Filed Under (Health Policy, Public Health) by Paul on 09-01-2013
Reading some of the press reports on Monday, following the Prime Ministerâ€™s announcement of the extension of the â€˜families and friendsâ€™ question to more organisations serving NHS patients, felt like an old and welcome friend from some years ago had returned. It made me wonder whether, after more than two and a half years of complete mayhem, the Government may be starting to find its touch with the politics of NHS reform.
Let me describe this old friend. We used to meet every 6 weeks or so when I was special adviser on NHS reform to the New Labour Government between 2001- 07. The great thing about them was that they always had a very similar story to tell.
With the NHS it would begin with the Government suggesting that it might be a good idea to tell the public something or other about the service for which they were paying. It could be something quite minor – or something very important. In its own terms it was not usually a very big deal. Indeed in other services it would be a normal experience for the public to know such information.
One of the earliest and more significant sightings of our old friend was in September 2001 when we published the NHS Trusts star ratings. This was a big deal – not because it was a particularly radical thing to do – in other areas of society it happened perfectly normally – but because it had not been done before in the NHS.
Another example was the publication of outcomes data for heart surgeons.
Whenever we published something like this we knew that within a few days, irrespective of the issue itself, there would be a â€˜rowâ€™ about its publication. This â€˜rowâ€™ would magnify the importance of the event and keep the issue in the public eye for some time.
The row might contain a number of different themes, but one that would always come through – a consistent trait of this old friend – was that someone would say that the public were not sufficiently clever to understand what was being published. It was â€˜very complexâ€™ had a whole range of nuances which â€˜only a few people would understandâ€™. It was therefore, wrong to publish it at all.
This would always be the response of some organisation or another within the NHS.Â Thatâ€™s what made it such an old friend.
The interesting thing about being in Government was that it took nothing to get this row going â€“ someone could be relied upon to react in this way. Journalists knew this too and within a few hours would have rung around and found someone to attack the publication in these terms.
The Government could then continue the row – and there were two ways of doing this depending on how bullish they felt at the time.
One could say, more in sorrow than in anger, that you are sure that the organisation concerned doesnâ€™t really think that patients canâ€™t understand star ratings – or mortality rates â€“ and that, given that the public pay for all of this, surely, surely they have a right to know?
Journalists would then go back to the organisation and ask them what they think, and the organisation would say, â€œNo, this is too complex a matter to be reduced to a single numberâ€¦ etc., etc.â€
Or the Government could, on behalf of the public, get angry and say, â€œRemind us again who pays for all of this! Remind us again who is the patient!â€ (â€œAt the centre of the NHSâ€ etcâ€¦.).
Whichever way this played out the old friendâ€™s visit always ended with the Government being seen to be on the side of informing patients – and some part of the NHS, or â€˜medicsâ€™, being against it.
That is why this stratagem is such an old and welcome friend. Easy to get on with and always ending on the right side of the argument.
One can never be sure with this Government, they have been so all over the place in their narrative about NHS reform, but with this friends and family announcement they might just have discovered our old friend.
It was a small uncontentious announcement. Most people understand what it means; most people probably think it makes some sense. OK, why not?
But then someone comes along and says, â€œNo, medicine and hospitals are all too complex for a single judgement (Something a patient would never know of their own accord of course!) so we shouldnâ€™t collect the data and tell the public.â€
The Government can keep this one going every few weeks – between now and the 2015 election. It will give them one of their few opportunities to demonstrate that they are on the side of patients, whilst there are those in the NHS who want to hide things.
Christmas and New Year is a time for old friends. Meeting this one again has reminded me of what good times we had those few years ago.