Seriously, Wes Streeting? After 14 wretched years of Tory austerity, stealth privatisation, draconian outsourcing, the Brexit workers drain and the horror and trauma of Covid from which – as you recognize – workers haven’t remotely recovered, the massive NHS plan is to be … naming and shaming? Full with inflammatory language that’s designed to scapegoat workers, such because the unhealthy managers you’ve branded the NHS’s “responsible secret”? Do you genuinely assume that is constructive?
At some extent when Ofsted – having contributed to the suicide of headteacher Ruth Perry – has lastly rowed again from its absurdly blunt software of one-word faculty inspection scores, it beggars perception that the brand new well being secretary thinks hospital league tables will assist the NHS. Streeting insists the brand new public rankings are a mandatory manner of stamping out poor efficiency. He desires hospitals judged on quantifiable elements akin to A&E waits, most cancers care and the dimensions of their finances deficits. Trusts might be publicly ranked from greatest to worst, with the CEOs of the worst offenders dealing with dismissal. In the meantime, the best-performing trusts might be rewarded with more money to purchase new gear or restore services, additional skewing the enjoying area.
There’s colossal cognitive dissonance on the coronary heart of this plan. Streeting himself is the primary to acknowledge the affect of structural inequalities on well being, recognising that deprived teams in British society are at better threat of in poor health well being and untimely demise. But his return to hospital league tables presumes that underperformance is all of the fault of these deplorable “unhealthy managers” and in some way divorced from the socioeconomic realities of the inhabitants they serve. He should know that hospital efficiency is intricately certain up with the supply (or not) of social care in a area, the prevalence of poverty, the supply of workers, native unemployment ranges and innumerable different elements past senior hospital managers’ management. Pretending in any other case is disingenuous.
Worse, league tables are a really blunt and really public type of ritual humiliation – exactly the form of punitive train that has demonstrably unfavourable results in healthcare. In actual fact, a “no-blame tradition” in drugs has been proven to enhance security by fostering openness, dialogue and studying from errors – but Streeting desires blame itself to be embedded within the coronary heart of his reforms. Penalising and shaming struggling hospitals dangers demoralising workers and inflicting sufferers to lose confidence of their native belief, all whereas pitting belief towards belief in a way that stokes suspicion and division. Trusts might be pressured into attempting to sport the system, pouring effort and vitality into the one efficiency requirements that “depend”, whereas neglecting different essential, but newly marginalised, points of care.
Hospital league tables are, briefly, a simplistic and retrograde gimmick. This zombie coverage ought to have died for good in 2005 when league tables had been scrapped 4 years after being unveiled for the primary time by Alan Milburn, then Tony Blair’s well being secretary and now Streeting’s prime adviser on the Division of Well being. Maybe Milburn thinks he didn’t go far sufficient final time, although this jaded NHS physician errs in direction of the definition of madness attributed to Einstein as “doing the identical factor over and over and anticipating totally different outcomes”.
My prescription for enhancing NHS efficiency is diametrically against Streeting’s in that it rests on the precept that nearly no person arrives at work to do a foul job. In actual fact – and in healthcare specifically – most individuals are motivated by a robust and easy need to do properly. They care. That is the foundation of the discretionary effort that famously used to maintain the NHS afloat, however which has all however been exhausted because the peak of the Covid pandemic. When workers go above and past what’s contractually obliged by staying late, performing small acts of kindness, taking effort and time to point out sufferers that they matter, the calibre of healthcare soars. It’s a small instance of a wider fact within the NHS – not all the things that issues in drugs will be counted, and never all the things that may be counted issues.
If Streeting persists in attempting to measure efficiency on spreadsheets and league tables, he’ll essentially omit what’s unquantifiable – the compassion, the tenderness, the humanity and the quirks that make drugs a uniquely human endeavour. What I do, for instance, after I discuss by means of with a dying affected person their biggest fears, or discover what helps them really feel like life remains to be price dwelling – or prescribe a gin and tonic in a glass with ice as a result of it reminds them of the life they love and never the demise that bears down. Measuring efficiency in numerical datasets entails erasing all of the elements of healthcare that can not be counted – and these we devalue and discard at our peril.