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Judging the real risks to the NHS

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Clearly distinguishing between problems affecting certain organisations and any impending systematic crisis is essential to prevent knee-jerk, short-term solutions and developing sustainable ones

Health reporting HSJ and LGC logo

The review section of last Saturday’s Guardian led with a long extract from Roger Taylor’s fine book God Bless the NHS. The book’s subtitle gives a clue as to why the paper gave it such prominence. It is: “The truth behind the current crisis.”

‘The danger of living in permanent crisis is not only does it sap morale, but it can mean when a real crisis comes along it can fail to register’

During the last decade the NHS has been “in crisis” over everything from waiting times to healthcare-acquired infections to financial meltdown (twice). There are also the reliable staples of “crisis over NHS reform” and, the hand-wringers’ favourite, “a crisis in caring”.

Like a seabed earthquake the Francis report unleashed a whole new tsunami of crises − with even the NHS staff survey getting the front-page treatment, despite attracting little attention for the (very similar) results it produced in the previous two years.

Jeremy Hunt stoked the fires in a well intentioned but misjudged speech, which likened the NHS’s performance to the disastrous medal haul achieved by Britain in the 1996 Olympics. The “crisis” headlines were duly dusted off, with “mediocrity” and “complacency” serving as proxies in this case.

Relentless attack

It is hard to know if the widespread reporting of this speech made Sir Bruce Keogh decide enough was enough. But it is a matter of record that the NHS Commissioning Board medical director hit back just a few hours after details of Mr Hunt’s speech were released, and at the same event the health secretary was due to address.

Before answering the first question about his review of hospitals with high mortality ratios, the mild-mannered knight asked to make a short statement.

He said: “Many people are being ground down by a relentless attack on those who are really trying to do a good job in our NHS − whether they are managers, doctors or nurses. One of the things I would like to come out of… my review is recognition of the fact that our NHS is still something we should be very proud of.”

Good for Sir Bruce.

The danger of living in permanent crisis is not only does it sap morale and purpose, but it can mean that when a real crisis comes along it can fail to register, and spark a response, until the damage is done.

The real crisis

And that real crisis could be arriving soon. The political discourse this week has been dominated by questions over whether previously protected departments should be spared the budget axe. Half of those at HSJ’s roundtable debate on whistleblowing thought care quality would be undermined by existing financial restraint. The remainder thought the NHS could − just about − stop things getting worse. It is hardly a reassuring message.

‘Berwick argues that, despite financial constraint, the NHS can adopt innovations to be among the safest health systems in the world’

At the Nuffield Trust summit, Care Quality Commission chief executive David Behan acknowledged quality would be, and in some cases already is, endangered by austerity. Mr Behan rightly added the regulator would make no “allowance” for lack of resources, but in doing so failing organisations and services may be rapidly dragged into the spotlight with all that entails.

Even Don Berwick, the man brought in by government to help the NHS achieve “zero harm”, acknowledges the dangers of austerity.

The NHS has to understand what it needs to do to improve in the environment it has to operate in. Clearly distinguishing between problems affecting certain services or organisations and any impending systematic crisis will prevent knee-jerk, short-term solutions, but give urgency to the development of more sustainable ones.

Professor Berwick argues that, despite financial constraint, the NHS can adopt innovations that will make it among the safest health systems in the world.

Roger Taylor, in his under-reported conclusion, ends his book by declaring: “We are still waiting for a leap forward in our health services. But we have good reason to hope.”

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