Is Jeremy Hunt serious about tackling the “culture of complacency” and “postcode lottery”?

13 March 2013

Last Friday the Health Secretary, Jeremy Hunt, attacked what he called widespread complacency in many NHS Trusts. In a speech to the Nuffield Trust, he acknowledged the often world-class and pioneering work done by the Health Service, but alleged that there are too many instances of providers focusing not on excellence but on meeting minimum standards, with patient care suffering as a result. Continuing politicians’ recent tradition of forcing Olympics metaphors into every conceivable situation, he said:

“I want to suggest that too much of the NHS is focused…not on achieving world class levels of excellence – the gold medals of healthcare – but meeting minimum standards, the equivalent of ‘not coming last.”

He went on:
the NHS is a huge organisation with some good practice, some bad practice and a great deal that falls in between…. I would never describe the majority of hospitals or wards in the NHS as mediocre – but I do believe our system fails to challenge low aspirations in too many parts of the system”.

Quite rightly, Mr Hunt also referred to the ‘postcode lottery’, where the quality of care and availability of treatments varies widely depending on where you live; indeed a recent report by researchers from Imperial College London described how rationing of certain procedures is causing a great disparity in the availability of surgical procedures over the UK. Again, though, it is hard to see whether or how the government will rectify this.

Any acknowledgement of the problems faced by the NHS is welcome, but Mr Hunt gave little new information on what this ‘complacency’ actually means in practice, or what the government intends to do about it. He referred to previous mistakes, such as hospitals being rated simply ‘compliant’ or ‘non-compliant’ against the Care Quality Commission’s national standards, and to a target culture where the bigger picture, i.e. the patient’s actual experience, was ignored.  He did not say in any detail what the government will do to fix the problem, other than referring to the plans to create a new Chief Inspectorate of Hospitals within the Care Quality Commission, through whom success will be celebrated and failure punished. Specifics of this ‘celebration’ or ‘punishment’ were not provided.

It is not enough simply to posture about problems in the hope of achieving positive headlines. With a further 14 NHS Trusts now under investigation in light of Robert Francis QC’s report into the failings in Mid-Staffordshire, one can see why politicians might want to appear to be taking these problems seriously, but words alone will fix nothing. 

In contrast to the platitudes, some of the government’s actions to date - forcing through a massive increase in competitive tendering for NHS contracts, refusing (so far) to impose a ‘duty of candour’ on doctors to admit mistakes when they are made, and making it harder for injured patients to bring legal action when they have suffered from negligent treatment – suggest that, despite the rhetoric, patients continue to lose out to political priorities and cost-cutting measures.  Obviously the government needs to be given time to implement Mr Francis’s recommendations; however the signs so far are not promising.

The imminent introduction of a ‘friends and family’ test, supposedly a more human measure to rate hospitals, is welcome, but much more will need to be done to declare progress with any credibility. 

We must also be careful not to overstate the problems faced by the NHS simply because recent headlines make it permissible. Despite recent failings, our health service still provides often fantastic care to millions of people which most, if not all of us, have experienced personally.  However, for patients to truly be at its heart, we must stop the availability of treatment being dependent on where we live, we must focus on judging hospitals by the patient experience rather than just statistics, and for that we need more than warm words and Olympic-themed metaphors. Until these problems are taken seriously and acted upon, patients will continue to suffer unnecessarily.

The consequences of negligent treatment are often catastrophic and, while specialist lawyers can help ensure that victims are compensated, they cannot make everything as it was before; we need to stop accidents happening in the first place. Stories of avoidable suffering caused by sub-standard care are still too common, and nothing in Mr Hunt’s announcement points to a real drive to improve standards.

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On March 17th 2013 Jase Ayathorai commented:

An insighful and balanced article.
Metaphors can and do have a profound effect.
However the objective analysis of intended effects of the quoted metaphors highlight the rhetoric rather eloquently and appropriately by identifying the need for accountability by doctors of their mistakes.

The adverse consequences of post code lottery for patients affected is a serious problem which has to be addressed in some shape or form by DOH. Cases of recent past has highlighted the problem.

The conclusion raises a profound questions that have to be addressed particularly in relation to consequences of negligent mistreatment.

The main barrier seems to be accessing clinical records to identify the source of negligent mistreatment once a legal professional has accepted the case.

When consequences are catastrophic, perhaps a no fault liability approach could be adopted as the injury would be evidential damage. This could then free dedicated doctors who make errors of professional judgment due to being overworked and duly shift liabilty vicariously to the Health Authority. In effect, it will prevent defensive medical pratice. However for those few practitioners who are personally responsible for failure to act with professional expertise boundaries, ought to subjected to stringent scrutiny to prevent further occurences.

An enjoyable read.

Jase.Ayathorai.
Year 2 LLB Student

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