Tom Goodfellow

“The NHS is safe in our hands. The elderly are safe in our hands. The sick are safe in our hands. The surgeons are safe in our hands. The nurses are safe in our hands. The doctors are safe in our hands. The dentists are safe in our hands.” - Margaret Thatcher.

As the wall to wall Thatcher coverage continues I have noticed that, so far, there has been little or no mention of her NHS reforms. I think there is a fairly obvious reason for this; simply that she started a process which gathered speed under Tony Blair, and which has now culminated in the Health & Social Care Act which is the biggest and most complex reform of the NHS in its history, and I suspect probably its biggest disaster.

The NHS was (and still is) completely incapable of controlling spending. Thatcher decided that what was needed to sort out these spendthrift doctors was a man with a cool business head. So the grocer’s daughter commissioned a grocer (Roy Griffiths, deputy chairman of Sainsbury) to investigate and report on NHS management. I am old enough the remember it, but to the new generation of doctors this is ancient history.

After a six month consultation period his report (October 1983) came in the form of a letter to the Secretary of State listing the changes he believed were necessary to get the NHS functioning properly. He blamed inefficient management and managerial structures for the financial chaos, and unsurprisingly he came up with a managerial solution to the problem.

His most famous sound bite was, “If Florence Nightingale were (sic) carrying her lamp through the corridors of the NHS today she would almost certainly be searching for the people in charge”. As a result so-called Griffiths managers were appointed to run the hospitals and power shifted away from clinicians into the hands of the managers.

The arguments for and against Griffiths rumble on. Most doctors of my generation blame his report for the start of the rot – a process by which doctors became more and more distanced from strategic clinical decision making. To be fair if you read the report it is clear that Griffiths actually wanted quite the opposite, namely that doctors should be increasingly involved in management. However once CEOs were made legally accountable for balancing the hospital finances, control was taken more and more centrally. This became the defining feature of the NHS in the Blair years.

In 1989 and 1990 Thatcher introduced two more Acts which had profound effects on the NHS. These allowed the setting up if the “internal market” and created the purchaser provider split. Health authorities ceased to run hospitals but were able to “purchase” healthcare from hospitals. It also allowed the setting up of GP Fund Holding and hospitals to become “trusts” to encourage open competition in health care provision.

The Labour Party opposed all the changes until they got into power. Then, other than abolishing GP Fund Holding, they embraced the new order like a hungry python with a pie. Blair took competition to heights undreamed of by the Tories, involving the independent sector and wasting £millions on inefficient contracts.

But to return to the start of it all, I am fairly neutral about Griffiths. The NHS needs to be managed properly and in many cases I think we are under rather than over managed. My own radiology department is a highly complex £20 million p.a. business yet we run on just a handful of fairly junior managers.

My colleagues and I know exactly what to do in order to transform our business into a modern thriving service delivering high quality timely clinical imaging and intervention. But our managers and clinical director have neither the ability nor the authority to make the necessary strategic decisions to initiate change which is what Griffiths wanted. All we can do is stand at the edge of the playing field, waving our arms and shouting “please listen to us”, but fairly confident that no body will! I emphasise that this is not a critique of our trust executive who are as much strangled by system as we are.

So now Thatcher’s vision reaches its conclusion in the Health & Social Care Act. Already our local CCGs are contracting with the independent sector to provide some primary care based imaging with no reference to us, and the Act has barely got going. If a sizable chunk of primary care imaging is outsourced our income will plummet and our ability to deliver will become even more constrained. I would not mind so much if I had any confidence in the CCGs ability to commission imaging or the independent sector’s ability to provide it – but I haven’t! My experience so far is that GP commissioners have little understanding of what constitutes a good imaging service or of the essential interaction between clinicians and radiologists.

So Mrs Thatcher rest in peace. But the NHS “safe in your hands” – I think not!

Last year my youngest daughter, who is waitressing her way through a law course, served Ian Hislop at a well known Oxford restaurant. While chatting with him she remarked that her father (me) was a lifelong fan of HIGNFY and that I regarded it as the pinnacle of my career when I once got a mention in Private Eye.

“Goodness gracious; what had he done?” retorted Hislop. She was able to reassure him that I was not a sinner, but that comments I had made on the most recent collapse of an independent company providing diagnostic (or rather non-diagnostic in this case) imaging had been quoted.

This came to mind recently as I settled into my chair for the fifty minute journey to London on Mr Branson’s Virgin train. On such trips I always treat myself to a copy of Private Eye and opened immediately to Medicine Balls, penned by the redoubtable Dr Phil Hammond.

Several years ago I had the pleasure of sitting next to Dr Phil at a posh dinner where he was the after-dinner speaker (and very funny he was too!). I have always enjoyed reading his columns which are generally both pithy, informative and to the point. The Eye has about 700,000 regular readers including, I am sure, many doctors. The investigative journalistic style of the Eye is, in my opinion, one of the great bastions of freedom in our society as they probe and reveal the shenanigans of public and political life. However I am now deeply concerned that this may now be under serious threat.

My reason for this is the recently cobbled together agreement by the politicians for the regulation of the press following on from the Leveson inquiry. I note the statement of the Prime Minister to Parliament, “Let me be clear: this is not by any stretch statutory regulation of the press.” But let us just take a few steps back.

