Published: 16/06/2005, Volume II5, No. 5960 Page 44

The NHS has a lot of experience, but often appears not to be learning. There are limits to the benefits of experience.

I like to use a tennis analogy. There are many recreational players whose performance has not improved in 20-30 years of playing. Regularly engaging in an activity does not lead to improvements in performance once a basic level of acceptable play has been attained.

For example, if someone misses a backhand volley during a game it may be a long time before they get another chance at that type of shot. In contrast, a coach can give players repeated opportunities to hit backhand volleys that are progressively more challenging, and eventually integrate them into match play.

However, unlike recreational play, such practice requires high levels of concentration, with few distractions and careful scheduling. A player who takes advantage of this will improve specific aspects of their game much more than they might otherwise after many years of recreational play.

If we transpose this model on to the NHS, we can see that it goes about its daily routine with little thought for improvement, with drills involving restricted focus to particular aspects of performance.

Instead, we press on with numerous distractions, trying to do everything we normally do yet trying to improve in particular areas where deficits have been identified. This is a bit like asking for coaching in the middle of a crucial match and not being able to stop to make use of it.

All performance improvement in any human endeavour requires focus, removal of distractions and specific practice - until the new skill becomes second nature and is integrated into general practice.

None of these requirements of focus, removal of competing distractions for a period of time and specific practice appear to be part of the culture of the NHS, and yet it claims to be an organisation constantly interested in improvement. This reminds me of the three most forlorn words in the English language - 'Come on Tim!'.

Dr Raj Persaud is consultant psychiatrist at South London and Maudsley trust and Gresham professor for public understanding of psychiatry.