Medical care does matter, but the system gets in the way

Variations in care are perhaps the worst aspect of the NHS. Indeed, the irony is that one of the world’s most centralised and controlled health systems, should also be so fickle. Despite the fact that funding from general taxation brings some equity to the financing of Britain’s health system, it also effectively offsets this.

As evidence mounts on significant and unnecessary variations in care, the power of voice and choice will be used by those who can avoid the worst. Until recently, appalling standards of care tended only to become evident to users when they suffered at its hands. This seems to be changing. A series of inquiries culminating in the scandal of Mid Staffordshire Foundation Trust, have begun to raise awareness of what can happen.

This week’s BMJ study provides the public with evidence to prove what any patients have noticed for many years; that the NHS largely closes down for routine care over the weekends. Patients can bellyflop from the high-level attention of Intensive Care or High Dependency on a Friday to the lowest levels of benign neglect over a weekend on a general ward. Patients exercising the rights to choose and book their routine operations would clearly be well advised not to choose a Friday. The authors of the latest study blame the problem on staff shortages at the weekend, to which they euphemistically refer as “well known issues relating to reduced and/or locum staffing”. Indeed they cite another inquiry which revealed that only a minority of patients who died following an operation had received acceptable levels of care.

For the first time the debate over the NHS appears to be shifting onto a critique of its clinical standards rather than the old issues of waiting times and buildings. Nurses, doctors and managers have all finally come under the spotlight.

However, it is important not to forget that their work is shaped by the system within which they must operate. And it is this system which needs a fundamental overhaul.

*Dr Tony Hockley is Director of the Policy Analysis Centre. He is author of Politeia study A Premium on Patients.

Dr Tony Hockley

Dr Tony Hockley is a Visiting Senior Fellow at the Department of Social Policy at the London School of Economics & Political Science. He is Director of Policy Analysis Centre Ltd and the co-author of Politeia’s Working Systems: Towards Safer NHS Nursing (2014) and A Premium on Patients: Funding the Future NHS (2010).

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