplace like any other.’ No, it isn’t. It is fundamentally unlike most workplaces, because the employers do not work there. The employers are the voters. All attempts to control their choices by unelected ‘independent’ guardians of morals are suspect. Yes, a sex pest, expenses fiddler or drunken bully does great damage to the reputation of the House, and should, in serious cases, lose the party whip; but his/her membership of the Commons itself must not be circumscribed by anyone other than the electors. The ‘workplace like any other’ doctrine opens the way to HR departments trying to run the place. Nowadays HR departments are Trojan horses for wokery. ‘Cleaning up politics’ is an admirable ambition. But the slogan can also conceal a different version of dirty politics, one which tries to frustrate democracy under a false flag.

The zeitgeist likes ‘misery memoirs’. Authors compete to show how badly their parents treated them. In most cases, this leaves the reader uneasy at the author’s betrayals, even when his complaints may be justified. So I recommend a short new book which takes this genre in a better direction. Dumble was the nickname of Tom Sackville’s father, the tenth Earl of De La Warr, and is the one-word title of the book. Dumble’s own father had been successful (serving in the cabinet) and glamorous: his son had charm and talent too, but also a difficult mixture of entitlement (he would stay only in the very best hotels) and a sense of unworthiness. He wasted money, dissipating his inheritance. He was depressive, eventually alcoholic. In the end, he threw himself under a Tube train at St James’s Park. Some might argue that telling this sad tale merely exposes private grief but, to this reader at least, the book feels like an act of love. What Dumble really liked, unlike most aristocrats then, was doing a job. He claimed that all he really wanted was to own a TV shop in Tunbridge Wells. He was managing director of Rediffusion, which dismayed his wife (‘Surely people like us become chairman’). Endearingly, he was much more interested in people who did good work than in those with his own ‘advantages’. He tried to do good work himself. I suppose his life was a failure, but lovable people often fail. It is touching when their children understand.

The Today programme carries an interesting item about how jackdaws decide when to take flight. They judge by the amount of noise from the jackdaw crowd. If it reaches a crescendo, they fly. This was described by the BBC as proof that jackdaws are ‘democrats’. It is interesting that the corporation equates democracy with whoever makes the most noise. The researchers said that when they played loud jackdaw noises into the throng, they could make the whole lot take wing. Jackdaw crowds, like human ones, are easy to manipulate.