Promises, promises

The most any government can hope for when it comes to the NHS is that it leaves it in better shape than it found it.  The hugely disruptive structural changes of the Health and Social Care Act are unlikely to amount to much more than jumping up and down on the spot come 2015, and funding will have flat-lined or dipped.  But the Government has made a number of  bold  half-promises that could make a big difference to patients. Will they keep any of them?

Routine services should be available 7 days a week.  This is currently ‘under investigation’ by  NHS Clinical Director (and former heart surgeon) Bruce Keogh. There seems little point in lighting and heating hospitals all weekend but only offering emergency services, and it’s outrageous that your chance of surviving hospital depends on whether you get sick ‘in hours’ or ‘out of hours.’ According to a Health Service Journal survey, NHS chief execs rate the ‘out of hours’ safety of their hospitals as only 5.9/10. The theory goes that if routine GP and hospital services were available throughout weekends, there would be fewer unnecessary emergency admissions. But Keogh’s plan requires investment, resources and union backing.

Performance of individual surgeons to be published in the summer. Another of Keogh’s, this will apparently start with ten surgical specialties (adult cardiac,  vascular, upper gastro intestinal, colorectal, orthopaedic s, bariatric (weight loss), urological, head and neck, thyroid and endocrine and interventional cardiology). If it can be done in a fair way that doesn’t discriminate against surgeons taking on harder operations and doesn’t hinder surgical training, it’s a great idea. It might even stop orthopaedic surgeons dabbling with unproven joint replacements (Eyes passim). It was first promised after the Bristol Inquiry only 12 years ago (Eyes passim ad nauseum).

Hospitals will be forced to own up to mistakes. So promises health minister (and former obstetric trainee) Dan Poulter. The ‘duty of candour’ was another key recommendation of the Bristol Inquiry.   Poulter is proposing to make it ‘contractual’ (from April 2013) rather than ‘legal’,  which would give it less weight and may exclude GPs and dentists. Minimising the harm done to patients, and being honest and compassionate when harm does occur, are both vital for a humane NHS but it remains to be seen if this promise is genuine or just a move to pre-empt the Mid Staffs Inquiry report.

A national database of children at risk. Another Poulter promise, to track 11 million children through school, social care, hospital and GP visits and quickly alert staff to those who may be ‘at risk’ from abuse. Another laudable plan, first considered by Labour in 2000 after the Victoria Climbie tragedy. The ContactPoint database – which cost £224 million to set up – was scrapped by the coalition for ‘privacy and security reasons’, and switched off in August 2010.

 ‘Ofsted style’ ratings for hospitals and care homes.  Jeremy Hunt is keen on this, with hospital ‘superheads’ brought in to tackle poor performance. This suggests Hunt has little confidence in the CQC and Monitor to keep the NHS up to scratch, and that a visionary leader can be persuaded to be parachuted into a failing hospital to turn it around. Labour tried this with mixed results. Given the number of hospitals currently in financial crisis and providing patchy care, this will need a steady supply of superheads. Or maybe the basket cases can be rescued by ‘super’ Virgin or Circle.

All pensioners to be tested for dementia. Hunt has shown a commendable interest in dementia but any benefits of earlier diagnosis have to be carefully weighed against the harms of anxiety and misdiagnosis. According to the Torygraph, the Hunt plan sees bank and shop workers trained to ‘identify the condition’. Is this wise?

MD