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Everyone driving but no one in control of the vehicle


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Friday, 9 September 2011

Everyone driving but no one in control of the vehicle

It has been another bad week for analogies. An official communication about the second reading of the health bill arrives with the cheery headline: “Putting patients and health professionals in the driving seat.”

Putting more than one person in charge of a vehicle is never a great idea.

Crash scene officer: “So who was driving?”

Patients and health professionals: “We all were!”

It may only be a figure of speech, but it exposes one of the real difficulties of the reforms. The driving seat is not a position anyone really wants to occupy, certainly not patients or health workers. In the passenger seat telling the driver where to go or in the back seat instructing him not to go any faster, yes. Driver’s seat, no.

In the generally rather poor Panorama programme, which turned out to be an extended opinion piece rather than the promised investigation, the secretary of state for health swerved the wrong way down a one way street when he compared hospital closures with the decision to close a supermarket.

You wouldn’t take a decision to close a hospital at head office, he said. The programme’s presenter, Gerry Robinson, disagreed. Where else would you take it? Cue crunch of ministerial gears and high-speed reversing manoeuvre.

The problem isn’t so much equating hospitals with branches of Tesco and Asda, though that isn’t wise in itself, but to go on to qualify the remark, as Andrew Lansley did, by insisting that hospitals will only ever close if patients agree to it.

This is only a realistic scenario if you can also imagine the following headlines appearing: “Local anger as hospital kept open”, “MP blasts health chiefs for failure to close much loved institution”.

And here’s another rhetorical fishbone to choke on. There will now be a “duty of candour”, according to the same people who brought us the multi-driver NHS. This is apparently “a contractual requirement on providers to be open and transparent in admitting mistakes”.
“The hospital removed both my legs instead of my appendix, but I was impressed by their candour,“ said a patient.

“It was us all right. Second major cock-up in a week, but at least this one didn’t die,” admitted a hospital spokesperson.

Health service providers already have a duty to own up to their mistakes and a much more important duty to avoid mistakes in the first place. Is anyone seriously proposing that an incompetent provider might mitigate other failures by acts of outstanding candour?

And what about organisations incapable of causing unnecessary harm to patients? No mistakes would make it impossible to demonstrate candour. Contract termination must surely follow.

geraldineflavell says:
Sep 09, 2011 08:44 AM
Although health service providers have a duty to own up to their mistakes, public perception seems to be that they don't, and in these circumstances, we are a long way from the candour that would indeed mitigate the effects of human error. How often do we still hear: "If only they'd said sorry". Don't let's undo all the good work we've done in moving towards openness and honesty by imagining we've got there.
ChristineWhittaker says:
Sep 09, 2011 08:50 AM
I never normally comment on blogs but I just have to say that this weekly network blog is the highlight of my week. In today's NHS it's very rare to hear even a chuckle let alone outright laughter but I have to confess to both! Nice to have an alternative analysis of policy.
mjthompson says:
Sep 09, 2011 10:04 AM
This weekly comment also is a highlight for me, a frustrated stand up comedian springs to my mind. The author also regularly manages to get to heart of the many issues the NHS faces, in a thought provoking, often very humorous way.
Panorama - poor?, not as poor as none of the main channels covering adequately the passing of the Health and Social Care Bill thorugh the House of commons. They Seemed more interetsed in the planned(?) abortion diversion by Nadine Dorris.
fkenward@gmail.com says:
Sep 09, 2011 11:04 AM
Go down t'road, turn left, turn right, come back a mile, turn left, go straight on, and come roun' to your right for a bit, an be guided by the sign post behind you!!!
johnbagshaw says:
Sep 09, 2011 03:28 PM
Brilliant analysis. The disease of politicians who want the kudos but not the resonsibility. How about the decision to put more police on London's streets Mrs May (oh, mine - well, we discussed it...)? Or to change interest rates Mr Brown (independence for the Bank of England - perhaps not such a bad thing that one)? Or to do ANYTHING in the NHS - let the unpopular decisions be devolved, and the popular ones be clutched to the ministerial bosom.
jrcox says:
Sep 09, 2011 05:52 PM
Panorama was an altogether depressing programme. Gerry Robinson has very good insight into the NHS but clearly not all the answers and why should he? He admits it and suggests careful moderation. In contrast, Andrew Lansley has all the answers said with conviction but no credibility and questionable motives. Leaves me frightened for the NHS. I would face a weekend of escapism if it were not for the distracting humour of the author. Thanks and have a good weekend whoever you are!
georgewebb70 says:
Sep 12, 2011 04:56 PM
I look forward each week to the opening "sketch". There is so much truth re the present situation we are facing, One author or many more power to your elbow. Now back to the nitty gritty that follows and helps to keep me informed and up to date as a governor. Many Thanks.
s.cribb@nhs.net says:
Oct 14, 2011 10:17 AM
The presumption here perhaps is that said patients and health professionals are driving a car? It seems to me more likely that they are all passengers clutching the wheel of one of those round crazy river boats at a theme park. They are all yanking at the wheel but still the boats spins in circles. Half the team have been thrown overboard and the other half a soaking wet!. Whats more no-one seems to quite know where the crazy river is flowing, the reason: someone somewhere is still building the course> So, in fact, we'll all end up where the architect's decide (provided the water doesn't run out) but like most of these theme park rides the boat usually ends up back at the beginning, doesn't it?