I recently read an interview with Sir Robert Naylor who commented that “the NHS is a victim of its own success”. Where you can be treated and sent on your merry way only to return later in life with more complex issues. Consider the old Cancer Wards where the patients that went in seldom came out again, in comparison with today where over 50% of oncology patients live for more than 10 years post diagnosis.
When a few trusts are struggling then they are doing something wrong but when nearly all of them are floundering then there is something wrong with the system and increasing the regulations and consequences of inspections isn’t helping anyone. Giving a fine and increasing inspections for a trust that is struggling financially will do the exact opposite of helping them to rectify the problem. As Professor Keith McNeil theorised of current health policy “people are trying to treat the infection with the wrong antibiotic and all we do is keep increasing the dose”.
A system that judges a hospital with low mortality, no hospital-acquired MRSA for over 18 months, and the best transplant outcomes in the UK as inadequate as it doesn’t have the ‘required’ number of nurses, is not a system that can trusted to evaluate the best care. One maternity department in particular was rated inadequate despite not having a single childbirth related death in over a decade, whereas another local hospital had had 5 maternal childbirth deaths within the last 3 years but was only rated as ‘needs improvement’ as it fulfilled more of the staffing requirements on paper. Lulling the public into a false sense of security when a hospital is rated good just because of the staff numbers, with no consideration as to the quality of care.
These institutions should be praised for providing exemplary care despite being understaffed and underfunded, not criticised for not fulfilling a government tick box.
Evaluations need to be focused on outcomes as opposed to being criticised for inputs. The OECD (Organisation for Economic Co-Operation and Development) noted that the NHS had some of the poorest outcomes because of a focus on process without paying due attention to outcomes.
The system is broken, becoming more fragmented with every passing policy, how long does this have to go on before we have a leader that stands up and says “this isn’t working, we’d better do something different”? We have Monitor, CQC and CCG’s all regulating quality and with each organisation wanting basically the same information in a slightly different way, how much money and resources is being wasted and taken away from patient care just to jump through all their individual hoops?
I am not against regulation, it holds everyone accountable and gives a shared focus, but the system needs to be aligned and to remember that people don’t work for the NHS just to have a job. There are many simpler and less stressful ways to earn a living after all. We work for the NHS because we believe in the work it does and what the NHS stands for. From commissioner to provider to regulator, we are all on the same team.