Stafford Hospital report to shape the health debate

The Robert Francis-led public inquiry into Stafford Hospital has heard from 179 witnesses

By the end of January or the beginning of February, Robert Francis QC is expected to have published the long-awaited report of his public inquiry into the Stafford Hospital scandal.

Hundreds of patients died needlessly while health managers were slashing their budgets in pursuit of NHS foundation trust status during a four-year period until 2008.

It's bound to put further strain on relations between the National Health Service and its political masters which have become increasingly fraught under the then Labour government and now under the coalition.

Asked if all the main parties had lost public confidence on health, the inveterate Worcestershire health campaigner Dr Richard Taylor didn't hesitate: "You've hit the nail on the head," he replied.

Dr Taylor, you'll remember, was elected as independent MP for Wyre Forest in 2001 and again in 2005 on a tidal wave of public outrage over the downgrading of Kidderminster General Hospital.

Now the state of the debate on the NHS has lured him out of retirement as the co-leader of the National Health Action party. It is planning to field candidates at the next election in seats which have figured prominently in arguments about health.

Stafford has a significance all of its own.

Could Dr Taylor stand there himself? He has so far refused to rule himself in or out, but don't be surprised if a unique political career has one more attempted comeback left in it.

Recent leaks to the Sunday papers suggest the Stafford inquiry will be more about the NHS as a whole than just one hospital. It's expected to call for better training of nurses, improved management and greater transparency.

Political contradiction

Both Labour and the current coalition governments have struggled with a fundamental political contradiction. The limitless expectations vested in the NHS by voters are not matched by a correspondingly unlimited readiness to pay for it.

I've seen how successive generations of politicians have wrestled with this herculean challenge.

As health secretary in the Thatcher government, Norman (now Lord) Fowler told me if the health service were like a rev counter in a car it would have been running in the red zone under successive governments.

One of his successors under John Major. Stephen Dorrell, did his best to redefine the cost of the NHS to the public purse in terms what he called "the best-value health service".

But let's not lose sight of the hard reality on the ground.

Local MPs know their constituents demand nothing less than a comprehensive range of services at their own local hospital.

Region-wide or even county-wide alternatives will always be a hard sell politically, whatever the merits, or demerits, of concentrating resources in fewer, bigger, centres of excellence, or of sharing certain services across a federation of hospitals.

There are precious few votes in these arguments for MPs battling to retain their seats.

NHS debate

So too will the recurring arguments about so-called 'health rationing' and 'postcode lotteries' as yet more high-tech, high-cost treatments become available, but at what price?

But none of this stops our politicians from calling for an open an honest debate about the NHS.

With over two years to go until the next election, perhaps now is the time for them to start having one. And my hunch is that the Francis report on Stafford could be the touchstone.

Health Secretary Jeremy Hunt is doing his best to anticipate the likely arguments by calling for a renewed drive on standards of patient care and a warning that managers who fail to deliver them will lost their jobs.

But will he pre-empt calls for yet another round of reorganisation to be heaped on top of the changes already being so controversially implemented by the coalition.

There are bound to be further demands for the NHS to be more tightly regulated, although former Labour health secretary Alan Milburn recommends instead greater openness, better public reporting and more honesty from health managers the moment things go wrong.

This will be among our talking points on this weekend's Sunday Politics West Midlands, when I will be joined by Labour MP for Walsall South, Valerie Vaz, a member of the Health Select Committee.

I hope you'll join us at 11:00 GMT on BBC One this Sunday, 13 January.