TWO weeks ago, in this column, I speculated that members of our political elite remain silent about the reduction in hospital beds, because they can afford private hospital care and because all major political parties have been complicit in health service sell-off and decline.

However, NHS decline is not just the work of a wealthy elite, or free- marketeers engineering a humanitarian crisis to force NHS “reform”. Things could never have progressed this far without professional failures, inertia and complacency of many others.

Discourse about the NHS is dominated by party political sectarianism and sentimental cliché. Anyone left of centre knows the script. The NHS is “our NHS”. If patients receive poor care it’s because of “Tory cuts”. Staff are never abusive or incompetent but “run ragged” or “over-worked and under paid”. All immigrant staff do a “wonderful job” and “the NHS would fall apart without them”. Campaigns to expose abuses are “typical of the Daily Mail”. And so on.

Worried older people – often lifetime Labour voters – remember how the NHS used to be and quietly express grave concern about care standards, often prefaced by “I love our NHS, but…”. Younger women who’ve given birth exchange horror stories about maternity units… and needless deaths. But few speak out. It’s certainly difficult and exhausting to complain and the administrators running the hospitals hinder rather than help. However, it isn’t just a callous bureaucracy keeping people silent. It’s misplaced loyalty and fear of disapproval.

I’ve spoken to too many patients and staff members who’ve felt their comments about poor care have been unheard, or even silenced, by ‘progressive’ acquaintances and colleagues. One man who contemplated a complaint about care standards told me he’d asked for support from a friend. It was refused. He said: “I wasn’t sure of his support. But I was shocked because he said the staff did ‘wonderful work’ – in a ward where neglect was obvious. He looked ashamed, but also accusatory, as if I shouldn’t complain.”

Many NHS staff are hard-working and under huge pressure. However, it’s equally true that some staff have colluded with a closed and increasingly neglectful culture and have failed to unmask abuses by colleagues. Some individual professionals have become callous in the face of poor practice. It isn’t low staffing which leads staff to chat together while an old woman calls for a bedpan. Or for night staff to have a physical fight with each other, while a dying old man cries in pain.

NHS trade unions have focussed on staff pay and job security. As a result they sometimes silence complaints by patients, rather than help expose poor care. Too often whistleblowers have been shunned by colleagues. Elsewhere bereaved family members seeking redress have been pilloried.

There have been numerous scandals involving cruelty and neglect of patients under both Labour and Tory governments. Shamefully, most have been investigated by the “conservative”, not the “progressive” press. Journalists of the right have been prepared to listen to complainants and their editors to publish. But the liberal left’s failure to support patients against rogue staff and poor management has left the NHS fatally exposed. The NHS and free movement of labour are shibboleths of the liberal left. Thus it takes courage to admit that large-scale immigration within health and care services hasn’t always benefited patients.

Since the NHS was founded, dedicated foreign doctors and nurses have come to the NHS to work and train. There have at times been shortages when we have needed to encourage greater numbers. However, it cannot be right that nowadays the NHS relies for its survival on staff from abroad because successive UK governments have deliberately failed to train enough doctors and nurses – and because profiteering agencies have done lucrative deals with trusts to supply non-unionised foreign staff. Too many staff have poor English, inadequate training and little understanding of the UK’s commitment to equal human rights and child protection.

When 26 per cent of our doctors are from abroad, often from countries where training is less rigorous than here, it’s not surprising that they’re disproportionately more likely to have complaints upheld against them.

The problem is compounded because, according to a recent report on locum doctors by Health Education England, some hospitals fail to report poor practice by a doctor or to share information, sometimes claiming “commercial restrictions”.

The NHS needs more than marches. It needs honest “critical friends” if it’s to survive as the greatest of our public services.