Tuesday, 13 April 2010
Good, But Could Do Better?
There are a few adverse comments in the report, probably to convince the watching public that they are doing something, but on the whole the ex-chief's handprint seems in evidence, to cynical little me. Having only left in January, Nial Dickson's influence, is unlikely not to have been present in its compilation. Sure, there have been a number of goals achieved in thirteen long and expensive years, mainly in the reductions in waiting times and the establishment of NICE, but waiting time reductions, at the expense of quality of care, seems a pyrrhic victory to me. As for NICE; well more a defeat, snatched from the jaws of victory.
They also congratulate the establishment of the NPSA (National Patient Safety Agency), as do I. It's somewhat of a pity that most Trust's ignore its advice and fail to implement much of it's protocols Also highlighted, is the reduction in Hospital Aquired Infection, but fail to register that it is the Trusts and the Dept. of Health's fault, that they allowed these appalling infection rates, to evolve in the first place. Dirty Hospitals and over use of antibiotics fails to get a mention as the root cause. Under reporting, is mentioned as a problem, even a major one, but it only mildly states that "there is some way to go, on creating a fully open culture of reporting (of incidents) within NHS organisations". No mention of any 'whistleblowers', note, or the need to support their courage, or future livelihoods.
In health promotion and the management of chronic illness, the best they can come up with, is the ban on smoking in public places, as being responsible, in the future, for less associated ill health. But, that progress in the reduction in the harms, caused by excessive drinking and obesity has been "elusive". Might have something to do with Government failing to kurb supermarket sales of drink, at loss leader prices, but we don't mention that. Or the rubbish science of the of the Dept. of Health and the Food Standards Agency telling us to 'eat healthy and exercise', when exercise does little to reduce wieght (although it can make you a little more healthy), and the diet suggested, rich in carbohydrates, is in fact likely to increase your wieght, not reduce it. They predict, despite the applause given to the dubious advice mentioned, a future upsurge in obesity-related ill health. Well there's a surprise then! You would think that after twenty odd years, of this type of advice, that it's obvious there might just be a flaw somewhere, in the hypothesis. But no, if it's not working, let's keep doing the same!
Applause is given to GP's for responding well, to the incentives provided for chronic care, against the 'performance indicators'. But as yet, little has been achieved in avoidable admissions to Hospitals. Which translated means; we've given out lots of money to doctors to hit targets, but it's done bugger all in keeping our diabetics, COPD and CHD patients out of A and E! More rubbish protocols no doubt, that do little, if anything to advance the health of the patient, but ticks lots of boxes and makes lots of money for the cash strapped doctors.
So far as clinical effectiveness is concerned; some progress is highlighted in the areas of CVD and Cancer. Falls in mortality for both, being credited to the huge expenditure in these areas. The truth is that CHD and CVD death rates have been falling, since the end of the 2nd World War, long before any interventions by Medicine. And Cancer rates have increased substantially, but mortality from Cancer has fallen, probably due to our ability to prolong life to the point where death is no longer counted. If you have survived five years after diagnosis you are (statistically) cured. The report does touch upon the fact that our NHS is lagging quite some way behind our European counterparts in these areas, but the level of censure is quite restrained. The same applies to their verdict on cardiac and stroke care, with variations in quality between parts of England and other comparable countries. So no bouquets there then. A curious conclusion is made about mental health services, giving the NHS an A-plus it would seem, for early intervention and crisis resolution leading to reductions in acute admissions. And here's me thinking there was a paucity of treatment possibilities other than a box a of pills and a waiting list for CBT, but I must be losing the plot. Probably because I couldn't get any treatment when I needed it (except privately of course).
Moving swiftly on to Patient Experience, we enter the realm of la-la land, with the assertion that "public satisfaction with the way the NHS is run, has been increasing steadily for the past few years". Which NHS are they talking about, and in which country? There is little evidence, that I have seen of such a phenomena, in fact the converse is true. Gosport, Stafford, Birmingham Childrens; the list stretches to my horizon at least, but obviously not the Kings Funds researchers, who seem to live in some sort of 'bubble' insulated from the Internet, the Newspapers and Dr. Foster and probably the NPSA. There is an entreaty for Trusts to build a complete picture of their patient cohort to further the ends of patient centred care, or some such waffle, but the view they have is a somewhat more rosy one than I have encountered, or had related to me.
They do take the Trusts to task, about the high rates of infant mortality especially for deprived areas and overall life expectancy for the poor. But they could hardly sweep it under the carpet when the third world does better than us in many of these areas of concern. But they spoil it all by telling us we face few financial barriers to accessing services. Yes sure we do, if we are lucky, go private, or have an accident on a weekday between 9 and 5. Outwith that it's a lottery. So their view of Equity is that it represents a 'challenge'. One more statement of the 'bleedin obvious' (how much do you get for writing this drivel).
Efficiency also is viewed as a challenge, with productivity being difficult to measure and the increase in activity seems to be limited to devising methods to measure it more efficiently! It also seems to suggest that efficiency needs to be targeted at patient services rather than losing a few overpaid,. fat cat managers, of whom we seem to have legions. And mention is made of the rather alarming fact that half of all the additional funds given to the NHS since 2002, has been given over to higher pay. As the management has had increases in the order of 84% in the last ten years with chiefs at 101%, it seems my taxes have gone to keep the 'elite' of the NHS in sparkling wine and Volvo's. I would rather it had gone to fund real nurses to get back to nursing.
Accountability gets a big mention with praise heaped upon the Government for instituting 'independent regulation' for health care organisations. Hang on am I getting this right? They have made professional regulation more responsive to public rather than their own interests. When? How? I am not making this up; honestly! The only thing they've got right, is that the arrangements for redress are yet to be developed. Too right they are! Will Powell's been waiting for redress for twenty years!
They conclude this pile of fawning irrelevent crap, with at least a few words of censure, that I have 'cherry picked' because at least I agree with them; "unwarranted variations in access, utilisation and quality of care, even where national guidlines exist". It then drones on about government needing to aspire to deliver quality healthcare, to all patients, all of the time.
It is without doubt, one of the most irrelevant, overblown documents I have read for some time. It plays to the Gallery of Government rhetoric, touches it's forelock to the NHS and makes a few slightly censorious comments about that which we all know to be defective. It's the sort of report I would expect from Andy Burnham's spinmeister, if of course I did not know any better?
If you wish to make your own decision about this report read it here.