Six months in… health

Michael Harris /   June 29, 2015 at 8:34 PM 1,211 views

It’s six months since we launched this version of Guerilla Policy. Here’s a selection of some of our favourite posts we’ve published in health. Thanks to all those contributors we’ve published so far. Like many areas of public services, the past six months in health have seen significant change – and significant uncertainty. Frontline bloggers reacted to the publication of the NHS Mandate back in December. Martin Brunet for example writing on The Binscombe Doctor Blog criticised the decision to target one and five year mortality rates for deaths from cancer as a political folly: “It is quite simply the wrong target and will result in bad decisions that will be bad for patients and wasteful of scarce NHS resources. The target should be overall mortality, nothing more and nothing less. 5 year mortality data were originally devised to assess the effectiveness of treatment. Here they are useful – if you want to know how one chemotherapy regime works compared with another then the overall 5 year mortality can be very helpful. The problem comes when we use it to assess overall performance, or start comparing data for different countries. …These cause politicians real headaches, and the danger of knee-jerk reactions and bad decisions.” Martin argued that such targets are easy to manipulate, for example by redefining ‘cancer’ by counting as many easy to treat cancers as possible. As Martin suggested, the hardest way to really improve survival from cancer is to genuinely improve treatment and care – but this is expensive, requires investment in the people who run cancer services, often relies on medical breakthroughs and has no guarantee of success. (Martin also argued in March that UK cancer care is better than we think). Meanwhile, Moira Fraser at Carers Trust regarded the NHS Mandate as a missed opportunity for carers. Also in December, Dr David Wrigley examined the madness of King [David] Nicholson, the NHS chief’s plans to make ‘efficiency savings’ (cuts) of £20 billion: “I believe these cuts are hugely damaging to the NHS and are being used to degrade the service and soften it up and allow many more private companies to move in – in a similar way that the British railway system didn’t have the investment it required in the 80s and 90s so it became a ‘basket case’ and the politicians could say ‘look how bad the railways are – we will have to move the private sector in to save it’. Indeed after rail privatisation the cost to the taxpayer for their rail service has rocketed – something that commercialisation of the NHS will bring about.” David has written and campaigned consistently about what is being done to the NHS, from the potential outsourcing of Commissioning Support Units, to Section 75, including urging readers to lobby their MPs and the Royal Colleges against the reforms. Health has also seen a succession of ‘scandals’ over the past six months that the frontline has often examined more critically (and responsibly) than much of the mainstream media – from Dr Kate Granger’s take on the Liverpool Care Pathway, to Mark Newbold’s reflections on the Francis report into Mid-Staffordshire. As Mark commented, vague references to changing the ‘culture’ of the health service are insufficient – the question we have to address is ‘Why do we struggle with ‘caring’ in the NHS?’: “We know that most hospital staff are competent and compassionate, and we know that staff who feel valued and supported will deliver good care. We also know from staff surveys that morale is low and that somehow, the system all too often acts to demotivate and disengage the staff who work within it. Sometimes, the impact of this demoralisation overcomes individual professionalism, and care problems occur. Doctors, nurses, and managers can all reach this ‘tipping point’, and we need to think through why it occurs.” Like many others, Mark’s diagnosis focused on the rise of managerialism, targets and performance culture, and the growing pressure on hospitals. In January, Malcolm Payne warned about the impact of increasing private provision on whistleblowing – with the risk of preventing future scandals coming to light: “We all need to be concerned about this, because since a lot of the NHS is going to be contracted out to private suppliers in the near future, the rights to whistle-blow over bad patient care is going to disappear. I can imagine the government would say that the right will still be there, but the reality will be that the pressure from employers not to raise any concerns about care standards will increase. And what will NHS employees do, faced with concerns about the people they are contracting with? Not a lot, if my experience of how they deal with unsavoury or just insipid care homes at the moment is anything to go by. Increasingly, the difficulties of contracted private providers will be ‘commercially confidential’ and there will be pressure not to disclose information which might be against the interests of private providers to the NHS.” Many frontline bloggers have reflected on what is being lost in all these changes. Jonathon Tomlinson on Abetternhs’s Blog captured the views of many when he wrote in February about the difference between listening and measuring: “Much of what is really important, the ability to listen seriously and have meaningful conversations with patients is being lost by the demand that every interaction is measured by data collected, diagnoses made, investigations ordered, treatments prescribed and the procedures undertaken rather than seriously paying attention to what our patients need to say to us. …it’s clear that if we don’t make time to listen properly to what our patients are telling us, we will treat every type of distress and every presentation as a disease to be coded, investigated and treated. If this happens we will have failed at our most important gatekeeper role, not the one between GP and specialist, but between suffering and disease.” The NHS in Scotland has provided an alternative model – from its increasing emphasis on person-centredness and the ‘co-production’ of health services with patients, integrating health and social care, tackling obesity and improving outcomes for children and young people (all posts courtesy of the excellent bloggers at AyreshireHealth). Julie McAnaulty at Campaigning for Health noted how the Scottish approach might help those challenging the reforms in England: “[The Health and Social Care Act] is not happening in Scotland, and that means politically that there is a point of comparison between the old NHS system and the new all-singing-all-dancing one in England. If things go wrong, it can be compared. If England runs short of doctors, then they can look and see if it’s happening in Scotland. If people are not getting treated for chronic conditions and they are in Scotland, then again there is an unfavourable conclusion that can be drawn on the new system. I am beginning to think that Scotland may have a key role to play in any efforts to reverse the situation in England, and I think we should do all that we can to help you on this.” For the moment however, the health service in England is burdened with reform – but who really wants it? As Dr Kate Granger suggested in December in her critique of ‘patient choice’: “…instead of creating a consumer market would it not be better to invest in a patient safety culture and focus on patient experience to improve care for everyone everywhere? For Trusts that are succeeding to share their best practices with organisations that are struggling? This blog seems to ask a lot of questions, but I think this is because there are no easy answers to fix the NHS. However, I do think the politicians are so out of touch with what patients really want and how healthcare professionals really work that they do not really understand what they are trying to change.” Let us know which other health bloggers we should be posting. Get in touch with us at: [email protected]

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