A chase with no thrill: in search of perfect healthcare

As a small child journeying to the seaside in the back of my father’s blue Ford Consul, I wondered why there was always another car ahead of us, why another boy would see the sea before me. I wished our car – special by virtue of its exotic fins, lavishly chromed grille and blueness – could leap forward regardless of danger, until eventually we led the procession and I was first to experience the thrill of the promenade, pier and sea.  

A story needs a beginning that lays down the quest, a middle that overcomes adversity and an ending that satisfies. We love stories – we read them; we watch them on TV, cinema and stage; we tell them to each other in the pub. Eventually, we come to believe that all of life is a story, and that each problem we face can become a story with a storybook ending.

‘Every grand plan’s ambition is to be the ultimate realisation of all the aspirations of the public, politicians, policy wonks and professionals’

A new chapter

In healthcare, every successive grand plan’s ambition is to be a story. Its proponents invent it with conviction as the ultimate realisation of all the aspirations of the public, politicians, policy wonks and professionals. Each is first lauded, then rejected and finally scorned for its inadequacies.

The Health and Social Care Act 2012, it is said, would have been received as wisdom from the outset if only Andrew Lansley had been a better storyteller – better able to fashion the horrible hotchpotch it became into a cogent and compelling tale.

As we approach summer 2013, a new chapter in the story of healthcare opens, with another review. Unfortunately, looking after the health of the nation has no beginning, can never fully overcome the complexities it faces and the end is always stubbornly beyond reach.

Healthcare is not so much a single narrative, it’s more of an epic. It is a continuous succession of twists and turns, creating unpredictable challenges, amazing successes, disappointments and, yes, failures. It is a constantly changing puzzle, which will never remain static for the time it takes to yield to one neat solution. It will never become less complicated, only more so.

Great expectations

The efforts of 2012 have taken their toll and some good people have fallen along the way. In mid-2013, many heads are bowed by the shame of Mid Staffordshire Foundation Trust, weakening our will by the indignity of public exposure.

Without great expectation, we survivors sink to our knees in penitent pose, praying that events will unfold as optimists tell and bring salvation. We flinch as pace is valued beyond patience, and gasp as the fist that grips clenches and unclenches, again.

We have learned that people want excellent individual care built around them. Most do not care too much whether it is delivered by the public or private sector. They will be content if we can conjure for them the unique combinations of professional contacts and interventions they need, when they need them, and do so willingly and kindly.

‘The public could not care either way about public or private, about the culture, credo or ethos of the organisation temporarily serving us’

Travelling by train from London to Birmingham some months ago, a determined Brummie was on his mobile throughout. By Milton Keynes, it was apparent he was trying to source a particular vehicle to transport an oversized load. He stuck to it as his phone cut in and out, redialling and chasing multiple contacts. By Rugby, the entire carriage was willing him on. By Coventry, success.

A huge heartfelt collective sigh, not experienced since Jessica, Mo and Ellie did the business at the Olympics, swept the carriage. And then the surprise ending. As we closed in on the final destination, we caught his final words to his contact: “Anyway, sorry I couldn’t shift it personally. Glad we managed to locate Big Load Ltd for you; suggest you ring them direct from now on.”

What do we want?

Excellent service was not in the mind of the orthopaedic surgeon whose email pinged into my inbox during a recent stint as an interim chief executive. Arrangements to shorten his clinic had failed, he claimed, and he was beyond furious. He was leaving the clinic early, with several patients still waiting, to attend an “important” meeting. Would I please take note, and ensure the administrative staff who had created this inconvenience for him were dealt with appropriately? Poor lamb!

The NHS community nurses who rushed to my mother’s home in the dead of night – I love you! We the public, as recipients of care, could not care either way about public or private, about the culture, credo or ethos of the organisation temporarily serving us, or the twaddle that comprises too many mission statements. What do we want? Service. When do we want it? Now.

At age 65, the NHS enters a new era. As the financial situation continues to bear down, providers will feel the pain. Clinical commissioning groups will struggle, the NHS Commissioning Board will overplay its hand, the system that is not really a system will clunk along – and ministers will do what ministers have always done, then move on.

We are flummoxed by the complexity of it all. The only true touchstone to guide opinion and promote success or failure will be the service we and our families receive.

At last, the shift coming since choice was first mooted will be upon us. It will be led by the power of opinion, spread by social media and Twitter, controlled by patients. Success will be redefined by truly great service. The money, what’s left of it, will follow success.

Dr Mark Goldman is a consultant in healthcare management