Ideas to improve the health service

In a HSJ survey one wag wrote that his biggest fear for the NHS under Gordon Brown was that he would “try to improve it”

Sadly the wag’s wisdom has gone unnoticed and now this emerges. It takes us across to the Health Foundation, another quango. (I can make the diagnosis as Dame Carol Black is on its board.)

“Nearly 100 professionals have submitted their ideas for improving the quality of healthcare in the UK as part of a prize draw run by the Health Foundation at the NHS Confederation conference in June and the foundation's own summer event in July.

Ideas covered a wide range of topics, including leadership, patient safety, clinical measurement and patient engagement, for example:

Find a way of reaching professionals not yet converted to user/patient involvement. Think laterally and perhaps outrageously. OK, here’s an outrageous thought. Maybe clinicians are well trained and intelligent, and know what to do and when. They do the best they can despite a crap system that pushes too many patients past them every day. Perhaps they are doing the best they can, and throughput targets (eg 18 week rules, 4 hour wait rules, 2 week cancer rules) prioritise speed over any real clinical engagement. Finally let me remind readers that those of us who actually like and see patients are intrinsically and existentially far more patient centred than the twaterati who prattle on about it.

Get clinicians who become patients to reflect upon their experience, write about it while it is still fresh in their minds and share it with their colleagues. What a revelation. Doctors would never have thought of doing this for themselves would they? Hit me with a Balint group. Hippocrates commented that the perfect doctor would have experienced all the illnesses his patients had suffered from to understand them better. He also pointed out the obvious health and safety dangers of this approach. Keats got TB. The medical profession has never been short of great writers, and our insights into our own illnesses are chronicled here, here and here to show but a few. And we haven’t even got on to Cecil Helman and his insights on both health and illness yet.

Give all healthcare professionals communication training to enable them to relate with and engage their patients in their health management. Hit me with a Balint group again. Better still hit me with a Neighbour, or a Tate, or a Pendleton or a Dalen, Draper and Kurtz, or Dowrick, or Linden West, or a Macleod or one of a host of others. How about a Moulton? What the fuck do you think doctors have been studying and learning about for years? Please do not dishonour and disrespect my experience, and that of my professional fathers, and their professional fathers, in the long line that goes back to Hippocrates by making asinine suggestions like this that only show the abyss of your own ignorance and false assumptions about doctors and other health professionals.

Lobby prime minister Gordon Brown to have a patient representative in his 'Cabinet of all talents'. One more shining whit to add to the colloquium.

Introduce a 'patient question pad' encouraging patients to consider and pose questions during the consultation, to be placed in waiting rooms and clinics. I’m sure no patient has ever had the gumption to ask his or her doctor a question. This’ll be just the ticket for them.

Set up joint working projects between school nurses and physical trainers in leisure centres to work on exercise and obesity.” Dr Rant always wondered what school nurses did. Nitty Norah, the bug explorer?

Well with such highlights, what need we fear that the NHS will run out of ideas? And even more here. (It’s even better that the culprits are named.) Here’s some gems:-

“Changing the culture of the grassroots NHS - less inertia, more focus. More heart”
The NHS grassroots is focused. Treat patient, curse managers. It works most of time. Sadly the infite force of curses runs into the massive mass of managerial bureaucratium. So far the massive mass is beating the force. But be sure the force is with us.

“To have a single point of access for all services, both health and social that is as easy to remember as 999. But not NHS Direct.” Isn’t this what a good GP surgery could and should do?

“Suggest to PMETB that a quality improvement project with rapid cycle and small changes would be more valuable in junior doctor "competency" assessment than "audit". Offer a prize for a completed project with most impact. Junior doctors could be an army of improvers!”
PMETB might have to learn to do short cycle audits itself too. It’s a prime case for organisational euthanasia, unless it improves its performance very smartly!

“Clinical audit to include ethnic category data collection identifying differential outcomes per ethnic group.” Wow, this’ll really enthuse us up for action. Don’t people realise that ticking boxes is dull, and ultimately fruitless. Keep it simple stupid. Or was it you who designed “Site Indicator Forms” that Mr Salmon found so helpful?

“Whatever programme you are engaged in, always talk to the patients/service users first and ask them what they need/want/wish.” If they don’t say what you want to hear just ignore them….but Pretend to Care. And may your hair not become two pointy.

“Continuity of care for patients / users by reflective, thoughtful practitioners; able to utilise evidence and research, translate it for patients (and student practitioners) and assist patients / users to reflect and evaluate their care - true partnership.” Ah yes, just what GPs have been trying to do for years. Cum scientia caritas and all that. Why then has the DH pursued policies that have made the GP job so difficult that it gets ever more difficult to do what is needed for the patients?

“Encouraging high quality research to produce Class I evidence and define the best treatment strategy when there are a number of options.” Well I never. Prejudice based medicine is all the rage, you know. As is evidence based politics.

“Having a "can do" philosophy.”
Go for it, girl. Do all you can. Your health service needs you. This is your moment. Seize the day. Once more up the pole to the mixed metaphors on the north face of the management cliché. Dance a hornpipe for us whilst you’re up there.

“Improve public health through supporting development of targeted comparable data and classifications.” Yes, that’ll do just what the NHS needs.

“Improve communication between all staff - clinicians and management.”
At the local hospital they have sacked medical secretaries. Letters take 4 weeks to travel 4 miles between the Centre of Excellence and the Ranting Shack. X ray results take 21 days to get back to us. Oh yes, we have great communications don’t we?

And when I tell management about the problem they do absolutely bugger all about it.

A carrier pigeon with a chiselled slate round its neck would get the message to me quicker than modern word processors.

“Let the patients speak. Let the clinicians listen!”
Surprise, wakey, wakey dopey head. We already do. How would it be if you listened to clinicians for a change?

“Ensuring that the senior leadership of commissioning organisations can demonstrate effective listening to the communities they serve through regular meetings with community groups in community settings, with community agendas.”
Michael Mandelstam gives the lie to this. The DH, SHA and PCTs are not democratic organisations, nor are most community organisations. Whenever a grass roots movement forms the SHA sidesteps it and closes the local hospital anyway.

“Mainstreaming mental health across health and social care.”
You have- the loonies are now running the asylum. We’re the escape committee.

And finally
“Develop a "failure of the year" award, which celebrates and learns from innovation that doesn't work.”
It’ll be a crowded field of nominations, including Donaldson, Carol Black, James Johnson, The Twaterati, MTAS, reconfiguration, PFI, PMETB, NPunFIT, to name but a few. However Patsy Hewitt is the clear winner. The Rant Foundation will present the TURD award at its annual dinner.
Some observers think Alan Johnson may win it next year.

The whole NHS reform programme would win failure of the decade.


So there we have it. With all these great suggestions the NHS will soon be humming over. Change implementation in full flow. Reconfigured services. Nice, communicative doctors. Easy access for patients. Full clinical and patient engagement. Good communication. All the time in the world for good communication between doctors and patients. All treatment plans implemented quickly. All communications done quickly between hospitals and primary care.

There is nothing in the suggestions that suggest that anyone contributing to them has any connection to the reality of day by day clinical practice.