Confusing, isn’t it? One week an international report gives England’s still-centralised NHS a pat on the back for rapid improvements. The next week another survey concludes that the NHS is more popular than it has ever been.
Some 70 per cent of voters are satisfied; even more are optimistic about prompt treatment.
Of course, we’ve heard it all before. Retro-reviews of the Blair-Brown decision to spend a chunk of taxes from the fast-fading boom on the NHS confirm what many people (me too) felt from personal experience: that the service – and its outcomes – had improved in many ways. As he sought to win an election, Andrew Lansley insisted otherwise.
So ministers have played down the good news as they struggled to push their Health Bill through its long committee stage in the Lords (“finished by Christmas”, a health minister assured me last week) and stressed the message: “No complacency, please.” They can’t all be right, can they?
I fear they can. An Old Etonian friend of mine, devoted to the NHS and an old enough Old Etonian to have had his botched London hip job fixed in a good regional hospital, was so despairing of all Lansley’s works the other evening that I had to draw his attention to the new NHS Atlas of Variation. It’s the one which reveals that dementia sufferers are 25 times more likely to get mitigating drugs and treatments in Lancashire than in Kent.
And much else. Do we despair at such local disparities as proof that Lansley-ite localism is a self-defeating recipe for rampant and chaotic postcode lottery-itis? Not necessarily, and the secretary of state’s 60 “patient outcome measures” – his Christmas prezzie to us all – are intended to keep clinicians and managers on their toes. It will need a powerful regulatory regime at the centre – more HSJ100 winner, Comrade Sir David Nicholson, than the CQC’s Cynthia Bower (number 50) – to enforce standards.
But deep down we all know that, for all the risks, greater transparency and locally driven initiative can inspire huge gains elsewhere, yes? So I will end my pre-Christmas column with a cheery tale I stumbled on. It concerns a remarkable family physician in the US called Jeffrey Brenner, working in the run down community of Camden, New Jersey.
Frustrated by a police refusal to map local crime so that resources could be focused on the neediest neighbourhoods, Brenner created his own. Thwarted again, he applied the same technique – known as Compstats by progressive cops like New York’s Bill Bratton – to hospital admissions. Lo and behold he found that 1 per cent of its 100,000 patients accounted for a third of Camden’s medical costs.
The most expensive patient cost $3.5m a year (£2.3m) and turned out to weigh 560 pounds. He had asthma, heart trouble, uncontrolled diabetes and booze and fags problems – he spent half his life in and out of hospital. Brenner got the hospital’s – and the patient’s – permission to take over his care and that of “worst of the worst” patients like him. With hard work they halved their medical costs and greatly improved their lives with appropriate interventions.
Of course, the story highlights a failure of the market-driven US healthcare system to address the huge marginal cost of its “outliers,” lessons now being learned.
It couldn’t happen here? Get real. At dinner the other night an analyst told me the 200 problem families in a single Essex town cost £45m a year. To cope with all the uncoordinated health, educational, social service, crime (etc) interventions they get each family would need to be brilliant. They’re not.