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NHS 'was too powerful to criticise'

The National Health Service "became too powerful to criticise" with even the most senior staff afraid of speaking out despite millions of patients receiving a "wholly unsatisfactory" service from GPs and hospitals, the official regulator has said.

David Prior, the chairman of the Care Quality Commission, warned that the service's perceived status as a " national religion" fuelled the problem and had left some areas of care "out of control" because honesty about failings was not tolerated.

The former Conservative Party chief executive also branded Health Secretary Jeremy Hunt "crazy" for telephoning round hospital chief executives who had missed A&E targets.

In an interview with The Daily Telegraph he said: " It became too powerful to criticise.

"When things were going wrong people didn't say anything. If you criticised the NHS - the attitude was how dare you?

"No organisation should be put on such a high pedestal that it is beyond criticism. Now it is getting more honest about our failings - which I think makes it more likely that we will address them."

He called for the "out of control" system of emergency care to be made a priority for reform and said it was "wholly unsatisfactory" that so many patients struggled to get an appointment with their GP.

"Their opening times have to be geared around the patients," he told the newspaper. "It's no surprise that Sainsbury and Tesco do most of their business outside office hours because that's when people can get to shop. Working people need to be able to see their GP in the evening or at the weekend."

Mr Prior told The Daily Telegraph he has found a "chillingly defensive" culture where even the most "alpha male surgeons" felt frightened to speak out for fear of ending their careers.

"I had not realised that the culture in some of our hospitals was so damaged," he said. "That was an awakening."

"When you are compared to a national religion, that is the problem," he said in reference to a description of the NHS by Lord Lawson.

He added: "I think targets can be distortive. Every time a patient arrives [in A&E] the clock starts ticking and not a lot happens. At three hours people start to get interested - and at three hours 55 minutes the chief executive is down in the A&E department. That doesn't make any sense."

Mr Prior raised concerns about the Health Secretary's decision to call th e heads of NHS trusts missing A&E targets within hours of them being published, the newspaper said.

"There is an obsession. It's crazy to have a Secretary of State doing that. Of course he's doing it, because he's held accountable but what it all leads to is more money being put into A&E departments when that money should probably be put into primary and community care to stop people falling ill."

Dr Maureen Baker, chair of the Royal College of GPs (RCGP), said: "We are pleased the need for investment in primary and community care to stop people needing to go hospital is being recognised, but we totally refute that access to GPs is currently 'wholly unsatisfactory'.

"We understand that patients get frustrated if they cannot get a GP appointment when they want one and this is the product of chronic underinvestment in general practice.

"Patients should expect high-quality care from their GP practice and this is being provided to more than a million people every day. However, we are trying look after a growing and ageing population, with more people suffering from multiple, serious long-term conditions, on the lowest percentage share of the NHS budget on record.

"GPs now carry out 90% of the NHS patient contacts for just 8.4% of the NHS budget. GPs want to do more for their patients, including providing more weekend and evening services, but this must come hand in hand with more investment in general practice and more GPs.

"The crisis that we are currently facing in general practice is just as bad as that in A&E, and has been caused by the accelerating diversion of resources from general practice to hospitals.

Dr Baker added: "Between 2005-06 and 2011-12 (the latest year for which figures are available) the overall NHS budget grew by 18% in real terms, but funding for general practice fell by 8.3% in real terms, despite a growing population and spiralling health costs. Overall, general practice has lost a cumulative figure of £10.2 billion over the last eight years.

"This slump in funding is making it more and more difficult for GPs to deliver the services they want to. An opinion poll, conducted on behalf of the RCGP, showed that 71% of GPs expect waiting times to worsen over the next two years due to the drop in funding.

"The GP workforce is already stretched to the limit. Another recent RCGP poll revealed that many GPs are routinely working 11 hour days with up to 60 patient contacts in a single day.

"In response to the decline in funding, the RCGP and the National Association for Patient Participation have launched a campaign called Put Patients First: Back General Practice which is calling for 11% of the overall NHS budget by 2017.

"On the suggestion that, in some cases, hospitals should take over primary and community care, if there is an argument for complete integration then primary and community care could just as easily take over hospitals, given the appropriate resources.

"We want to provide services that are geared around our patients lives and our document, The 2022 GP: A vision for general practice in the future NHS, suggests ways of improving out-of-hours care by reshaping services to deliver better care and better co-ordination of care for patients.

"One of the ways of achieving this is by involving a range of professions: medical, nursing, pharmacy and social care. Working together across federations of practices would also lead to better out of hours responsiveness and allow us to develop different models that are able to address the needs of different populations of patients, such as the frail elderly.

"General practice is the cornerstone of the NHS - providing good value care for patients in their local communities. Funding for general practice must be increased as a matter of urgency so that GPs can offer more patients appointments, more flexible opening hours to accommodate the busy lifestyles of our patients, and come up with new ways of working to manage the demand and help alleviate the pressures in other parts of the NHS."


From Belfast Telegraph