Thursday, 8 September 2011

Honesty and deception

The main criticism of the NHS reforms is undoubtedly the strong potential for the NHS to be handed over to the private sector bit by bit, or at least the potentially lucrative bits of it. There is I think an open mindedness to the concept of abolishing PCTs, which many see as far too controlling, and giving more power to practices through commissioning, but the thought that segments of the service will so blatantly be sold off to Cameron’s mates so that they can skim off the top drives most of us to teeth grinding apoplexy.

You have probably noticed that Trusts are already starting to act as if they were private companies. For example, I will bet that your Trust has a mission statement. A completely meaningless and empty phrase that appears on Trust literature to give the impression that the Trust is a dynamic, forward thinking, hypersuperlative organisation, when in fact at best the care is no better than it has ever been, and at worst, well Stafford springs to mind. Perhaps they should focus less on telling us how wonderful they are, and more on showing us.

Something else that Trusts are indulging in is the active soliciting of feedback from the “clients”, as patients are now referred to. It is not enough that the staff are overwhelmed by useless tick box forms, now the patients are asked to fill them in as well, by prying into the “patient experience”. How was it for you?

The results of these will always be positive, because despite the attempts of management to fuck things up the medical and nursing staff usually manage to deliver the goods in spite of the increasingly difficult circumstances. For which the management will then take the credit.

But the results of these surveys will always be useless. The bottom line is that the British don’t like to complain. When was the last time you had a poor meal in a restaurant, with indifferent service, and not only failed to complain but left a tip for the surly ape who threw the food at you.

This unwillingness to complain was brought home to me once by a patient. I had been seeing him for some time, and none of my endeavours gave him any benefit. I wondered if a change of approach might help and referred him to one of these multidisciplinary teams that everyone thinks are the way forward. Some weeks later I received a letter from the team leader telling me how well the patient had responded to their approach, and that he had informed them that he was so improved that they had been able to discharge him.

I was somewhat surprised therefore when he subsequently reappeared in my clinic with the same problem, claiming to be no better. I showed him the letter. His exact words were; “Well, they were nice people, and they worked hard, so you tell them what they want to hear don’t you? But actually it was a complete waste of time. Utter crap.”

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