The Mid Staffs lesson you WON’T hear from Francis or the Tories

I wrote on Saturday about the Francis Report into the Mid Staffs NHS (MSNHS) ‘failings’ and tragedy, and the reasons why David Cameron was remarkably circumspect in his statement in the Commons on Wednesday. Robert Francis’ lengthy investigation into the events at the Trust have identified a number of contributing causes, and recommends a number of measures to reduce the chances of a repeat of them.

The government’s circumspection is partly because it would be easy for the opposition to accuse it of exactly the same attitudes and failings that Mr Francis identified at the Mid Staffs Trust, but even more because the precedent set by the recent Lewisham downgrade decision allows the Tories an alternative route to erode NHS services in preparation for privatisation.

They can therefore afford to eat a little ‘humble pie’ now, in order to soften the impact of any fallout from the continuing investigations into 5 other NHS Trusts that have achieved similar quality scores to those that raised warning flags over Mid Staffs, in the knowledge that they can continue the progressive dismantling of the NHS via their alternative route when necessary.

However, the scope of Tory ambitions against the UK’s greatest social achievement is such that they won’t make merely passive use of the Francis Report, and will be busily making plans to actively exploit the report and its recommendations.

Conversations I’ve had with NHS campaigners over the last 24 hours or so have revealed deep concerns over the extent of these plans and the ways in which the Francis Report might be used against the NHS. These concerns are various, but all centre around the ways in which the lessons of the report might be twisted to accelerate and extend the assault on the NHS and its founding concepts.

I’ll look at some of those ways in a separate post shortly, but for now I want to examine the underlying public feeling about happened at Mid Staffs, and to provide some context for understanding what went on that will, if understood widely, help to counteract the Tories’ inevitable attempt to misuse the undoubted tragedies at Mid Staffs as a weapon against the NHS as a whole.

The Mid Staffs deaths

It is estimated that the number of ‘additional’ deaths (people who died who otherwise wouldn’t have) because of poor care at Mid Staffs was somewhere between 400 and 1200 – over a 3-year period, not per year as some have misapprehended. The media – and politicians – have been trying to use these figures to stoke a sense of public horror, and to cast a bleak light on the NHS in general.

The wide gap between the minimum and maximum numbers should ring a warning bell – as should the word ‘estimated‘. It’s impossible to know how many of the people who died at Mid Staffs during that 3-year period would have died anyway. The official estimate reflects that high level of uncertainty.

Some context

Any death is a tragedy, and an avoidable death even more so. If the official estimate is correct, somewhere between 133 and 400 people a year died avoidable deaths, so without question the events at Mid Staffs were a terrible tragedy. But to appreciate it properly, neither underestimating nor overestimating the scale of the poor care at the Trust, we need to understand how many people were treated by the Trust in that period.

Mid Staffs treats around 250,000 people a year, with around 63,000 being admitted as patients. That means a rate of avoidable deaths of 1 in every 158-474 (0.2-0.6%) patients admitted or 1 in every 626-1,880 (0.05-0.15%) of the total people treated. Looked at another way, hundreds of thousands of people were treated in each of the identified ‘failure’ years with good outcomes.

This is not in any way to minimise the consequences for the people who died, or for their families, but simply to set in context statistics which, in isolation, might seem even worse than they are.

It’s also worth noting that the local people still seem to offer Mid Staffs strong support, and to understand these nuances. A petition of support for MSNHS organised by a local pro-NHS campaigner was signed by over 20,000 people.

A comparison

The big risk is that the government will use the failure at Mid Staffs, and the ensuing report, to justify sweeping changes in the NHS as a whole, even though the report stresses that yet another reorganisation is not the answer.

I’ll go into detail in a separate article on some of the likely ways they’ll do this. But to judge correctly on any measures the government proposes, and the justifications it puts forward for them, it’s necessary not only to understand MSNHS in the context of the wider NHS, but also the NHS itself in a global healthcare context.

Many senior Tories are known to be admirers of the (pre-‘Obamacare’) US healthcare system and others funded via private health insurance. Because it would be cheaper for the wealthy to pay for their own healthcare than to pay toward a National Health Service that cares for everyone, free at the point of need, this is an attractive option if you’re extremely well-off and don’t care too much about what happens to those who are not.

Even a cursory look at the details shows that any move toward a US-style system would be insanity – for the vast majority of us.

45,000 (at least)

The people who died at MSNHS died because they received poor care – but they received care. People are fallible. They make mistakes – sometimes very bad mistakes. Even the best nurse in the world, or the best doctor or surgeon, can make an error that costs someone’s life – and there is no system of oversight in the world that can prevent this completely.

But in the US, 45,000 people a year die because they could not access care at all. Unable to get insurance for a specific condition, or to afford health coverage at all, as many people die in the US because of lack of health insurance as MSNHS treats in total as in-patients in 9 months.

And the Harvard estimate is cautious – many estimates put the number of deaths through lack of health insurance as high as 100,000 a year.

Not only that, but with health insurers in the US putting up their premiums by 20% or more, the number of people who can’t afford health insurance (already 44 million!) is going to rocket and so is the number of deaths – without any statutory checks and balances to control the greed and callousness of health insurance providers.

And all this happens in spite of the fact that the US spends more than twice as much per head on its health system as the NHS costs us even before President Obama’s attempt to launch a socialised medicine programme.

The lesson

So, what is the lesson that’s missing from Robert Francis QC’s report and the impression that is being carefully, cautiously but insistently cultivated by government ministers and spokespeople?

Winston Churchill is famously quoted as saying that democracy is the worst of all systems of government – except for all the other ones.

The unspoken lesson of Mid Staffs is similar: the NHS is flawed, imperfect and sometimes lets people die avoidably. Its care is, inevitably, imperfect – but we can all access it when we need it, no matter what our personal circumstances.

Of course we should always do everything we possibly can to help the NHS minimise deaths and maximise good treatment – and every death is a tragedy.

But if we allow the government to erode our affection for this great institution, for the doctors, nurses, healthcarers and others who provide care ‘free at the point of need’, and to continue with their stealthy, piecemeal dismantling of our health protection – then we risk losing a treasure because we were persuaded that a blemish on it meant trashing it rather than cleaning it up.

For all its flaws, and even with the avoidable deaths that happen – every year, in every Trust because they happen in every hospital in the world – the NHS is incomparably better than any alternative the Tories want to foist on us.

It may not make as sensational a headline, but even at its worst we’re far, far better off with the NHS than with anything else – and we must fight tooth and claw to resist any attempt to use the MSNHS tragedy or any other to weaken it further or spread it more thinly.

Because that’s what the Tories plan to do – and it’s what they’ll continue doing even while they wring their hands and shed crocodile tears about avoidable deaths.