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Wednesday 03 July 2024

“Humour is a coping mechanism — but also a cry for help”

By Matt Ross

Doctor, comedian, broadcaster, writer, health campaigner and politician manqué, Dr Phil Hammond is now drawing up a manifesto to rescue the NHS and boost the nation’s health. On the eve of a watershed general election for the UK, he spoke to Healthcare Manager’s Matt Ross.

Dr Phil Hammond pictured on stage, 2024

Contemplating the imminent general election, Dr Phil Hammond is recalling his own ill-fated venture into politics: during an appearance on Channel 4’s Countdown in the run-up to the 2019 election, he rashly announced that he would be standing against Tory MP Jacob Rees-Mogg. “Everything we do in medicine goes through the prism: ‘Is it intelligent and is it kind?’ So I founded the Intelligent Kindness Party — IKIP,” he explains. “I was going to have a field day.”

Unfortunately, Labour and the Liberal Democrats — having initially suggested that they’d give him a clear run — changed their minds. “Labour hated the LibDems for going into coalition with the Conservatives, and the LibDems hated Labour because they didn’t think Corbyn was strong enough against Brexit,” he recalls. “I said, ‘Would you like to win collectively or lose individually?’ and they said, ‘We’d like to lose individually.’ So I had to step aside.”

Hammond has enjoyed much greater success in medicine, comedy, journalism, broadcasting and health campaigning — approaching each discipline with the same idiosyncratic flair that he might have brought to the world of politics.

First of all, he’s a doctor: qualifying as a GP in 1991, he spent 20 years in general practice, five years in sexual health, and 11 years working with children suffering from chronic fatigue syndrome. But meanwhile, he’s also been Private Eye’s medical correspondent since 1992 — writing under the pseudonym MD — and a broadcaster for nearly as long, producing series including BBC2’s Trust Me, I’m a Doctor and Radio 4’s Struck Off and Die. He recently interviewed eight senior medics for Radio 4’s Doctor Doctor, and is currently preparing for two Edinburgh fringe shows – one of which, presented with former Royal College of GPs president Dame Clare Gerada, aims to devise “a manifesto to improve the NHS, social care and the nation’s health.”

Coping mechanism

As every NHS worker knows, medicine and comedy are close bedfellows. “Everyone who works in a life-or-death industry — whether paramedics, police, nurses or doctors — has a dark humour that sustains you through the wee small hours,” says Hammond. “It’s a coping mechanism; but it’s also a cry for help in a high-pressure situation.”

Combining the two in his career hasn’t always been straightforward. In the 1990s, Hammond helped expose high death rates among babies receiving heart operations in Bristol. “I broke shocking medical scandals on stage at the Edinburgh fringe, which I think in retrospect was inappropriate, but I also documented them seriously in Private Eye,” he recalls. The recommendations made by the subsequent public inquiry — at which Sir Brian Langstaff, who’s just chaired the infected blood inquiry, was leading counsel — pushed agendas such as patient empowerment, continuing professional development, care standards and transparency on performance which have become mainstream since.

Many of these changes have been positive, says Hammond, but some recommendations have not been implemented, while others have had unforeseen consequences. The inquiry’s report, for example, argued that “we need to replace clinical negligence litigation, where to gain compensation you have to prove that an individual was to blame — and that often takes decades — with a system where if somebody suffers serious harm from healthcare, they’re compensated without having to prove damage,” he explains. “Successive governments have shied away from that, because they think it will be monstrously expensive, but putting a case through court for ten years is monstrously expensive!”

Meanwhile, healthcare regulatory bodies have multiplied and the performance of clinicians and hospitals has come under far greater scrutiny. But in Hammond’s view, until errors are understood as systemic failures rather than the fault of individuals, the incentives to hide problems and shirk responsibility will remain powerful. Just as in the infected blood scandal, he says, in Bristol “the cover-up went to every single level” of the hierarchy: constantly increasing the pressure to find scapegoats only encourages people to bury problems deeper. “This angry litigation-blame culture actually has the effect of suppressing the truth, rather than encouraging it,” he argues.

It also drives clinicians out of the system – the General Medical Council and General Dental Council have “been aggressively prosecutory over fairly minor errors,” he says – and fosters a harmful aversion to risk. “Some heart surgeons will say that they don’t want to do harder operations now because they don’t want to be top of the deaths league,” comments Hammond. “There’s a consequence to saying that we want to be aggressively transparent about everything.”

People need to better understand risks, he argues, rather than pretending they can be eliminated. “There is no such thing as ‘do no harm’,” he says. “Every single drug or vaccine causes serious side-effects for some. If you give resources to one area, you’re necessarily depriving another. What we’re trying to do is the most good for the least harm at an affordable cost — and that’s what management is all about.”

headshot of Dr Phil Hammond in a flowery shirt, 2024 Hammond: The most effective NHS leaders know their organisation inside-out and "make a moral case, a clinical case and a financial case" for reform. 

