Daily Mail, January 28 2002

Tony Blair is seeking to present himself as the champion and defender of doctors and nurses and the public services. This is distinctly rich; more indigestible, indeed, than a Jamie Oliver sauce.

For until last week’s uproar over the Whittington hospital, the government had identified the medical profession as public enemy number one in New Labour’s version of the class war.

Seizing on undoubted causes for concern such as the Bristol heart deaths or Dr Harold Shipman’s murderous spree, ministers tried to deflect concern over the state of the health service by portraying doctors as an arrogant cartel conspiring against patients’ interests.

In its attempt to break doctors’ influence and spirit, the government has tried to dumb down medicine itself. So GPs are being encouraged to perform tasks hitherto done by hospital consultants, and nurses to make diagnoses and deliver treatments previously done by doctors.

This is about as helpful to our beleaguered doctors or nurses as a frontal lobotomy. For there is one thing that our public service professionals need above all else, and what by its every action the government conspicuously refuses to acknowledge. It is the need to be freed from political controls.

The NHS is now in the terminal care ward because - like other public services such as education or policing - it has been slowly strangled by central government’s finger on its windpipe.

Ministers dare not raise in tax what the service needs, with the Treasury behaving over the years like a bulimic — alternately bingeing and starving in its approach to NHS funding.

In addition, the service has had to change direction in response to every whim of successive governments. The Tories dramatically increased centralised control. But the current government has taken this to extraordinary lengths, with civil servants and even ministers barking contradictory instructions down the phone to health administrators fearful for their jobs.

For years, the growing difficulties of the NHS were camouflaged by the sheer dedication of its doctors and nurses. It was their commitment to public service that kept standards as high as they were.

Now, however, the limit of what they can do has been reached. The Whittington crisis is replicated around the country and everyone knows it. Even committed doctors are now saying what a few years ago would have been unsayable: the NHS cannot be cured.

Dr Colin Brown, a consultant physician from Sheffield, has written: ‘We are all sick to death with this NHS. Let’s change it’. Surgeons from Kent and Canterbury hospital have also broken ranks to say that conditions in their accident and emergency unit are appalling, and that the nurses go around in tears.

Is it any wonder? The service is only kept going at all through the heroism of its staff. But their numbers are haemorrhaging badly.

Clinical staff are there to relieve pain and affliction, but instead find themselves incapable of preventing such distress. Who can be surprised, then, that so many are leaving their jobs in medicine or nursing or not applying in the first place?

The cause of this crisis is far more fundamental than a shortage of public funds. The stuffing has simply been knocked out of what it is to be a professional.

The essence of professionalism is independence. This is vital if doctors or nurses are to focus on their first and overwhelming duty to look after the interests of their patients. That independence, though, has been destroyed.

Clinical staff are controlled by government through its managerialist wish-list of targets, outcomes and performance indicators. These embody the ethic of the balance-sheet: value for money (care on the cheap), smaller waiting lists (distortion of clinical priorities), or increase in throughput (pushing patients out of hospital before they are properly recovered - sometimes causing them to be readmitted and thus grotesquely inflate the ‘throughput’ figures).

The ethos of management accountancy rules. So clinical staff have increasingly become pen-pushers and form-fillers, with nurses stuck behind desks rather than attending at the bedside. Teachers and police officers are similarly being diverted away from teaching and policing by a wildly proliferating bureaucracy.

Now this is not to say these professions don’t need to put their own houses in order. Doctors are indeed far too slow to throw out incompetent practitioners. Nurse training has disastrously downplayed the significance of dressing, feeding or other basic needs, with the result that care of the elderly in particular leaves a great deal to be desired.

Teacher training has long embodied the destructive progressive education dogma. Police forces have forgotten the importance of delivering a consistent message that no disorderly conduct or rule-breaking will be tolerated - the lesson applied with such success in New York, whose former police chief William Bratton is addressing British chief constables tomorrow.

The government has realised the need for public service reform. But it also foolishly believes that it can deliver it from Whitehall. It cannot. Front line nurses, teachers and police officers have been effectively abandoned by leaders of their professions keen to do the government’s bidding. These have tamely gone along with the whole managerialist shebang because their careers depend on it.

And there’s the rub. Doctors, nurses, teachers and police officers all have their attention firmly fixed upwards to Whitehall, when they should be able to look downwards and outwards to the people they serve.

They will never put their own houses in order if they are told what to do. They have to be accountable to patients, parents or victims of crime. What has gone wrong can only be put right by listening to what the recipients of their services are telling them and having the freedom to act in their best interests.

People will only want to become public service professionals if politicians get out of their hair. Why should anyone want to be a doctor or a nurse when they are not allowed to make independent decisions? Why should first-rate administrators volunteer to be under the Whitehall cosh when they could be proper managers in the private sector?

The government dimly realises this. But it can’t shake off its control-freak impulses. So it talks the talk, but contradicts this in practice. Its advisers are now making some very radical sounding noises about self-governing hospitals and patient choice.

But the bottom line is that the Treasury will still hold the purse strings. And what self-respecting doctor wants to say to a patient - as doctors are now forced to do: ‘There are drugs available to relieve your pain and distress, but I’m afraid I’m forbidden to prescribe them by the National Institute for Clinical Excellence’?

If Tony Blair really wants to champion doctors and nurses, he should make all hospitals properly independent, revolutionise health funding so that clinical staff become accountable to patients who are encouraged in turn to behave responsibly towards the system, and remove himself and all politicians from health care altogether.