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The Carry On legacy lingers


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Friday, 25 February 2011

The Carry On legacy lingers

For a certain sector of the population, the relationship between the NHS and the patient was defined somewhere between 1954 and 1967, when two seminal works of the cinema were first aired.

Doctor in the House gave us the archetypal bombastic consultant, the terrifying Sir Lancelot Spratt before whom patients, junior doctors and nurses trembled. This was an upper middle class, paternalistic NHS emerging from post war austerity. Its doctors were handsome toffs and its nurses were wholesome, attractive gels who wouldn’t stand any nonsense.

A little over a decade later and the celluloid NHS had dropped a couple of levels down the class system and several dozen degrees down most other scales. In Carry on Doctor the sardonic Dr Tinkle, the bumbling Dr Kilmore, busty Nurse May and Hattie Jacques’ officious Matron waged war on oafish, recalcitrant, lead-swinging patients whose main complaints were piles, gout, infected “waterworks”, indolence and hypochondria.

Apart from its contribution to toilet humour and sexual innuendo, Carry on Doctor’s enduring legacy was the power of its stereotypes, which have still not been completely eradicated.

Doctors and nurses are still not caring or compassionate enough, while patients are still not grateful enough for the care they receive or not considerate enough to avoid getting ill in the first place.

The real gap, of course, is between people who are undervalued, overworked, underpaid or under stress and those who are sick, frightened and suddenly not in control of their situations.

The answer promised by the health and social care bill is more control – not the traditional kind which has command in front of it – but control devolved to health professionals and patients.

Doctors will get to manage the money which will result in decisions being taken in the best possible interests of the patient, and patients who will get control of their own care through more effective local democracy, closer relationships with their doctors and through more choice about where and how they are treated.

The acid test of whether this is working will be the experience of the patient, which is not just about the treatment they receive but how they are treated, and not just about whether they feel better but how they feel.

If our ability to give patients what they want as well as what they need sometimes falls short, perhaps it’s because measuring experience is difficult. The tools we have had in the past haven’t been up to the job. “There needs to be a move away from the reliance on national surveys with long lead-times and small samples.”

The quote is from a report by Patient Opinion, a website which has spent five years collecting the experiences of patients and feeding them back to the NHS.

The report concludes that it’s not just the measurement but the experience that’s wanting.

The biggest problem perceived by patients and their carers is the attitudes of NHS staff. Nearly a third (30%) criticised staff for lack of care and compassion. Nearly half of those who complained about the quality of the care environment (46%) were concerned about nutrition. To put it another way, they didn’t like the food.

By contrast, “choice of providers, dignity and inclusivity – all at the heart of government reforms – feature low, highlighting a potential mismatch between what matters most to patients and the decisions of policymakers,” the report says.

Experience doesn’t cease to be subjective just because it’s collected online, but there is something powerful about the ability for patients to express their opinions directly. The internet makes it possible to ask everyone what they want and what they think. Dr Paul Hodgkin, founder of Patient Opinion, writing in the March issue of Commissioning Excellence, calls this “accountability for die for”.

This is an optimistic document which also points out that four out of five of the experiences of the NHS reported by patients are positive. Noting the criticisms of staff, it concludes: “These are, in essence, customer service issues that each member of health service staff could personally focus on and improve.”

Turning patients into customers won’t cure some of them of a tendency to complain – it may make them worse – but it might finally lay to rest the ghosts of Dr Tinkle and Matron.
In Their Words: What Patients Think About Our NHS, a report by Patient Opinion.

Visit the Patient Opinion website.

The March issue of Commissioning Excellence is published next week.