The health service needs intelligent change

http://www.theguardian.com/society/2015/feb/05/health-service-needs-intelligent-change

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So, the penny drops (Publishing patients’ death rates is backfiring, surgeons tell NHS chief, 31 January). Who’d have thought it, that publishing consultant-level results would lead some to decide against operating on patients with a perceived higher risk of mortality? It is the NHS management response though that is interesting. Apparently, this is not the time to “row back on transparency”; “information for patients … helped surgeons raise their game”.

Two points. First, the purpose of the surgeons’ intervention is to warn us that the collection and publication of this data does not lead to greater transparency. On the contrary, whereas we used to think that all surgeons, like all other properly qualified medical staff, were acting in the patients’ own best interest, now we cannot be sure: some, in response to the “transparency” inducing data are instead considering their own positions, and we have no way of knowing which are and which aren’t.

Second, even setting aside the harmful unintended consequences of the death-rate publication experiment, what kind of world are we living in where we think surgeons need to “raise their game”? Are we worried that the supervision they receive within their long and intensive training is insufficient and needs to be supplemented with supervision by an untutored general public, albeit armed with statistics that its lack of expertise renders superficially informative but deeply unintelligible? Or do we think that we somehow have to hold them to account because they do not feel accountable for their actions themselves? If the latter, then we really are in serious trouble and no amount of perfunctory supervision will help.Dr William Dixon and Dr David WilsonLondon Metropolitan University

• Alan Milburn urges Labour to embrace NHS “reform” (unspecified) to avoid the electoral disaster of 1992 (Miliband’s focus on NHS ‘mirrors lost cause of 1992’, 28 January). Luckily, we have learnt something since 1992. For the past quarter century England has led the world in market-oriented reform of the public services. The politicians have created a form of permanent revolution, notably in health and education, without any recognition that constant turbulence doesn’t generally make for good outcomes.

The successive upheavals have hardly ever been evidence-based, nor have they been piloted, properly evaluated or developed with staff and user involvement. Usually the architects and drivers of these pet projects have moved on, or down, by the time the chaos has become widespread, as in the cases of Andrew Lansley and Michael Gove. Worst of all, the obsession with pursuing these reforms has distracted the governing system from focusing on the things that matter most but make less of a splash, such as providing enough doctors, nurses, hospital beds, teachers, school places and opportunities for high quality staff training and development.

No service can stand still, and intelligent change based on persuasion and realistic timescales is essential. But the old style of reform that Milburn appears to be promoting isn’t part of the solution, it’s a significant part of the problem.Ron GlatterEmeritus professor, Open University

• The NHS returned surpluses to the Treasury of £2.1bn in 2012-13 and £2.2bn in 2013-14. If these had been used to increase the tariff paid to hospitals and fully fund emergency admissions above the contract, hospitals would not be in deficit now. There would have been enough to increase rather than decrease the money spent on GPs. I’m glad that finally managers have spoken out as so called “efficiency savings” are damaging the NHS (Report, 30 January). Again this year the US independent Commonwealth Fund put the UK health service top for cost-effectiveness as well as equity and satisfaction.

One cannot escape the conclusion that it is a deliberate government policy to underfund the NHS as part of its privatisation agenda. We are a rich country, as Mr Cameron reminded us during the floods – fifth in the world according to the IMF – and a civilised country should be able to provide good health and social care for its population. Last week, Ed Miliband and Andy Burnham launched Labour’s 10-year plan, which aims to do this. It can be funded by getting rid of the wasteful market and the bodies which support the market.Wendy SavagePresident, Keep Our NHS Public

• I am 78 years old. Recently, I was discharged from Sheffield Royal Northern hospital after open heart surgery. As far as I know, the several conditions from which I suffered have been successfully treated, and in due course I’ll be able to resume my former active and, I like to think, useful life. In my opinion, Miliband and Burnham have got their policy on the NHS spot on. Political strategists should bear in mind there are a lot of us oldies, and we tend to vote more often than younger people. The future of the NHS, in something like the form originally conceived, is to my mind easily the most important domestic issue in the forthcoming election. After all, what sort of a country do we want to live in?David JonesMatlock, Derbyshire