My mission statement

The times we are working in now need a great deal of accelerated change and there must be no negotiating that down. So my mission statement for this part of my consultancy career is to be clear that there needs to be and will be a lot of change from the work that I do with individuals and organisations and if organisations don’t want that, then it is probably best to go somewhere else.

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Saving the NHS: – A health care system free at the point of need with equal access for all.

Filed Under (Health Policy, Reform of the NHS) by Paul on 18-04-2012

The role of public information matter in creating greater equality of access.

Yesterday’s post made the point that some of the fiercest arguments about ‘Saving the NHS’ have been about the way in which the state has organised the NHS rather than about the basic principle of equal access for all – free at the point of need.

I made the point that those wanting to save the NHS include some who believe passionately that the one they want to save is a strong central state organisation.

They see the activities of all the reforms over the last 20 years as trying to undo the central power of the state over the NHS – and therefore trying to undo the NHS itself.

I think they are right about the former but not about the latter.

One of the continuing aspects of this argument that has surprised me in its tenacity is the nature of the public’s right to information.

Before the coalition Government messed up its narrative for reform so badly I had felt that the argument that the public should have access to all possible information about the NHS and its delivery had been won. By 2010 I felt that those who were arguing against open access to information had recognised that in the world of the internet, that battle was lost.

But the Government’s failure to establish any strong argument for reform has impacted on the whole reform movement – even public access to information.

This is a really important and telling argument that cuts across what one person might want to save about the NHS – and another wants to change.

There are those wanting to save the aspect of the NHS that does not publish information about the outcomes of doctors and health providers. For them ‘Saving the NHS’ means saving a system which does not bother its users with the enormous wealth of information that exists within it.

Medicine is full of information. The NHS has masses of data. Some of it is not very good data and some of it is really good information. For the last 12 years or so all governments have been trying to get more and more information out to the public about the different ways in which the health service performs.

For much of that period I have been involved in debates with people who genuinely believe that the provision of this information is in some way ‘wrong’. There are several arguments that are deployed.

  • The public aren’t interested in having the information.
  • The information is not very good and not about ‘real’ things.
  • The provision of the information to the public will increase inequality. (Just to make the point – for the third argument to have any salience at all obviously depends upon the first two being wrong)

Over the last dozen years that I have been working with the NHS I have come to know a number of doctors. Given my age and theirs, a number of them and their loved ones have needed good NHS care during those years.

To a person they have been able to find advice on where to go for treatments (and where not to go) by making a few phone calls.

I am not saying there is something morally wrong with this. If you work in a service and are a part of a profession that works in that service, it is inevitable that you will either pick up first-hand knowledge or contacts that can tell you where to get it. It’s the same with teachers and universities, and is actually the same in the construction industry.

This is important and really useful knowledge.

And because of the way in which this knowledge is treated at the moment (only being available in what has been referred to in education as ‘the secret garden’) it of course reproduces inequality. If you know a doctor as a friend you can ask for access to it. If you don’t, you can’t.

And the friendship of doctors is a class-specific experience.

What I want to do is make this available to the public as a whole.

Some of this information is picked up in the day-to-day interactions with other professionals (what in the trade would be called a ‘reputation analysis’). This is often very difficult to collate and verify.

But the profession makes important decisions for their families on this basis, and I think the public should be allowed to do so as well.

One of the most important realities in this debate is the fact that, even if it wants to, the old NHS cannot control the provision of information to the public. There are significant organisations such as CHKS and Dr Fosters who over the last dozen years have been collating and publishing this information.

They are alongside a growing array of different health informatics engines (some of which are apps) which are changing the face of NHS information every month or so.

So I know there are some who want to ‘Save the NHS’  by keeping information to themselves.

But for me one of the reasons that the NHS failed to develop equal access for all is that it failed to put enough time and effort into developing equal access to information for all.

Comments:

One Response to “Saving the NHS: – A health care system free at the point of need with equal access for all.”


  1. Paul, I agree with you completely that publicly available outcomes data drives improvement in healthcare delivery.

    Evidence shows that professionals improve their performance by knowing how they perform compared to their peers. Professional pride, ego, and competition drives this improvement. Patients and carers weigh in now through surveys, but more needs to be done to make this data transparent. This is not always comfortable but it works. And the end result is fewer errors, better outcomes, more satisfied staff, patients, and commissioners, and higher performance by all. It’s win win win.

    I wrote about this in September 2011 in a resource centre piece in HSJ titled “Can competition transform healthcare delivery in the the NHS?”

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