Now the news is that the public and patients were pretty satisfied with the NHS as it was. Ben Page of MORI was already making the point in July last year that the Ipsos MORI Issues Index back in 2002 showed the NHS as the top concern of more than 70% of us with only 10% of us worried about the economy. In May 2010 those positions are reversed although the NHS was still the most important for around 20% of us. This rather contradicts the idea that the pressure for change in the NHS comes from patients and public. Most of our blogs have been tracking the evolving public debate on the NHS with the emphasis on our particular perspective – the patient and public – and with a particular emphasis on the local, the front line and the GP practice.
The end of this particular piece of string is a quote from Mr Lansley in a February blog where he said
“In this Bill patients will come first: involved in every decision about when, where, by whom and even how they are treated. There must be nothing about me without me. The Wanless Report in 2002 called for patient engagement to happen; it didn’t, now it will.”
Everyone needs a place to start and a guide to the debate if they are not to get lost. When Caroline Millar went to the House of Commons in February to give our evidence to the Health Committee, the Chair Stephen Dorrel remarked that no one could blame the GP consortia if they felt a little giddy as they stand to be pulled in so many different directions by so many different bodies and interests. The potential for bewilderment was clear from Val Moore’s account of her most recent Patient Liaison Group meeting where patients attending were apologising in advance for asking ‘stupid’ questions and feeling guilty for not knowing the answers already – no need Val assured them. No one knows all the answers. Perhaps GPs and their patients can learn together and in the process understand how they can support each other in making decisions at both the individual practice/ patient and the commissioning levels.
Who is Minding the Store?
In the meantime who is minding the store and delivering the service? A disturbing piece of research about managing the NHS came up with the finding that many NHS managers were up to their neck in projects which gave them no time to be in charge of the service they were supposed to be delivering. The new projects and the new metrics that came with them originated from on high and took precedence over the processes to treat patients – the research showed that 85% of patients’ time was spent waiting for the next stage in their patient pathway. In our blog ‘The Heart of the Matter’, we were looking for reasons as to why Ann Abraham’s report about care for the elderly made such depressing reading. Why is it so hard to shift attitudes and change behaviours in the NHS? Trusts make promises to the Ombudsman to improve, to retrain and not repeat the errors of the past. But if, as the Lean Enterprise Academy’s research shows, no one is leading and managing that change, the Trust’s acts of contrition will change nothing. Just another project.
QIPP – the latest project
The process that is supposed to manage change across the service by ‘doing better with less’ is QIPP – Quality, Innovation, Productivity and Prevention. We reference QIPP in a number of blogs repeating the point ably made in a Policy Exchange report focusing on incentivising quality improvement in diabetes care, that a process that builds pathways and care in co-operation with patients will deliver the benefits promised by QIPP. Certainly those with long-term conditions need a strong process on their side since the record for the implementation of the National Service Framework of Care for Longterm Neurological Conditions is abysmal. As we say in a February blog, at the halfway stage the Neurological Commissioning Support team found that:
‘5 years after this NSF was published, not a single audited site could meet a single Quality Requirement’.
So the great debates go on in the chambers of the legislature, the GPs are giddy, NHS managers are involved in projects without outcomes and Pathfinders are over the target as we speak to drop the marker flares for the massed bombers of NHS Command with KPMG flying as top escort. Time to reassert the voice of the individual in a new creative way – take a look at Georgina Craig talking about Experience Led Commissioning putting the patients’ story right at the start (and heart) of commissioning. And while we are on the topic of the patient voice, welcome to the re-launched Patient Opinion site – I like the way the patient experience story is linked to outcomes. And dig the very cool purple haze site design – Hodgkin’s homage to Delysid and Jimmy Hendrix’s greatest song imho, says ageing 60s person.