Published: 06/10/2005 Volume 115 No. 5976 Page 17

Sometimes I think that I am becoming slightly paranoid about the media, but it does seem that the vast majority of articles, TV and radio items about the NHS are negative.

A recent BMJ research article stating that 90 per cent of people are now benefiting from better care was reported on breakfast TV as 'the NHS is failing 10 per cent of patients'. Ever felt like giving up?

Now I know the old adage that bad news sells newspapers, but do we have to take some responsibility for the image the public has of a service in crisis? Does the public have unrealistic expectations of the service because the staff do? Is this because NHS staff want and expect to deliver the best and are unwilling to accept compromise?

We should not be surprised since the majority of staff join the NHS not to make a fortune but to make a difference. Staff taking care of individual patients see only too clearly what they want to do, and get frustrated when their ideals are compromised. But while not wishing to be too restrictive, are we too eager to go to the press and public about the latest problem?

For many months during the winter newspapers used to be full of horror stories about accident and emergency patients being consigned to trolleys in corridors, waiting for hours to be seen by a doctor. This was not acceptable. So understandably the service was directed to make radical improvements, and by the end of last year we had a service in which 98 per cent of patients were seen within 24 hours.

However, now I hear people saying this is a bad thing - too many patients are now going to A&E departments because they are seen so quickly. is not it a funny world where we complain that people use our service because it has improved?

No one talks widely about the patients who are now treated in their own home rather than being admitted to hospital.

The problem now is the failure of primary care. If patients could be seen more quickly in GP surgeries fewer would go to A&E. But access has improved in primary care. When I was a GP trainee (yes - it was a long time ago) there were two options for a patient who wanted to consult a doctor. Either they had to book an appointment a week in advance - or even longer for some doctors - or they had to be seen as an 'extra' at the end of a long surgery. In this case, both doctor and patient felt hassled. No-one knew when they were going to get out of there.

Then advanced access was introduced and a target was set whereby patients had to be seen by a doctor within 48 hours. Yes in some surgeries there is a real scramble for the phones at 9am (though this is not new), but now all patients can be seen by a doctor within two days. By a number of means, primary care trusts have increased the capacity in primary care: walk-in centres, same-day treatment services or new skill-mix.

Frustratingly, these changes are reported in the medical press as a threat to the continuity of traditional primary care - doctors are overworked, but reluctant to accept alternative ways of managing demand. The tabloid press, meanwhile, claims the targets have been fiddled because patients do not see their own doctor.

A recent headline in the London Evening Standard read: 'NHS in crisis, beds to close'. In some instances this may be right, but unfortunately this particular story was just scaremongering. Locally, it has been shown that we have too many acute beds.

Length of stay in our hospitals is too long in many cases. If we improved our clinical efficiency to achieve average lengths of stay, we could close 500 beds. This does not require massive service change or huge community investment.

Patient care will not be compromised by this. Rather these changes will allow hospitals to be financially stable and minimise the risk that at the end of the year in order to achieve financial balance operations are cancelled or outpatient clinics cancelled.

The NHS has had huge investment over the past five years, but this goes hand in hand with a huge rise in the expectations among both staff and patients.

I remember being told early in my managerial career that it was easier in many ways to manage a service that had little investment because people expected to be challenged on their performance and everyone realised that with so little investment only a few changes could be implemented.

Over the past five years we have all been optimistic about the future of our own department, surgery or hospital.

We have all expected our empires to grow in this time of plenty.

Perhaps we lost the rigour of scrutinising performance to make sure we were doing the best with what we had before we asked for more. We need to remember these skills quickly - before someone else does. .

Lise Llewllyn is chief executive of Brent PCT and a regular columnist for HSJ.

Her next column will be published on 10 November.

An HSJ conference on Effective Patient and Public Involvement takes place in London on 3 November.

Among the topics:

what constitutes an effective forum;

the impact of next year's abolition of the Commission for Patient and Public Involvement in Health;

how PPI performance will be measured by the Healthcare Commission;

PPI: the clinical governance perspective;

the governance structures of foundation trusts and how they may enhance community engagement.

Speakers include: Anna Coote, director of PPI, Healthcare Commission; Leslie Forsyth, director for PPI, CPPIH; Sarah Squire, director of patient experience, clinical governance support team; Karen Doherty, mental health involvement manager, Westminster primary care trust.

For more information and to register your place, call 0845 056 8299, e-mail hsjconferences@emap. com or visit www. hsj-ppi. co. uk