The joy of ministerial responses

Civitas, 30 July 2009

by Peter Davies

There’s a glorious pattern to ministerial responses.  Here’s the Department of Health’s official spokesman quoted in The Daily Telegraph, in repost to our book ‘Putting Patients Last’, released today, in which we argue that the new generation of NHS organisations, set up ‘businesses’, still have much to learn about customer service.  Under pressure from government, we find they still put the demands of the state, rather than the needs of patients, first.

But back to the pattern.  The first response is bluff and denial. “It is clearly important that performance on key areas… is monitored and the NHS held to account where it is not delivering, to ensure that patients continue to receive a high-quality, safe service.”

We wouldn’t disagree that NHS activity and quality needs to be measured- what we say in the book is that there are too many things being measured that either are not helpful or are not useful for any purpose- patient, medical or managerial. If they are not useful they are distracting and that means wasting staff time and resource.   Mervyn Stone, emeritus professor of statistics at UCL, recently has described the dire consequences of ministerial innumeracy, for one.

Let’s compare policymaking with medicine.  At present doctors rightly are being encouraged to become ever more “reflective learners”, and to demonstrate for  appraisal and revalidation that they show “reflection in action”. This means being able to learn from experience, and to take both welcome and unwelcome feedback, and think about it, starting from a view that “there may be something in what you say.” It’s the exact opposite of how government departments work. It’s asking us to drop our bluffing and asserting, and to look at the evidence for and against our current practices.

What chance of “reflective government” or “evidence based policy making”?

My friend and GP colleague Seth Jenkinson describes how any problem can be dealt with in one of four ways:-

1.    Deny the problem – possible for the short term, and involves a lot of energy to maintain the pretence
2.    Sort the problem itself- if you have enough energy, enthusiasm and resource to do this
3.    Sort out how you think about the problem- usually the most sensible route, but it involves reflection, thought, and discovering new responses to the problem. Demands some integrity and commitment, which are not always qualities we can muster.
4.    Move away from the problem- useful at times, sometimes necessary, but often only temporary solution. The same problem seems to crop up again in the new place.

I suspect that when the government changes there may be a sharp discontinuity in health policy. The current structures are incoherent, unbalanced and contradictory, as we describe in our book out today. In essence, there is a profound contradiction at the heart of the NHS: organisations are supposed to be acting like businesses and tailoring services to “win” customers, yet are operating in a system that fundamentally doesn’t want them to.

The pretence of there being a coherent whole will, I suspect, become unsustainable.  Significant new thinking is urgently required.

Peter Davies is a GP Principal at Keighley Road Surgery, Illingworth, Halifax