David Cameron blocks his ears to inconvenient NHS truths, conferring only with supporters. Journalists are barred from hearing what staff tell him on his photo-opportunity hospital visits. Tuesday’s Guardian poll shows how far he has lost the public trust he tried so hard to win on the NHS.
He should meet Carol, who has just quit after 17 years as a waiting-list clerk. She got in touch to express her disgust at what she was ordered to do. When she protested to a senior manager, he said this was happening around the country, so I won’t reveal her hospital, unfairly picking on just one. This foundation trust boasts on its home page: “In these days of patient choice, it is more important than ever before to listen carefully to the views of our patients.” But their patients’ views might be unprintable if they knew how far political imperatives have overridden and warped medical priorities.
The national target says 90% of patients must be treated within 18 weeks of first referral by a GP. With annual budget cuts of 4% for the next four years, that’s a tall order as the NHS undergoes its greatest ever upheaval. Just to survive, the NHS always needs 2.5% above inflation, so most professional observers think it will erupt: already 18-week waits are up 43%. Waiting-list clerks are at the sharp end where the cash crunch meets the impossible target – and here’s what Carol says she was ordered to do:
She was told to cancel operations for anyone who was already waiting over 18 weeks, and instead to fill that theatre time with people closest to breaching the 18-week limit. “I was told to call people who had already gone over the 18 weeks and pretend there was no longer theatre time for their operation, and not give them a new date.” She was told not to book anyone already in breach until April and the start of the next financial year, or to book only one for every nine still under the target. Instead she was told to fill theatre slots with as many short, minor operations as possible.
Next she was told to use devious means for knocking people off the waiting list. The worst was when she was told to call a mother of three young children to offer her a short-notice slot for Christmas Eve, knowing she would refuse and so could be knocked off the list for refusing. “We would offer operations at very short notice to people getting near the 18-week deadline. You hope they’d say no so you count them as a refusal and knock them off.”
She protested first to her line manager, then to the one above and finally to the one above that. “I said I wanted these instructions in writing before I would lie to patients. Of course they said it could never be written down. But the manager in charge of operating theatres said other hospitals were all doing it, so we had to too. There’s no other way to stay within target.” Did the consultants know? “One complained, really upset at not getting patients seen according to priority of need, but they bullied him and he was told to be quiet. They warned that Monitor inspectors would put us on alert.”
Cameron’s new ban on mixed-sex wards after a long Daily Mail campaign has made matters far worse. He boasts that mixed-sex wards are now virtually gone. Carol’s hospital trust boasts the same on its front page. She says: “Take rheumatology. People come in for one day for injections for pain, with a session once a month. Now it has to be men one month, women the next. Sometimes there might be just four men, say, and the other places are wasted. Many have to wait two months not one month now.” This is what happens when political gimmickry is put before health need.
When Labour was driving down waiting times, there were similar stories of gaming and tricks: some A&E departments roped off corners and called them “wards” to keep within a four-hour trolley wait. “There was a bit of it then,” Carol says, “but nothing, absolutely nothing, like what’s happening now. I started in the early 1990s when there were two-year-long waits, and I’ve seen them drop so fast in the past 10 years. Now managers are deciding lots of patients are ‘not in clinical need’. But a builder who can’t work waiting for a hernia operation is in need, isn’t he?”
Carol was so shocked she walked away after registering her complaint. In her last weeks she was allowed not to phone her own 18-week waiters and cancel their operations – but, she says, “everyone else still had to do it”. “Clinical need is forgotten. It’s all about managing the figures now.”
Professor John Appleby of the King’s Fund health thinktank says he hears of waiting-list cheating from many hospitals and will suggest the National Audit Office investigates. The government on Monday claimed credit for figures showing A&E use is falling due to better GP commissioning. Appleby says it has nothing to do with a GP system not yet in place: the last government began fining A&Es treating too many people, so hospitals now channel more patients straight into annexed GP clinics – good practice, but nonsense figures.
Targets always tempt statistical massaging, but the extremity of this cheating means no waiting-list figures can be trusted. As the NHS enters a period of austerity that the former health secretary Stephen Dorrell says no other OECD health system has tried, honesty is essential. Doctors and managers do their best, but if asked the impossible they must say so openly and transparently. Voters deserve to know the truth. So, whistleblowers, please get in touch.
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