comment: The NHS is well-placed to succeed where other health systems fail

Published: 10/04/2003, Volume II3, No. 5850 Page 17

US doctor and academic Dr Don Berwick, an NHS modernisation father figure, has a colourful turn of phrase (the HSJ interview, pages 20-21). One that did not make the final cut was his description of the NHS reform process as 'one fry short of a Happy Meal'. This is not an American version of 'one sandwich short of a picnic', but rather a comment on how he believes the current changes still lack some key 'big ideas'.

One of those often cited by those with a background in US health is the lack of 'teambased' care for those with chronic diseases. Dr Berwick believes that 'patient centredness', in particular, 'is not yet firmly in the minds of leaders or clinicians'. He asks:

'Wouldn't it be better if the British patient and their family felt that they really, really were in control, that we wanted to meet them on their terms?'

Dr Berwick defines this as 'conceiving of the patient as our boss, our host, our compass'. In practice, it means facilitating informed choice and respecting the cultural, social and individual needs of patients. It is a challenge, he reminds us, that no healthcare system has properly met. Patient centredness - with its prioritisation of patient safety, the requirement to dismantle boundaries between primary and secondary care and the necessity of taking patient experience as well as outcomes into account - is profoundly challenging to traditional methods of healthcare provision.

But the NHS, with its ability to set and drive policy nationally, could deliver this change on a significant and transformational scale - and with this in mind it is encouraging to see the potential for the expansion of patient choice being explored at national level (news, pages 6-7). The resulting increase in satisfaction levels would underpin the continuing, costly increase in investment. Not to do this will risk a continuing slide in public support, just when the NHS needs it most.

Dr Berwick's analysis of the NHS may strike some as 'naive' - particularly his assessment of the impact of politics on the service. But his remains a challenging voice likely to influence policy for some time.