Spot the difference….

James Gubb, 14 November 2008

It’s illuminating reading the DH’s two most powerful policy documents under New Labour, The NHS Plan (2000) and Lord Darzi’s recent review of the NHS, High Quality Care for All (2008). The latter is certainly more refined and less concerned with quantity, not making attempts to dictate the need for x more staff, equipment, buildings etc. Instead, it sets quality of care as the ‘irrevocable’ first. But are they actually that different?

Crucially, for Lord Darzi, quality rightly includes not just clinical effectiveness and safety, but also patient experience: the ‘quality of caring…the compassion, dignity and respect with which patients are treated [that] can only be improved by analysing and understanding patient satisfaction with their own experiences’. The NHS, as Nigel Hawkes put it in The Times, has ‘embraced the idea that customer is king’.
However, the rhetoric of quality is not so different from that in past policy documents. The NHS Plan (2000) asserted: ‘The NHS will ensure that services are driven by a cycle of continuous quality improvement’. It was supposed to be all about quality. ‘Quality’, it said it words very similar to that in High Quality Care for All, ‘will not just be restricted to the clinical aspects of care, but include quality of life and the entire patient experience’.
Indeed, many of the qualms behind the reviews are remarkably similar. References to ‘people [being] concerned that too much of what the NHS does is dictated by the needs of the system rather than the needs of the patient’; to ‘incentives [that] have not supported quality, patient responsiveness and partnership’; and a desire to ‘liberate the potential of staff [in] the NHS [to] shape its services around the needs of patients’ are all found in both the NHS Plan and High Quality Care for All.
Indeed, Lord Darzi has acknowledged that ‘progress has been patchy…particularly on patient experience’.
Why this unnerving similarity? Why – as is reaffirmed by the UK’s ranking of 13th in the Euro Health Consumer Index 2008 released today – despite record levels of funding since 2000, are the clinical outcomes and patient satisfaction achieved by NHS far from satisfactory and below most other developed European countries? Why are inequalities in health widening? Why we are consistently failing to achieve against the fundamentals of health care delivery: a patient-centred, clinically-empowered and safe health service? Why is morale so low and standards of behaviour and accountability declining? Why, in 2007, did only 48 per cent of staff in acute trusts agree that ‘care of patients/service users is my trust’s top priority’ (Healthcare Commission, 2008)?
The assertion of the Euro Health Consumer Index director Dr Arne Bjornberg that the UK risks “raising expectations that the healthcare system cannot deliver” is poignant. Is state-direction really the best way to achieve high quality universal health care?