Listening to Jeremy Hunt’s speech today it is clear that he is not trying to undertake a fast-track PhD in the structures of NHS but staying firmly on the ground of patient advocacy and promoting a culture of compassionate care. He talked a lot about the frail elderly, the friends and family test (which mustn’t fall into the CQC misunderstanding of rating a service and applying it to the whole system), of capturing the values that brought staff into the NHS in the first place. All very important and also shows he’s not come in to micromanage and get involved in operational issues.
He is right to do this, it would be folly to try and become an expert in two and a half years. And he made many valuable points about not tolerating mediocrity in hospital performance, not minimising the pain of experiences like Mid-Staffs to save the feelings of staff in the NHS who are committed and conscientious.
However Jeremy also called for politicians to be realistic –and this is where he wasn’t as consistent as he could have been. Yes we should strive to be the best, but we won’t always be able to give the best available care. Absolutely no mention was made of costs! One can’t have a multi-focal lens implant to replace your cataract on the NHS because although it’s considered the best treatment, it’s too expensive. If you need a prosthetic limb, there is no way the NHS can afford the latest robotic version. I wear a hearing aid and I have no choice at all over the model I am offered. Aspiring as a service to give the best possible care is right; managing patient’s expectations over what treatment they can expect is another and the two were conflated.
This is precisely where we need politicians to lead, especially as we can see coming towards down the track the express train of financial restraints and increased demands we are going to have to manage. Sentimentality is still trumping rational judgement in the NHS. 750 people turned up last night to lobby Boris Johnson about the downgrading of Lewisham Hospital. Second-rate medicine and the need to spend money in the most efficient way possible still come as second-place considerations to the sacred-cow of “saving the NHS”. This is partly because local doctors and politicians are not courageous enough to promote the real public interest of high quality, safe care and continually default to self-serving institutional behaviour.
It’s also partly the NHS “public service ethos” that has become the smokescreen behind which apathy and mediocrity can thrive. Challenge any part of the NHS and it is interpreted as challenging the reputation of the whole system and immediately rebutted as a cover-up for your real intent of ‘back-door privatisation’. This completely shuts down the crucial need and moral imperative to evaluate and address failings immediately. Six years on, this is what ‘Cure the NHS’ is still trying to do post Mid-Staffs.
We have to move on to a grown-up conversation. This reactionary approach is stifling the necessary and urgent discussions about sustainable healthcare in the 21st century and doing the best we can with the money we have. The NHS has to get over itself. It needs to be challenged and reassured by systems such as the Veteran’s Health Administration in the USA where transparency and reporting of failure was crucial to turning around a failing system. We don’t have a failing system, but there are too many experiences of poor or mediocre care.
Any plan for delivering the best possible care we can has to include:
- Politicians and NHS employees taking part in genuine discussions about the public interest – a strategic review of services, and communicating the cost-pressures is urgently required to help make the case.
- High profile rebuttal of the anti-privatisation lobby who keep hijacking genuine debate about addressing NHS failings.
- NHS Trusts being sign-posted (by the new Chief Inspectorate?) to copy good practice and actively engage patients as partners in service improvement.
- Personal Healthcare Records which are a matter of urgency to combat years of paternalism, so the public have all the information required at their finger-tips to know about their treatment, access advice and be the service integrator, sharing information between relevant parties.