A small step, but where’s the giant leap?

James Gubb, 25 June 2008

The Conservatives made a first small step in the right direction on NHS policy yesterday, reaffirming their pledge to scrap the endless targets that have – to not put too fine a point on it – bludgeoned the life out of the health service over the past decade or so; and instead focus on outcomes. As this blog has written many times – such as here and here – targets are a sure way to demoralise staff and distort clinical priorities like none other. Outcomes are what we should be looking at.

The problem is that the Tories don’t grasp the other side of the mantle, brilliantly exposed by Nigel Hawkes in a comment piece in The Times today. Targets are even going out of Labour’s vocabulary, but are just being replaced by other means; the Nuffield Trust, describes at least 24 other ‘quality-reform’ methods that New Labour has used. Health care has become ever-more the domain of the state; the Thatcher, Blair and Brown administrations’ rhetoric of choice, competition, plurality, ‘patient-centred’ care remain just that, rhetoric.
As Hawkes says: ‘if patients had power, stroke treatment would already be better than it is, rather than lagging behind almost all conmparable countries…[but] the structure of the NHS militates against [this].
‘Unlike in systems funded by insurance, few NHS patients really feel that have an entitlement. Care is delivered as if by a beneficient charity, not a service patients have paid for in their taxes, and from which they ought to have certain expectations.
‘Changing this near-feudal attitude will take more than tinkering with data. It will probably need a reform of the funding arrangements, too.’ Bravo.
So come on Mr Cameron, where’s your mettle? As we have said time and time again, other European countries are equally committed to universal health care, but provide it in a very different way, where the patient is less a passive recipient than a co-partner in care. On quality of care and patient satisfaction they are streets ahead. We should be taking note.