With NHS staff being forced to witness our patients dying in corridors, in cupboards, on floors and in stranded ambulances, we can only thank our lucky stars that the country’s second most powerful politician is the man who last year published Zero: Eliminating Unnecessary Deaths in a Post-Pandemic NHS.
Because the chancellor, Jeremy Hunt, cannot possibly stand back and permit these crisis conditions to continue, can he? He knows better than anyone – having written 320 pages on precisely this fact – that avoidable deaths are the very worst kinds of death, the ones that sicken families and clinicians to their core.
Let’s remind ourselves of how strongly Hunt feels about this subject. The blurb of his book, published only last May, rings out with moral righteousness. “How many avoidable deaths are there in the NHS every week?” he asks. “150. What figure should we aim for? Zero. Mistakes happen. But nobody deserves to become a statistic in an NHS hospital. That’s why we need to aim for zero.”
He even offers a road map towards achieving that end that, unusually for a politician, centres on radical candour. Don’t lie. Don’t deflect. Don’t spin. Don’t cover up. Be honest and open about mistakes and failures because this is the first, essential step to fixing them.
To the collective despair of frontline staff, the government’s actual, as opposed to rhetorical, response to the humanitarian crisis gripping the NHS is a perverse inversion of everything the chancellor purports to hold dear.
First, Downing Street tried to ignore it. The day after the president of the Royal College of Emergency Medicine (RCEM), Adrian Boyle, estimated that between 300 and 500 people were dying avoidable deaths every week as a result of the total collapse of emergency services, the health secretary, Steve Barclay, was chirpily tweeting about the merits of parkrun.
Next, the government tried denial, with one of Rishi Sunak’s spin doctors flatly refusing to accept the assertion that the NHS was in crisis. Perhaps to them, political spinning seems like a game. But as someone who has to hear the moans and face the anguish, I would say that attempting to dismiss real people’s avoidable deaths – their actual, unnecessary experiences of misery, indignity and terminal suffering – is a form of dishonesty so stone-cold disgraceful it shouldn’t come within a million miles of government.
Mercifully, for sheer no-nonsense, evidence-based pushback against the facile denials churned out by the government, Boyle and the RCEM vice-president Ian Higginson – both of whom are frontline emergency consultants – have been outstanding.
Take Higginson’s recent turn on Times Radio immediately after the government’s efforts to discredit those figures for avoidable deaths. The association between delayed inpatient admission and increased mortality is well established. One study shows that for every 82 patients whose inpatient bed transfer is delayed beyond six to eight hours from arrival in the emergency department, approximately one extra death occurs. So Higginson rightly condemned the unedifying “battle of machismo and denial going on” before politely posing the following – devastating – question: “Is there an acceptable number [of avoidable deaths] that our colleagues in NHS organisations and politicians are seeking? Or do we simply accept that right now patients are dying waiting for ambulances, in car parks, outside hospitals?… This is a real problem that affects real people every day of the week.”
Hunt, of course, has already provided the answer to Higginson’s first question. Zero. Zero is the acceptable number of avoidable deaths in the NHS. So how – why – are we here yet again in the wretched situation of frontline staff trying to tell the truth about patient harm while political leaders with the power actually to do something about those harms focus instead on managing optics?
The government claims it has given the NHS all the funding it needs. It hasn’t. Sunak stated in his new year speech this week that since September, “we’ve put half a billion pounds into what’s called early discharge, to help move people into the community this winter”. He hasn’t. Only £200m – 40% – of that emergency funding has actually been given to the NHS and local authorities. The remaining £300m has not materialised and will not be disbursed until, possibly, late January.
With one in seven hospital beds across England occupied by medically fit patients without the care packages they need to safely leave hospital, that is unforgivable. Because every bed space we can possibly release is quite literally a matter of life and death for the patients at home with heart attacks and strokes waiting for ambulances that never come.
Be under no illusions. If it wanted to, the government could reduce the avoidable death toll this minute. It could fund the block booking of care home beds – as it did during Covid – to discharge thousands of medically fit patients from hospitals. It could mobilise an emergency crisis force of volunteer carers to help support patients at home after discharge. It could end the insanity of the pension trap for senior doctors that forces consultants to cut back their hours unwillingly or else face punitive six-figure tax bills. Above all – if it cared about the endemic burnout and hopelessness that propels so many desperate staff these days into quitting the NHS they used to cherish – it could once, just once, break its 12-year obsession with curating NHS headlines, and tell the truth.
Because the chancellor is right. Nobody deserves to become a statistic in an NHS hospital. Yet through their collective inaction at a time when so many patients’ lives are actively imperilled, Hunt, Barclay and Sunak have all made it perfectly clear that when push comes to shove, only the right type of avoidable death really matters. The ones caused by political choices? Come on. Not only are those ones irrelevant, they don’t even exist at all.
Rachel Clarke is a palliative care doctor and the author of Breathtaking: Inside the NHS in a Time of Pandemic
Do you have an opinion on the issues raised in this article? If you would like to submit a response of up to 300 words by email to be considered for publication in our letters section, please click here.
