The hiatus in posting has been productive – I swear! I have recently written an article for a political opinion website, United Politics, on the ‘weekend-effect’. Jeremy Hunt, the Health Secretary, has claimed that increases in mortality on the weekend could be avoided by better staffing on Saturday and Sunday. But he’s been manipulating and deceiving the public through selective data presentation. Give it a read here:
So: is the NHS working?
This is the question I – perhaps over-ambitiously – want to address. By working, I mean producing the desired outcome. Not working as in “working hard,” which it most definitely is doing.
Achieving the goals set out by the seven principles is the desired outcome in this assessment. But this isn’t a conventional test. Six out of seven might normally be a respectable score.
In our case, surely failure to achieve any single one of these goals would represent a significant problem at the core of NHS healthcare provision? In addition, a shortfall in one area would undoubtedly compromise the ability of the NHS to deliver on the others. Things don’t work in isolation.
When tackling a complex issue such as this, I like to adopt the idea of ‘chunking.’ This is a commonly used tactic based on research into working memory – working memory being the cognitive workspace in which we do all our thinking and active memorising. Chunking refers to the idea of assimilating smaller units of information into larger understandable ‘chunks’ which have some over-arching relationship or meaning: for example, letters becoming words becoming sentences.
The seven principles are already chunks to begin with. Within each principle, there is an immense amount of detail, thought and consideration chunked into one pithy sentence.
But we can do better! The principles can be grouped into two broader roles the NHS serves, as outlined below:
Principles 1-4 are concerned with ‘The NHS as a Healthcare Provider’ – how the NHS ensures adequate access to healthcare (principles 1 and 2) and delivers excellent healthcare provision (principles 3 and 4).
Principles 5-7 are concerned with ‘The NHS as a Public Body.’ A public body is defined by the cabinet office a “formally established organisation that is (at least in part) publically funded to deliver a public or government service, though not as a ministerial department” (as outlined in a rather dry – yet informative – document found here). NHS England is the largest public body in the UK, and is accountable to the Department of Health via the NHS mandate (although the relationship between NHS England and the DoH is far from a clear or simple one).
In its role as a public body, the NHS needs to communicate with other public bodies and governmental departments which are critical for service delivery (principle 5); to spend money effectively (p6); and to be held publicly accountable for its decisions (p7).
It is important to stress that these artificial groupings I have concocted are not wholly independent of one another – for example, achieving high standards and clinical excellence (p3) both requires and facilitates the efficient use of resources and effective spending of taxpayers’ money (p6). I hope to cover these interactions in subsequent posts but the topic is immensely complex – there is enough material to write a thesis (or a hundred). Without a little bit of coarseness and simplification the whole point of this blog – to provide some simplicity and clarity – would be lost.
In the next blog post, I want to explore the principles concerning access to healthcare, which are crucial part of the NHS’s role as a healthcare provider.
Is the NHS a comprehensive service?
Is access solely based on clinical need, or are other factors at play?
I believe in the NHS.
I support everything it stands for.
When it is criticised, a nerve pangs inside and I can’t help but jump to its defense.
I think it does a good job – I hope it achieves the principles laid out by the NHS Constitution (see here). These are values we can all get behind.
But how objective am I? The NHS has influenced almost every aspect of my life. The bond I have with it is an intimate one: academic, financial, moral and emotional. The human mind is not always a rational agent in such relationships.
The institution I love has received a battering in the media on many fronts: health inequality, inefficiencies, vacant posts, job dissatisfaction, poor outcomes, A+E crises etc.. My belief in its principles have remained stalwart. But introspectively, my faith in its execution has diminished.
In the first (few) post(s) of this blog, I want to explore the efficacy of the NHS. What is efficacy? The OED defines efficacy as: “the ability to produce a desired or intended result.” The desired or intended results are presented, free for public perusal, on the website mentioned previously; all-in-all, there are seven of them. So, what better way to consider the health service’s efficacy than to take each principle in turn and critically appraise the evidence in an objective manner, to see if the NHS is meeting its goals?
As I write this having just read these goals, I can’t help but feeling proud to be a miniscule cog in the colossal engine of the health service (for the medics: a single blood cell in its circulatory system). I also feel uneasy. Aspiring to such greatness leaves a lot of room for short-falls. A promised land that is never reached.