Monday, 9 May 2011

What's it all about, really?

The news channels are filled with chat about the Health Bill. Having just woke up from a kip after a night shift, this struck me as odd, as I am pretty sure that the nature of the debate I was hearing was stuff we were all talking about a month ago. To my sleep deprived mind, I could not work out how this had made it back to the agenda.

As with many things the answer came via Twitter, from @katycheema who told me ‘after last week's elections, the health bill is the figurative playground where everyone is chanting 'fight, fight'. Spot on.

It should be interesting, and now that  the matter is in the media, there is a good chance to put forward ideas about how the health bill should be altered to meet the needs of the public better. I know that the Department of Health has opened up a forum for sharing ideas about what should happen (, and the challenge for all of us, now that we have managed to get others to listen to our concerns about what is wrong with the health bill, is to provide suggestions to how it should be altered - the no-change option ceased to be an option months and months ago.

I don’t want to influence your views on what should and shouldn’t happen now, but what I would like to do is to remind you what it is all about. The language of the debate about the Health Bill has often been funereal, with the death of the NHS being a consistent theme. But this has always worried me a little, because the goal is not necessarily the protection of the NHS per se, but rather the preservation of the principles of comprehensive, effective healthcare, free at the point of use for our population. I know that I have just rehashed the guiding principles of the NHS, but my point is that the NHS as we know is one way of meeting these ambitions, and if a better way of achieving these goals comes up, that involve fundamental changes to the organisation and structure of the NHS that make it unrecognisable from it previous form, then that in itself is not a bad thing. The goal is patient access, outcomes and experience,
Sometimes the resistance to change is simply resistance to change, rather than a focus on what the health service is trying to achieve.

From one on-call shift, one can see that however hard we all work, the NHS does not always put the patient at the centre. What is interesting is that it is so easy to allow patient care to be influenced by factors other than what is best for the patient. A number of times over the weekend, I found myself debating the best treatment for patients with other doctors, and realised that the nature of our conversation had almost precluded the argument being concluded on the merit of clinical arguments. The main factors at play were intellectual tussle (who could generate the best argument - a particular hobby of mine, aka intellectual masturbation), interprofessional rivalry (who has the most kudos), overwhelming tiredness, pride, and uncertainty combined with reluctance to admit uncertainty (see the first factor). I am happy that in the end, all of my patients received a good standard of care, but I had to be on my guard.

Politics is a daily reality wherever one works, but it seems to have an embarrassing salience when it occurs in the context of a patient’s care. The familiarity of other people’s sickness and fear undermines its resonance, but we fail in our roles if we ignore it: so much of healthcare is about the memories people take away from their experiences in hospitals. Most of my patients do not know good healthcare from bad, but they do know whether they have been treated with compassion, respect and dignity.

So when you’re thinking about how the Health Bill should be changed, remember that it is all about the patient - their outcomes and their experiences. And do not be afraid of dramatically changing the NHS if it helps us improve both.

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