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Perpetuating mediocrity in the NHS – personal, political and professional self-interest

June 23, 2011

Sometimes it’s a shame that the Times website is behind a paywall – not often, but sometimes.

Today it prevents me linking to two articles which cut to the chase about the state of the NHS and the motley collection of self-interest and short-term political expediency which continues to prevent the urgent changes needed to drag the NHS into the 21st century.

It’s interesting how many groups and individuals who kept quiet when Andrew Lansley struggled to explain the rationale for his reforms are now speaking up (King’s Fund, RCN this week just two examples) – but thank goodness they are. As explained many times before in this blog, the true state of the NHS today is not wonderful or “special”, and far from needing protection it desperately needs change, improvement and real honesty about the horrendous variance across services that each day damages patients and wastes money. Every doctor and politician knows this and failing to be public and honest about it is at least a professional disgrace, if not an immoral dereliction of duty.

Professor Sir Bruce Keogh writes in the Times about how self-interest and politics serve to perpetuate mediocrity in the NHS, damaging patient care and wasting money. His focus is paediatric surgery, but the core points are true across much – if not all – of the NHS. Of course, the status quo (and those arguing for it) is protected by the near total lack of transparency on quality of services, outcomes and patient experience in the NHS. Professor Keogh has the distinction of having led his speciality in delivering open, comparative data on performance – but the rest of the UK medical profession has failed to follow this lead. How many of us really can tell if we have a great GP, rather than an average or sub-standard one? If your child or mother is about to have an operation are you really sure they are getting the best care? Remember, the badge of the NHS only tells you who is paying – it tells you nothing about the quality or safety of the service.

On the opposite page (25) Camilla Cavendish highlights how “vested interests” stall reform of public services. Referring to her recent articles and reviews of the NHS, she makes a similar point to that above: the massive variability in quality and outcomes and how vested interests “defend shocking underperformance”. Observing that most citizens don’t push for change, she suggests that the lack of information (transparency on outcomes again), combined with inappropriate trust in professionals is partly to blame, but that this will change as websites connect patients with similar conditions allowing them to compare their treatment. Which of course is why we created iWantGreatCare three years ago, and why we continue to see a steady increase in the number of patients – and their families – using it.

Vested interests may threaten reform and perpetuate mediocrity – but only when these are the vested interests of politicians and a minority of doctors. Social and technology changes are rapidly enabling and giving power to another, far more powerful, vested interest – that of the patients and the public for high quality, safe, consistent care.

This is a vested interest that rather than resisting change will drive it forward. It is patients and the public that can save the NHS, not politicians and (definitely) not doctors. As Thomas Jefferson famously said, “Whenever the people are well informed, they can be trusted with their own government”. As people become more informed about the true state of the NHS they can be trusted to do the right thing and make the bold, necessary decisions that politicians seem unable to do, and which doctors’ unions will not do.

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