Thursday 25 June 2009

The Emperor's new clothes

Everyone said, loud enough for the others to hear: "Look at the Emperor's new clothes. They're beautiful! What a marvellous train! And the colors! The colors of that beautiful fabric! I have never seen anything like it in my life!"

A child, however, who had no important job and could only see things as his eyes showed them to him, went up to the carriage. "The Emperor is naked," he said.

The quality of healthcare in the NHS is highly variable.
Some if it is excellent, most of it is average (by definition of course), and some of it is bad.
Some of it is bad.

This last point needs repetition, because unless everybody recognises and accepts this - and keeps talking about it - things will never get better.

Patients and their carers need to talk about it, healthcare professionals (especially doctors) need to talk about it loudly, and providers need to make it their job to talk about the good and bad parts of their services.

Most importantly, but most unlikely to happen, is that the government and Department of Health need to not only accept it, but to shout loudly about the huge and unacceptable variation in quality (outcomes and experience) that the NHS delivers - and to tell every tax-payer whether their local GPs and hospitals are great, average or poor.

However to do this politicians (thinking about forthcoming elections?) have to tell the public that despite huge investment in the NHS:
1. No one can really tell you where or who gives the best care (or the worst)
2. You may be getting care which is unacceptably bad.

Just like MPs expenses, the only thing that will lead to the "root and branch" change essential to improve the NHS is total transparency about variation in quality, and identifying publicly the places (and individuals) that deliver great care, and those that absolutely do not. When done properly, this will allow the power of patients to drive the transformation that the DH, NHS and doctors have failed to do. Of course some of this is difficult, and it will lead to a lot of painful change but that is no reason not to do it.

And if anyone dare tell you that this is already being done, you might remind them that the Mid-Staffs Hospital was rated as "Good" and Monitor allowed it to become a Foundation Hospital - in the years that at least 400 people died unnecessarily on its wards.

What would the child, "who had no important job and could only see things as his eyes showed them to him", say?

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