There was undoubtedly some very bad behaviour some years ago by certain sections of the press. As a result people have been prosecuted and imprisoned, large fines paid and a well-known newspaper has closed with many job losses. The actions of some were criminal and they have paid the price. However in response to vociferous pressure groups such as Hacked Off the decision was made to set up the Leveson enquiry. This recommended the setting up of a new press regulator, underpinned by new law, a rather unsurprising conclusion if the chairman of the enquiry is a lawyer!

However fearful of making an enemy of the press two years before a General Election David Cameron decided to back-pedal on his previous commitment to implement Leveson in full. Instead he opted for a regulator to be set up by Royal Charter with a little new underpinning law.

So now rather than a full and open parliamentary debate what we have is a decision on this most crucial issue, the freedom of the press, taken by a small group of politicians in a late night meeting behind closed doors. The only people present were the representatives of the three main political parties and Hacked Off crusaders. There were no representatives of the media to lend some balance to the discussion. To me it seems deeply disturbing that crucial policy should be framed, it would seem, to appease a vociferous campaigning group.

The Royal Charter will be overseen by the Privy Council. This is an unelected, secretive and unaccountable body, controlled completely by Downing Street. This has nothing to do with democracy as we know it.

But hang on a minute! A couple of years ago many of our politicians were crucified by the press over the ‘expenses’ issue, and huge damage was done to their reputation by the associated revelations. It is hardly surprising that, in consequence, they have a deeply ingrained hostility to the media and an obsessive desire to enforce external control.

So what has this to do with Private Eye? Well the little bit of law behind the charter allows courts to impose “exemplary” (i.e. massive) damages on any publication which does not sign up to the charter. Ian Hislop has stated publicly that he will not sign just as he refused to be subject to the Press Complaints Commission. Despite its reputation The Eye has a surprisingly good record of getting it right and quickly apologising if wrong.

There is, in my view, a high risk that this disastrous bit of political manipulation will be used by an angry victim of The Eye to wreak revenge with possibly the most serious consequences for Hislop and his team.

They are prepared to take the risk, but I am sure that the challenge will come sooner rather than later. I would be very sorry indeed if the publication was to be brought down in this way.

Many years ago when I was just a lad of about 11 years my best friend was Jonny W. For several summers we had played happily together, usually in his garden because his Dad was well off and they owned a significant property in a smart area of North London.

However Jonny proved to be a fickle friend. One day when I turned up to play as usual the big boy from next door was there too. His Dad owned a large toy shop in the neighbourhood and he went to a private school. The taunting began immediately and Jonny decided to side with his new best friend.

Then the big boy decided that they were going to remove my trousers and pants. They tried but did not succeed because I fought back and finally escaped on my bike with hot tears streaming down my cheeks and their triumphant laughter ringing in my ears. The sense of betrayal was overwhelming and I was far too embarrassed to tell my parents about what would probably now be regarded as attempted sexual abuse, and anyway we didn’t speak of such things in those days.

But what doesn’t kill you makes you stronger, and I learned an important childhood lesson that we are not defined by the way unkind or cruel people treat us. I had loving parents and other friends so I soon recovered. At the end of the summer Jonny and I went off to different secondary schools and I never saw him again although I heard in later years that he had “gone off the rails”.

You may think that this is a pretty trivial event as compared to some of the horrific accounts we are hearing these days of childhood abuse, and you would be right. However, the fact that I still recall all the details and the raw emotion after more than fifty years shows that such incidents do imprint themselves deeply in the minds of children.

While the BBC is busy self-flagellating, and grossly overpaid managers are fretting over their futures it is too easy to forget the real victims of childhood abuse. There is one very obvious reason for this. Many never recover psychologically and grow into deeply troubled teenagers and adults, some manifesting extreme antisocial behaviours. And, to be blunt, society would rather not be bothered with them.

I am a trustee of a small mental health charity dealing with psychological trauma, including children. This year we were contacted by the head of a local primary school in a deprived area of town. She was asking for help with about ten of her pupils, children from very troubled and abusive backgrounds. If they turn up to school at all they are smelly and neglected, often hungry and all very disturbed and disruptive. They all probably should have been taken into care, but social services are broke and do all they can to avoid this.

To fund the therapy (including family therapy) we decided to approach Children in Need for a grant. However having completed the complex application process we were subsequently informed that they did not fund any project which took place within school hours because it was wrong for children to be kept from their schooling! Despite explaining that it was almost impossible to keep these kids in the classroom let alone “school” them, and that it was the school itself seeking help they were adamant. I should point out that this exclusion is not stated explicitly anywhere on the their grant application website.

So there we have it! Tonight we will see TV and pop stars strutting their stuff aiming to bring in £millions for Children in Need. This money will be used to fund nice clean shiny projects like after-school clubs and playgrounds. It will support childhood cancer research projects (despite the fact that most cancer charities are awash with cash), and no doubt will contribute to hospitals such as GOSH who already have massive legacies, and support from Lord Sugar.

It will give many opportunities for celebrities to be photographed surrounded by happy smiling children. But the profoundly neediest children, victims of the current media obsession, will get nothing because mental health issues and psychological trauma are things that society would rather avoid. Most of these kids will end up costing the taxpayer dear in the long run. Many of the boys will end up in prison.

To say that I am a bit cross about this is somewhat of an understatement. I, for one, will not be watching tonight.