'Absurd' divide between doctors and managers 

Hence the importance of good management in health and care. “There are few more complex and important roles than managing a health budget, a health estate etcetera,” comments Hammond, decrying the “absurd, pathetic divide between doctors and managers”. In the best-run health providers, he adds, senior leaders know their organisations inside out — “they walk the wards” – and benefit from “really senior clinical input, from people who are prepared to collaborate with the managers rather than fight them.”

The most effective NHS leaders, he believes, are also able to “make a moral case, a clinical case and a financial case” for sensible reforms at the Integrated Care System (ICS) level, such as concentrating specialised care provision within centres of excellence and focusing resources on public health goals.

Long a campaigner for action on public health, Hammond argues that “if you want to improve future health outcomes, you put money into education before the NHS, because there’s strong evidence that the better educated and wealthier you are, the healthier you are.” Far better, he says, that “instead of pulling people out of a river of illness, we wander upstream and stop them falling in”. ICSs will “get more bang for their buck” if they channel resources into supporting people to eat and sleep well, take exercise and develop “warm human connections”.

Sitting ducks

The UK’s track record on public health is terrible, says Hammond — so when Covid-19 arrived, “we were sitting ducks: public health and waiting lists were out of control. We’d had a decade of austerity, rising health inequalities, child poverty etcetera, and the virus mercilessly found all the weaknesses in our system.”

Sadly, the measures introduced to curtail the pandemic created new problems. “Scaring the shit out of people about a killer disease then sending them home on their own had a double whammy on mental health,” he says: fear and isolation formed a poisonous combination. And in the pandemic’s wake, NHS services have fallen into a vicious circle, with delays further stoking need: “The increases in waiting lists mean that [health conditions] aren’t being picked up early, and we’re waiting until they translate into emergency events,” he explains. “Then the emergency services are overloaded, so people are stuck in the back of ambulances. At every level of the system, there are pinch points that explain why health has gone downhill.”

Some of the health and care system’s problems are rooted in demographic changes and the nature of Covid, says Hammond, but others have their roots in decisions by successive Conservative governments. Making steady improvements in public service delivery demands stability, he says, but the Tories oversaw two major reorganisations, then appointed five health secretaries within the last three years. Meanwhile, private providers have taken on the simple procedures and less complex cases, leaving NHS bodies with the hard ones: “The NHS has become the safety net for all the really sick people, without the profits from the easy cases to help fund that,” he says.

'Trust has broken down'

“I’m not party political, but I think we probably do need a change of government,” he concludes. After the pandemic and months of industrial action, “the bottom line is that trust has broken down between this government and frontline staff.”

At the time of writing, it looks very much as if Hammond will be getting his wish on 5 July. What would he like the next government to prioritise in health and care? Above all, he replies, don’t throw everything up in the air again: “If anyone says they want a major structural reform of the NHS, they should be sent to Rwanda.” Elected leaders should be open about the system’s problems, he says, and focus on getting one big thing right — ideally social care. “People need to be honest and say: ‘Look, we’re in a bit of a mess. We can only fix certain things in one go, and this is the one we’re going to focus on first’,” he argues.

Hammond also wants to see a simplified system for regulating health providers, and — 23 years after it reported — the implementation of the Bristol inquiry’s recommendations on clinical negligence. “When there’s a scandal, there’s still a tendency to burn the notes and bury the X-rays and protect your backside, because you know you’ll be hung out to dry in the courts,” he says, yet in most cases, problems occur because too few staff are rushing to deal with overwhelming demand within organisations long starved of capital investment. “If you don’t have the right staff on a plane, it’s not allowed to leave the runway — but the NHS has to take off with a load of demented patients, half a wing missing and a hole in the fuselage every day,” he says.

Ideally, Hammond would like to see mandatory safe staffing levels. Failing that, “improving the offer to staff is the most fundamental thing. We’ve got to make the NHS a decent place to work.” He also backs a Public Health Act, requiring an audit of all new government policies which would block those likely to foster ill health.

Labour’s focus on public health gives Hammond hope here — and he’s been impressed by shadow health secretary Wes Streeting. “He clearly understands what it’s like to be poor, to be gay, to recover from cancer,” he comments. Streeting has been “slightly pugnacious with doctors and unions and managers and middle-class lefties. People in opposition are necessarily a bit pugnacious,” he adds. “But I think he will learn that you have to collaborate to really achieve stuff.”

Hammond also admires Labour leader Keir Starmer for “making them electable” after the Corbyn era; meanwhile, the Tories’ “fag-end government that partied through the pandemic” looks ever more unelectable. Yet even if Starmer does pull off the first Labour general election win in 19 years, it will be a long road back to recovery for our health and care system.

“The economy is in a pretty dire state. Brexit and the pandemic have made us demonstrably poorer. A lot of really good European staff have left the NHS, and we can’t keep on stealing staff from poor countries that need them more than we do indefinitely. So they’ve got a handful of problems that aren’t quickly fixed,” says Hammond. “I think they genuinely will give a shit. But gosh, it’s going to be hard.”

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