Monday, 30 January 2012

NHS reform – a game of three halves

There were three articles in yesterday’s UK Sunday Times which nicely summarise the state of play for the NHS right now

‘Battered Lansley certain of victory in NHS fight’ is the first headline.  The article states that 65% NHS workers want the Bill withdrawn, 66% believe that it will make the NHS worse and 84% are concerned about the role of the private sector. Nothing new there. And as I, and many commentators have written – this Bill is an unpopular, poorly thought out piece of legislation. But as the article also states – it almost certain to become law.  As the newspaper piece goes on – history shows that most changes recommended by any UK Secretary of State for Health are unpopular but have been implemented anyway. But of course Lansley’s weak narrative and lack of concrete evidence to support his radical shakeup don’t help and a piece of legislature in itself doesn’t create change. It’s the people at the coalface who make things happen. Or not.

‘NHS told to reduce weekend deaths’ is the next headline as Lansley has ordered a ‘fundamental rethink’ on how hospitals are run at weekends due to concern over patient death rates. He states that ‘hospitals should be truly 24/7’ as currently diagnostic facilities, some operating theatres and treatments are unavailable and junior doctors take on additional responsibilities on Saturdays and Sundays. This follows research by the organisation, Dr Foster, which estimates that hospital mortality rates are up 20% at weekends. These figures beg further investigation but highlight a key point. It’s not just the ‘big picture’ that needs attention, it is the way hospitals function on a day to day basis that really need close scrutiny. Policies and practices, pathways and procedures all need review.

And finally another hot potato – ‘Rippon tears into nurses for lack of care’ reports how the well-known broadcaster Angela Rippon, who is now vice president of the Patients Association criticised the ‘minority of nurses who were not compassionate and caring’ The story started with a disappointing tale of a group of nurses huddled round a shopping catalogue at the nurses’ station saying they were ‘too busy' to attend to patients pressing their buzzers and calling for help. There are sadly all too many reports like this to ignore the fact that standards of care are falling not only in our hospitals but in clinics and health centres.

So what about this game of three halves?

One: Let the politicians, unions, medical associations and all other interested parties continue to debate the merits or otherwise of the Health and Social Care Bill. It will become law and then it’s up to all NHS workers to pull together and somehow make it work.

Two: Bill or no Bill – hospitals must be better organised, leading to measurable improvements in clinical and operational practices.

Three: Standards of care must be reviewed and transformed. Now. Leaders must lead by example. Managers must manage performance. Nurses, therapists, receptionists, doctors, ward clerks; anyone associated with patient contact must demonstrate a calm, caring, courteous attitude or suffer the consequences.

Now that’s what I call reform.


Chairman Chegwin said...

I think your "third half" concept touches on why opponents of the Bill haven't been able to make the case to the wider public.

Patients and the public do see substandard care happening in our hospitals (particularly but not exclusively with the elderly); they experience being passed around a system they don't understand and find it difficult to access and challenge; many face rationing decisions and unexplained cancellation of treatments and then they see clear examples of neglect and a lack of respect from nursing staff when they finally do make it in.

This is why I think the public does think that some kind of reform is needed. The "Service" expects people to fit around it rather than the other way around. Plus all the public are hearing from opponents of the Bill - and the vested interests in the NHS - is that they want to preserve the status quo, out of some misguided belief that all is well or a quaint adherence to the past.

But that is not a message that is resonating around the country....

Finchers Consulting said...

Absolutely - the waters are getting very muddied.. A good example is my sister, who was admitted through casualty yesterday and was kept waiting on a trolley for most of the day before she got a bed (in the good old days of 4 hour targets I doubt that would have happened) but posted on faceboook (clearly feeling better) that the 'care was wonderful.' It's amazing what a quickly adminstered drip, some kindness and piece of toast can do!

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