Reasons to be cheerful

4 Jul 08
VICTORIA MACDONALD | It has long been a source of frustration for politicians that if you ask a member of the public what they think of the National Health Service they will grumble and moan and say it is all going to rack and ruin.

It has long been a source of frustration for politicians that if you ask a member of the public what they think of the National Health Service they will grumble and moan and say it is all going to rack and ruin.

But when you ask them about their own personal experience, they will generally say that it was wonderful and the nurses were lovely and the doctors could not have done a better job.

Indeed, an Ipsos-Mori poll last year found a 30-point gap between what people think about the NHS at national level and their views of local services. At the same time, almost three-quarters of people agreed with the statement: ‘The NHS is crucial to British society and we must do everything to maintain it.’

All this week, the health service is celebrating its sixtieth anniversary, rightly highlighting everything it does so well. To do otherwise would be as crass and churlish as congratulating someone on their six decades but adding: ‘God, your crow’s feet are bad!’

So, while we can probably all think (too easily) of examples of health service failures, now is the time to rejoice in the successes.

The NHS has unquestionably improved over the past ten years or so. Massive building programmes have transformed its very fabric, casting the long corridors and dingy Nightingale wards into the last century.

The walls are no longer institutional grey and the permeating smell of disinfectant and stewed cabbage, which always clung to your clothes long after you had left the building, has gone.

More importantly, waiting times are down and there are more doctors and nurses, who are also better paid than ever before.

Neither can anyone deny that there has been record investment in the service, even though it can be argued that the funds have not always been wisely spent.

And there is still plenty of room for improvement. Even the health secretary says there is more to do. After all, this is, and always has been, a long-term project.

But what have not been destroyed are the fundamental principles of the NHS. Now these are to be enshrined in an NHS Constitution. The government’s draft proposals, published on June 30, set out the NHS’s rights and responsibilities to us as patients and, in turn, our rights and responsibilities. Turning up for appointments, for example, would be a good start.

In turn, we will, under the proposals, have the right to be treated with dignity and respect and given a professional standard of care in a clean environment. Who could possibly complain about that?

Tied up with the constitution proposals was the release of health minister Lord Darzi’s report, High quality care for all.

None of the suggestions in this report is wildly radical, indeed many are not in the least bit controversial. The exception is, of course, the plan for polyclinics — and the British Medical Association might have backed itself into a corner over that one.

But that is probably as the government would want it at the moment. What with everything else on Prime Minister Gordon Brown’s plate, the last thing he needs is the huge outcry that accompanied, say, Margaret Thatcher’s overhaul of the health system in the late 1980s.

It is not even as interesting as the 2000 NHS Plan from then health secretary Alan Milburn. This not only made a lot of exciting promises, such as increasing staffing levels, but also spelt out a relationship with the private sector for the first time — something the government has since pursued with vigour.

But Darzi’s report does one thing that will be welcome to NHS staff — it contains no suggestions of structural upheavals. Instead, it is very much about the clinical aspect of health and medicine today, with quality at the heart of it.

It is hard not to laugh mirthlessly though, when Darzi’s document talks about ‘putting the patient first’, as if that were a new and radical idea. Yet, if patients’ right to choose where they are treated — rather than this decision being at the whim of their GPs — is enshrined in the NHS constitution, that really would put patients first.

And Darzi’s plan to measure the quality of care and outcomes of treatment across the service is exciting — the first attempt of its kind in the world. Perhaps it will lead to more paperwork — but if it works, and we can be told why and how it works, then that must improve the care patients receive.

One health expert even described the report to me as seminal, as having great vision. That might be a tad over the top but in this sixtieth anniversary week there is a marked lack of cynicism surrounding the NHS, and it is not often that this happens.

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