Thursday, 4 April 2013

Nostalgia and the NHS

On BBC Radio 3 last night, Samira Ahmed hosted a debate on whether nostalgia was obscuring clear debate about changes in the NHS? GP and blogger Dr Jonathan Tomlinson argued on  behalf of the NHS. Journalist Ian Birrell argued against.

Ian Birrell painted a view of the NHS that many of us within it would not recognise. One of elderly patients dying in squalid conditions, doctors stifling change, doctors encouraging long waiting lists and disapproving of patient choice. Of course there are isolated examples of these, many of which are put under the microscope by the media. But these descriptions are not typical of the NHS.

Many of us within the NHS would love to and do engage in discussions about how service delivery can be improved. The NHS is constantly evolving and improving. Waiting lists have been driven down considerably. Care is becoming increasingly patient centred. We put the patient at the centre of everything that we do. Or we try to. And we deliver results. Cardiovascular mortality is falling faster than in any other OECD country, for example.

Compassionate care for patients with complex needs, especially the elderly and disabled, is precisely what the NHS strives for as it delivers universal comprehensive healthcare. Hospitals talk to each other and to GPs as a national network of organisations, mostly working together. We believe that healthcare is a basic human right. There are occasions when we fail, but those are the exceptions. As Don Berwick said, we leave no one out.

Healthy debate is essential to progress. What is hampering good debate and progress is the continuous cycle of redisorganisation costing billions of pounds. Teams of excellent administrators within PCTs, responsible for many of the recent service improvements, have been disbanded with a huge drain of talent. Instability leads to poor morale which, in combination with staff shortages, leads to poor care. The current reforms will lead to increasing competition and fragmentation amongst healthcare providers and spiralling administration costs. How we reverse some of these changes, and avoid a US style healthcare system driven by market forces and profit, will be the next big challenge that faces the NHS.

I invite both Samira and Ian to spend a day with me at the NHS frontline to see how things are being done well in the NHS.

Jonathan Tomlinson's response to this debate can be read here.