After the breast cancer screening scandal, it's time to accept that our beloved NHS isn't always fit for purpose

It could have been worse – from the point of view of the government and the NHS. The failure to call nearly half a million women for their routine three-yearly breast screening could have been exposed by an NHS whistleblower or by investigative reporters or by the think tank that first noted the discrepancy in numbers, resulting in panicked phone calls to surgeries, a rush to hospital screening departments, and furious accusations of a “cover up”.

As it was, the problem was identified in house and some four months (it would seem) had been given over to deciding how to respond: who would make the announcement, what it would say, arranging a hotline and providing extra staffing at screening departments for the additional appointments that would be needed, before the health secretary issued his statement in the House of Commons. The impression was thus created of an appalling lapse that had surely cost lives but was now – so far as possible – on the way to being rectified. Oh, and by the way, there might be compensation somewhere down the line.

Not that this will be of much consolation to those who believe they have lost family or friends as a result of the blunder. Nor should it be; not just because it is estimated that up to 270 people could have died before their time, but because it reflects exactly the sort of error that that seems to plague the – sorry, “our” – NHS.

We have, first, the interaction that has proved so lethal – and so expensive – to UK governments in general and the NHS in particular: human responsibility and IT. Practically everyone I heard interviewed in the hours after Jeremy Hunt’s statement blamed a computer error or “glitch”, with not even a nod towards the fact that someone, somewhere, must have messed up on the inputting side if what came out managed to exclude a whole age group of people, and for almost 10 years.

But why has the NHS and data become such a dire combination? Why are hospitals still humping around huge volumes of patients’ notes on trolleys (which all too often fail to turn up in time for the appointment)? Why does every department and every function seem to exist in its own little world? Where are the lines of responsibility? And why are some mistakes, like the remedies, so long drawn out?

Disputed responsibility may contribute, as well as a reluctance to learn. Successive attempts to persuade the front line of the NHS – and isn’t every aspect of the NHS a front line in its own way? – to adopt something akin to an airline pilots’ model of checklists, reported errors and learning, has never really gained acceptance. Yet the bill for negligence claims rises year by year, costing money that could be better spent on other things.

Some delays in tackling problems may also lie in genuine differences of medical opinion (or infighting among professionals). It is hard to see any other explanation for the 20-year delay in linking the anti-epilepsy drug, sodium valproate, to possible birth defects, and issuing advice accordingly – by which time as many as 20,000 children in the UK were affected. It was only last month that official advice was passed down, restricting the drug’s use for women of childbearing age, even though the risks had been the subject of a long-running campaign. France, for one, drew the same conclusion much earlier.

Nor is this an exception. Some health systems across the Channel seem quicker both to respond to clinical developments or problems and to try to pin down responsibility. A case in point would be the catastrophe of contaminated blood products that came to light in the late 1980s and cost or blighted thousands of lives.

In Germany, the then health minister made the decision as early as 1993 that all those affected would be paid a monthly allowance in lieu of costs and compensation. In France, in the same year, the head of the national blood transfusion service was sent to prison for distributing harmful health products. The prime minister at the time, Laurent Fabius, was also prosecuted, along with two other ministers, and his reputation was long tarnished as a result.

Compare this with the UK’s treatment of its contaminated blood affair – essentially a subsection of the same global scandal. Those afflicted are only now able to look forward to their day in court. An inquiry was one of Theresa May’s first promises when she became prime minister. But relatives have still had to fight every inch of the way: first to secure a judge-led, rather than NHS-led, inquiry, then to qualify for state legal aid. Why has any resort to justice taken 25 years longer than in Germany, and nearly 20 years longer than in France? And why have official attitudes been so grudging?

One answer may lie in the – often uncritical – regard in which we, as a country, and our political establishment holds the NHS. Individual negligence claims are made and settled: all right, it is eventually admitted that mistakes are made. But big mistakes, affecting hundreds and thousands of people? “Our” NHS would never do that, would it? It is, is it not, the best in the world?

Corroboration for such a view comes in part from satisfied patients (who often have little knowledge of how things work elsewhere). It also comes from the much-cited Commonwealth Fund survey, which has placed the NHS top overall of the 11 countries it surveys, with particular excellence in categories such as care process and affordability. Rarely highlighted is that the same survey places the NHS 10th out of 11 for clinical “outcomes”. In other words, we may have excellent processes, but when it comes to results – well, not so good.

After admitting the errors over breast cancer screening, Jeremy Hunt also announced an independent review. Let’s hope, first, that it is completed without delay; second, that it pins down responsibility, and third, that it hazards how cooperation between man and machine in the NHS could – should – be improved. If it were also to open the way for a less rose-tinted view of the NHS, then a real prospect of improvement might be at hand.