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Forget the health bill: optimism deficit is the real crisis


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Friday, 24 February 2012

Forget the health bill: optimism deficit is the real crisis

Nearly nine in 10 of people who voted in a poll on NHS Networks this week feel less optimistic about the future of the NHS than they felt this time last year.

130 people had voted at time of writing and 116 of them (89%) are gloomy about the immediate prospects for the NHS. 

As these things go, it was a sensible question, which offered the opportunity to register a no change vote – an opportunity taken up by only a handful of respondents, or to put it more scientifically, 7% of those who took part. Nine individuals.

If we were writing the headline for the national newspapers we might have “90% of staff despondent about future of the NHS” or “NHS insiders say ‘no’ to reforms”. 

'So what?' you sigh. The result of the poll might be depressing, but it’s hardly surprising. The papers are full of concerns about the NHS expressed by doctors, nurses, opposition politicians and the public. It says something about the parlous state of affairs that 95% or 98% declared pessimists would have been credible, too. 

Results that confirm our opinions and prejudices tend to go unchallenged, while those that contradict them are strip-searched for evidence of bad science. 

Our survey won't make any headlines because it simply confirms what people already know and what most people feel. If we wanted to get a story out of it, we would need a result that showed the confidence of NHS staff in the future of the service at an all time high. Then there would be outraged accusations of ballot-rigging and scorn at the tiny size of our sample (less than 0.01% of NHS staff, since you ask). But our figures are safe from scrutiny because they simply confirm what is obviously true. People are worried and getting more worried.

Outrage is rarely disagreeable. Readers whose blood is at boiling point are much more easily moved than those who are mildly interested in what you have to say. The Daily Mail trades on this very successfully. NHS going out of its way to treat gypsies, giving short shrift to brave women who drove ambulances in the war, allowing puking, drunken dole cheats to give taxpayers the finger from A&E departments? Dear sir, I wish to my disgust in the strongest terms possible by buying your newspaper again tomorrow.

But let’s not be pious. All newspapers and broadcast media do this. In the case of the broadsheets, the provocation is subtler and the rabble is less aware that it is being roused, but just the same buttons are pushed to much the same effect. 

Our modest survey has no such designs on your blood pressure or your state of mind. We might have got the same result in any one of the past ten years. The NHS is so important we're inclined to fear the worst.

But that wasn’t the question, which was about optimism - a state of mind, not a statement of objective fact. If nine out of ten of us are no longer optimistic we have every reason to worry, because the morale of the people who work in the NHS is the single biggest determinant of the fortunes of the people who use it. 

The future of the NHS won’t be decided by the ebb and flow of funding or the tedious reformation of structures or the presence or not of the profit motive – wasn’t it Bevan who ‘stuffed their mouths with gold’ to get doctors to sign up in 1948? 

These are perennial issues. Doctors, nurses and managers were doing more with less long before QIPP was coined. All health services everywhere are under-resourced and rationed in one way or another. 

But the loss of optimism, the waste of spirit, could make the difference between a faulty system and a broken one.

Prove the sceptics wrong. We’ll keep the poll open for another few days. Cast your vote here.

vinod.patel@warwick.ac.uk says:
Feb 24, 2012 08:48 AM
I think the reason for the optimism deficit is the lack of vision in our Health Service that all people, patients and healthcare professionals (non-clinical and clinical) can easily remember. I am 100% that NHS staff come in to work to do a good job to improve the health of others. So what vision? Well the below works for introducing Medical Students to what we do in Healthcare.

I call it an "Algebra of Healthcare" - an idea stolen from Arundhati Roy's book "algebra of Infinite Justice". Such vision statements are not unusual, however, the POETIC acronym also provides a structure and vision for what we might aspire towards in clinical and healthcare education, this enabling a shared approach to health service delivery and education.
The POETIC vision is:
P Patient-centred, Public health driven,Professionally inspired,Partnership oriented
O Objective clear:Outcome driven- sets out what we want to achieve and why
E Evidence based – informed by audit, quality assurance, research and evaluation of education and health innovation
T Team oriented – multi-disciplinary, well trained, supported by interprofessional education initiatives
I Integrated – effectively integrates curricular components across non-clinical and clinical teaching and between topics and integrates learning opportunities with primary and secondary care, community organisations and health, education and social care agencies
Innovative – supports and promotes innovations, actively encouraging students to become involved
C Cost effective – supported by robust evaluation of impact of educational initiatives on improved patient care, safety and health outcomes but always under high standards of Clinical Governance.
matthew.butler@slam.nhs.uk says:
Feb 24, 2012 04:53 PM
Not a representative sample, dude!
jpatterson says:
Feb 24, 2012 07:33 PM
Absolutely right. I made no claim for its statistical validity; quite the opposite. I dare say that if we got into representative territory the result wouldn't be dramatically different, but I'd love to be proved wrong. If you check the poll, which has now had another 150 or so votes, there is a touch more optimism showing. Norman Lamont might have called it the green shoots of recovery.
oly@shipp.org says:
Feb 25, 2012 10:38 AM
Loving the articles, should be a weekly prescription for everyone. Funny and true, one of the best blogs around - keep 'em coming!