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A health-obsessed NHS is no use to anyone


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Thursday, 28 March 2013

A health-obsessed NHS is no use to anyone

We live in a world obsessed by health. Some of these obsessions are harmless and a few are good for us. In the former category we might include people who explore the outer reaches of alternative medicine where herbalists, spiritual healers and snake-oil vendors do business.

In the latter category are those who have made it their business – in some cases their life’s work – to stay well. Meet them at any health club and compare personal bests, muscle repair remedies, protein drinks, rehydration techniques and core stability regimes.  These people will probably live to be 140, but without their own knee joints for the second half of their lives.

Most of the rest of us are more or less normally interested in our health, enough to take care of what we eat, avoid drinking too much and make sure we get some regular exercise; and enough to seek medical advice if we’re worried about something or start to feel unwell.

A small minority are unhealthily obsessed with health. Among them is the NHS.

The first resort of a sick mind is to blame the body. Hypochondriacs invent health problems to justify anxieties they can’t otherwise explain or don’t want to confront.

The NHS has a heap of middle-age anxieties including money worries, lack of job security, workload, waning popularity, change, the future, growing old.  If that wasn’t bad enough, it has just messed up horribly, people have died needlessly; a fine career record has been spoiled.

In his overlong diagnosis of what went wrong and his overcomplicated prescription for a cure, Robert Francis unwittingly gave the NHS the opportunity to resort to type. Introverted, introspective and prone to worrying about its own health, the NHS rarely needs an excuse to start feeling for lumps.

In his report, Mr Francis identified many of the things that stand a good chance of curing the NHS of Mid Staffs, such as minimum staffing levels on wards. Rather than treat the obvious symptoms, cut out the diseased parts and set the patient back on the road to recovery, the government has selected from the lighter items on Francis’ extensive a la carte menu of recommendations and added a few waffles of its own.

The quest for The Culture, silly tests to find out whether nurses really care or are just pretending, the endless initiatives, new unenforceable duties of candour, whistleblowers’ charters, re-engineered inspection regimes, expert patients armed with tape measures and speed guns – all of these are designed not to encourage the NHS to get well or even to treat the existing sickness but to seek out conditions it doesn’t even know it has yet.

The window-dressing will cost a fortune and achieve nothing. The relatives of the victims of Mid Staffs are not so easily fooled. Few of them have shown any interest in apologies or ritual reparations. Most of them just want to see the NHS get better.

As last week’s poll showed, the money is a secondary issue. The NHS can survive financial privation (up to a point), but morale is low, staff everywhere are disaffected , embattled and demoralised. They do not feel valued, nobody is telling them they are doing a great job, they are losing their sense of purpose and going through the motions. They do not feel trusted, a suspicion that deepens as the machinery of regulation and inspection becomes more elaborate.

The NHS needs to be self-critical, but constant criticism has the opposite effect, stunting the growth of individuals' critical faculties and making them less responsible for their own behaviour.

Rightly or wrongly NHS staff have come to feel that the people exhorting them to care more couldn’t care less. This is the real waste of resources which threatens to drain the life from the NHS and the sickness at the heart of the system, but it won’t cured by becoming still more inwardly focused and cautious.

People who spend a lot of time worrying about their health are unhappy and distracted, they struggle to lead normal lives and maintain relationships, their work suffers and they are prone to mistakes.  Institutional hypochondria has the same characteristics but on a bigger scale and with more disastrous consequences.

The more obsessed the NHS becomes with its own health, the less capable it becomes of looking after itself or anyone else.

anoop.maini@gmail.com says:
Mar 28, 2013 02:03 PM
The last sentence is very profound indeed. But it can also be turned around. How do we make the NHS obsessed by the health and wellbeing of patients?

At an interesting meeting i had with a behavioral economist at Imperial College, he said: The single largest influence on behavior looking across all studies was setting a goal and giving frequent feedback against it. This requires measurement.

So perhaps we need to stop measuring everything, except for "health and wellbeing of patients". And then set goals, and give frequent feedback.

The next challenge is how do you measure health and wellbeing? Well i am working on this at the moment, and if the money put into Francis were put into this, then we'd probably have an answer soon!
jpatterson says:
Mar 28, 2013 02:46 PM
I'd be interested to hear more about what you're up to. On leave next week but back Monday 8th.
simon.westonsmith@esht.nhs.uk says:
Mar 28, 2013 02:59 PM
Another thoughtful insight into our woes. Thank you.

Our culture of compassion will only be further diminished by more regulation.
jpeter1@mac.com says:
Mar 28, 2013 04:18 PM
How sad with so much data available that the editor remains in self-denial. Would have have made the same feeble excuses if it were private medicine under attack?
jpatterson says:
Mar 28, 2013 05:23 PM
Hi John
I'm not really clear what point you're making. Data about what?
harry.longman@gmail.com says:
Mar 28, 2013 08:22 PM
Cogently explaining why it belongs there. It has always been said that hard cases make bad laws, but we seem stuck on the opposite tack of only making laws after hard cases.
Funny if it wasn't so tragic. Anyone else think that the organisation people who will benefit most from increased regulation will be the same ones who thrived under the old regime? Sorry, I'm sounding as if something has changed.
tsmith says:
Mar 29, 2013 09:34 AM
Firstly, as usual a very insightful blog, I hope it's read by policy makers. Regarding data, for example, many studies, some very recently in the news, consistently show that staffing with fewer qualified nurses results in higher patient death rates. Would be interested to hear what data John above is referring to.
jemma.mcleod@live.co.uk says:
Mar 31, 2013 04:36 PM
This is an intriguing post; Our society today has become health obsessed hypochondriacs, and this isn't just the NHS, we all are, and we all influence the NHS's actions to finalize the decisions they make.

I would be interested to see what your views on the increase in gastric band operations over the past 6 years is. Are they unnecessary? Is is right?
Please take a look at my blog post on this issue.

robin.cameron@nhs.net says:
Apr 02, 2013 10:22 AM
A perceptive Blog (if a little tongue-in-cheek). I couldn't agree more about the need for more 'qualified' nurses. It's not just a numbers game. If Trusts fill shift rosters with semi-qualified or unqualified nurses, bumped up by a scattering of itinerant 'Bank-Staff' (here-today, gone-tomorrow with too little empotional investment into the patients on the wards to which they are temporarily seconded). It leaves the remainder, the full time, fully qqualified in all the procedures and processes of the ward speciality in question, in too small a minority. These too few people haven't got shoulders broad enough to fill the 'care-gap' left by all the rest.