Back to the basics
As mentioned a couple of days ago, the 2006 Patient Survey results were published today by the Healthcare Commission. The Guardian
The Healthcare Commission found 30% of inpatients have to share bathrooms or shower areas with the opposite sex, in spite of government guidance that the practice is upsetting, particularly to women.
It identified a handful of trusts where most patients have to wash in mixed-sex facilities, which rarely exist in public buildings outside the health service and which ministers claimed to have eradicated. At St Mary’s teaching hospital in central London, 59% of patients shared mixed-sex bathrooms.
The commission’s huge survey of 80,000 inpatients’ experiences also found that 20% of people who could not eat without assistance said they did get enough help.
The target culture is of no benefit whatsoever in producing real improvement.
The commission praised the NHS for achieving persistently high levels of patient satisfaction. The survey, conducted last autumn, found 90% rated the overall standard of care as excellent or good, with only 2% saying it was poor.
But after drilling down into the details of patients’ experiences, it found many hospitals failed “to get the basics right”.
You can give a building that is in disrepair a new coat of paint but that does not fix the structural problems.
British Medical Association consultants’ committee chairman Dr Jonathan Fielden said: “It is gratifying that this survey reflects the immense efforts from doctors to improve the quality and experience of care for their patients despite the financial pressures placed upon the health service.”
“It is the political meddling that gets in the way, diverts attention and leads to so much of the waste.”
The Guardian goes on to suggest a path for Gordon Brown to follow.
Compare now the patients’ views about what the NHS is really like with opinion polls showing what the public thinks about the government’s handling of the service. While the inspectorate was questioning patients last autumn, an ICM poll for the Guardian found only 25% of voters thought the NHS had improved since Labour came to power in 1997, compared with 30% who said it had got worse and 39% who said Labour had made little difference. In spite of all the extra billions that Brown, as chancellor, poured into health, Labour has been trailing behind the Conservatives on territory that it used to dominate.
Brown’s advisers must ask why the NHS’s reputation is so bad when its service is regarded by users as so good. Perhaps the most plausible reason is the persistent bad-mouthing of the NHS by its staff and by the media. A service with 1.3 million employees, including many of the most trusted professionals in the land, ought to have 1.3 million goodwill ambassadors. Instead they are, for the most part, disgruntled and fearful that their service is on a slippery slope towards privatisation. In spite of substantial pay rises over recent years and recruitment of extra staff that should have reduced work pressures, the mood of optimism that greeted the NHS plan in 2000 has dissipated.
The disregard shown towards staff is being repaid in full.
Every health minister I can remember has gone on a listening tour, or held an expensive consultation exercise, round and round the roundabout, and they got the same answer: patients want shorter waiting lists, a GP who will visit them, an A&E reasonably near by. Health service staff want more pay and fewer reorganisations. Who do you listen to?
Quite often what patients want & what staff advocate are not too different, within the realms of the possible of course. There will always be a few quibbles.
We have had new types of hospital and a far wider use by the NHS of private treatment centres, walk-in centres and NHS Direct. Everyone has had new contracts, with nurses taking on greater responsibilities, consultants taking on extra money and GPs devolving responsibility for out-of-hours services to others (while taking on extra money). There has, generally, been a public consensus supporting all of this. Taxes have risen a little to fund it.
And then Patricia Hewitt came along, brandishing a Bold Reform Agenda that encompassed closing down much-loved hospitals across the country in the name of “care closer to homeâ€, greater efficiency and super A&Es not yet established. At the same time the Treasury cracked down on previously hidden debts and, hey presto, like a too busy consultant magicking a private appointment out of his diary, the Government magicked defeat out of triumph. Its ratings on the NHS have plummeted and with them trust in the Government, and the Tories have taken the lead – despite having no health policies to speak of at all.
Masterful inactivity has something to be said for it after all.
After all, just how does one re-negotiate a contract signed just three years ago?
The Health Select Committee has looked at hearing aid provision but there is more to come.
Paul Hodgkin who runs Patient Opinion evangelises the benefits of a two way conversation in the Guardian.
The NHS concentrates on efficacy and efficiency but these are aesthetic aspects of care. Questions such as: were you included in decisions? Did staff make you feel precious or worthless? are just as important. Too small to be dealt with by formal contracts, they gain some bite by being voiced on the public space of the web. Add comments from patient groups, and feed these conversations back to hospitals and primary care trusts, and the small voice of the individual can become the kernel of real change.
Again, paying attention to the requirement for basic care might be an idea.
It looks like IBA Health have finally bought Isoft for £140 million along with liability for debts to the tune of £89 million. Let us hope that they have rather more luck with Lorenzo.
Update:
It appears though that CSC has still not given its blessing.
IBA had come close to abandoning a combination with iSoft less than two months ago after becoming frustrated at CSC’s position. A number of other potential bidders for iSoft - which has been in talks with a string of suitors for seven months - are understood to have lost interest soon after talking to CSC.
So in this game of hardball, I imagine that CSC is having to satisfy CfH of the fitness of IBA to complete the deal.