It is always good to hear the NHS’s top brass trumpeting the service’s virtues, as NHS chief executive David Nicholson did when launching his third annual report. At least his list of modest triumphs serves to counteract some of the negativity generated by more regular reports of NHS failures in the Daily Beast.
All the same, it is only human nature to mutter “Steady on, Dave” in a week which also saw those unexpectedly large £1.7bn trust surpluses highlighted by the Commons public accounts committee. I like to think of them as “Hewitt surpluses” though it is chancellor Alistair Darling who will end up reclaiming most of the savings which Patricia Hewitt’s prudence forced on managers.
Anyone in search of a realist’s antidote to sunny Nicholsonian optimism could do worse than tuck into the recent Commons debate on the next stage review, as assessed by the health select committee.
It is not that MPs were negative in the Daily Beast sense, only inclined to question some underlying government assumptions.
“Friendly but sceptical”, as I wrote in the margins of Hansard, which is how it should be.
That translates as concern about the treatment of individual constituents in hospital (Wyre Forest’s medico-MP Richard Taylor’s letter from parents writing about their son’s death was as shaming as any I recall); but also about the spread of those Darzi-promised 150 GP led health centres, at least one per primary care trust, without serious prior evaluation of their effectiveness.
More than one MP asked why, if pilot schemes are right to assess personal health budgets (“not right for everybody”), it is not equally prudent to test polyclinics, as ministers no longer call them? Ben Bradshaw, the Department of Health’s emollient No 2, has no real answer to that.
GP led centres are proving popular in many areas, though politicians still fight over their location: why Basingstoke? asked South Hampshire’s Sandra Gidley. Why Banbury, not Oxford, Bradshaw himself asked the local PCT. Why only one per PCT when health data suggests that some deprived areas (Hull, for example) need two or three, asked committee chair Kevin Barron. I think I know the answer to that: Alan Johnson is a Hull MP. Imagine the outcry.
What Mr Bradshaw does say is ministers have had a hard fight (he called it an “argy-bargy”) with the British Medical Association to get more overall primary care into deprived areas and to get GPs everywhere to open for longer, patient friendly hours: 8am-8pm access, 365 days a year is what voters want, he told MPs.
“It is desperately important that people complain, through the official complaints procedure… we need to change the culture in which the patient feels they are the passive recipient of healthcare and that the doctor, manager or bureaucrat knows best.
“Everyone in this country needs to get into the mindset where they behave more like a consumer.”
No one picked him up on this. It is pure Blairism and we all know what he means: patients should be more assertive of their rights.
But is the consumer parallel the appropriate one, an illness like a new TV under warranty? I am not convinced it is. Nor are the mechanisms in place that will provide resolution instead of further disappointment.
In this familiar battleground the one observation which struck me as novel came from Lib Dem Sandra Gidley.
“The way to get health professionals working together is to start at university,” she observed. Not easy when medics tend to arrogance. One trick gleaned in New Zealand is to mix younger med students with pharmacists and nurses who had been in training longer. Think about it.
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