Problems in the NHS aren’t down to a lack of funding but due to mismanagement - David Behrens

A decade ago, nearly three-quarters of us were content with the way the health service was run. There was room for improvement, we thought, but we were not disenfranchised. Indeed, at the opening ceremony of the London Olympics we showed it off as one of our proudest achievements, alongside the industrial revolution and The Beatles.

Today, just 29 per cent of us remain onside, according to the annual survey of British social attitudes. In the last two years alone, outright dissatisfaction with the NHS has doubled to 51 per cent – the highest figure since records began.

It’s not the principle that is in question, it’s the practice. Almost everybody who took part stood squarely behind the concept of a service that delivered free healthcare to everyone in need. But few believed the NHS was still providing it.

To what extent is that the government’s fault and how much of it is down to the service itself? More cash in the kitty would obviously help, but only if it is spent sensibly – and therein lies the most telling statistic. When asked whether taxpayers’ money was indeed being used wisely, only three per cent of those surveyed said yes. That, to put it less scientifically, is hardly anyone.

It’s not hard to see why. How, for instance, can a shortage of money be blamed for your GP being willing to talk to you on the phone but not in person? It saves neither time nor money, and with no physical examination possible it reduces the art of diagnosis to guesswork. The likelihood of something going wrong creates more expense and misery further down the line.

At a practice in Leeds last month, a chair was allegedly thrown through a window when someone’s frustration at what appeared to be an appointments lottery boiled over. A councillor pleaded for restraint. It was important for the public to understand that doctors were working harder than ever, she said.

Important it may be but it’s far from obvious. If GPs aren’t seeing patients, what are they doing instead? What else is left other than mountains of paperwork? With some 1,000 public relations staff on the payroll, the NHS ought to be doing a better job of explaining it.

A large part of the problem is that too many NHS managers are almost pathologically averse to criticism – by patients or their own staff.

Nowhere is this more so than at one of the country’s largest health trusts, where a legacy of defensiveness has created a “toxic culture” of bullying.

Those were the words this week of Rob Behrens, the Parliamentary and Health Service Ombudsman and not a relation of mine. He reported that despite 500 complaints in two years about the Birmingham University Hospitals Trust, as well as multiple avoidable patient deaths and the suicide of a junior doctor driven to her wits’ end, there had been a failure to accept or acknowledge the problems. Instead, an entrenched and corrosive staff culture had set in.

Yet even after such a damning expose, the NHS remained in denial. A day after publication, its Birmingham website was proclaiming the demonstrable untruths that it was “recognised as one of the leading NHS trusts in the UK” and “committed to the development, health and wellbeing of our people”. A response to the ombudsman’s review completely whitewashed its contents, displaying the same contempt for the public as for its staff.

This sleight of hand serves to undermine confidence in the whole service by taking the rest of us for fools. It will have been the work of one of those 1,000 PR practitioners, who collectively earn £57m a year. And to judge from the satisfaction survey they’re as effective as sticking an Elastoplast on an open wound .

In an organisation crying out for cash, £57m would pay for an awful lot of medics on the front line – real doctors who confront problems, not spin doctors who won’t even acknowledge them.

Can the NHS ever rebuild the trust it used to enjoy? Of course – but it must first be frank about what it’s doing wrong as well as what it gets right. That’s a bit of PR advice that won’t cost it anything.