LISE LLEWELLYN ON THE DANGERS OF PESSIMISM

Published: 14/04/2005, Volume II5, No. 5951 Page 17

I have recently returned from a King's Fund study tour to South Africa - a country that has arguably undergone the most radical change of any state in recent history.

Once ruled by a fundamentally unjust and degrading government, it now has one of the world's most thought-out and principled constitutions.

Our group of chief executives from a range of NHS organisations had the privilege of meeting many community leaders - from highranking individuals in government and business to 'ordinary' men and women working with young people, children and the unemployed in the townships.

In each person the commitment to deliver real improvements in the community was evident for all to see.

The overwhelming impression from this extraordinary country was of a genuine wish to recognise and learn from the past and a real, almost palpable, feeling of excitement and hope.

The group returned with a multitude of impressions, but the predominant one for me was the positive attitude of everyone we met.

Time and time again people 'skipped over' the hard times - though when pressed the stories were astounding - and while recognising that the country still had a long way to go to deliver the hopes and aspirations of the constitution, gave repeated examples of the positive changes happening now and the advances already made.

Progress was always illustrated and the need to make steady, realistic and sustainable improvements recognised. This was a real example of positive stories generating and supporting transformation.

I wonder if a group of chief executives from the South African health service who came to study the changes occurring in the NHS would return home with the same lasting positive impression?

Probably not, and over the next few weeks I think things will only get worse.

Pre-election, the NHS will inevitably become a political football in which any improvement will be minimised and any problems magnified.

But it is not just the politicians who tell and re-tell the negative stories. Too often we all find faults with the service and each other.

A prime example is the improvement in accident and emergency services. We may be struggling to achieve the 98 per cent target in a few units, but overall the scale of improvement is staggering.

The public required an improvement and it has been delivered. We may argue about the validity of a 98 per cent versus a 95 per cent target and why it took professionals so long to recognise the need for improvement or the impact on admissions, but prolonged arguments between managers and clinicians undermine the good news. For patients, the experience of A&E services has improved enormously.

The NHS itself has an unerring ability to highlight the negative - the soon-to-be-defunct star-rating system is based upon the avoidance of penalty points.

Meetings on performance with strategic health authorities only occur when performance has gone astray - potential waiting-list breaches or financial overspends.

And when was the last time a communications alert was centred on a good news story rather than a crisis?

True, the NHS and other organisations - such as HSJ - now run high-profile awards ceremonies to recognise and share good performance.

But how many of us have heard, even during the applause for the winners, cynical comments from surrounding tables - 'but We are doing this' or 'It is not all It is cracked up to be'? Why have we become so disparaging of each other?

I am sure that in each of our organisations we can see a wide range of staff making real changes in their own services, but It is almost as if we either take this for granted or do not want to talk about it just in case we find the changes do not suit everyone.

The 'wow' factor I experienced during a recent visit to one of the general practices in my patch made me stop in my tracks. No single earth-shattering, radical change that would capture headlines, but a genuinely committed team working together to deliver the best care possible.

The community it serves is one of the most deprived in the UK, the consultation rate is double the national average and the practice has a 28 per cent annual patient turnover, making life-long continuity of care a rarity.

But the team focuses on the things it can alter to improve health and healthcare. The whole team has developed specialist interests - from diabetes to mental health. It believes there is no such thing as just a receptionist.

The practice can offer consultations in a range of languages - professional development has involved intensive language courses as the availability of interpreters is just not sufficient for optimal patient care. The practice practically demonstrates how primary care can be flexible within existing resources.

The challenge I face now is how to remember this and other positive stories and keep telling them. The next time I hear that the problems of increasing attendance in hospitals is due to failures in primary care, I will be able to recount the services offered by this practice and others like it.

It is easy to be negative. We need to recognise the improvements that are still needed to deliver the NHS we all want to work in, but let's talk about progress made as well as hills still to climb.

In South Africa I had the privilege to see first hand that positive stories do generate the enthusiasm needed to tackle problems And at the next awards ceremony please can we just concentrate on applauding the winners. .

Lise Llewellyn is chief executive of Brent primary care trust.