Stupidity about health targets and cancer

In today’s Guardian, a senior NHS doctor, using a pseudonym, talks about the target culture which led to the scandal at Stafford Hospital yesterday, in which 400 more patients died in three months than would normally be expected at a hospital of that size serving that type of community. Despite their poor care record, they achieved “foundation” status, which is supposedly a mark of excellence:

The Mid-Staffordshire trust that ran the hospital was making an aggressive attempt to tick boxes and achieve foundation status. In theory, once you have got more control, you can spend more money - but in pursuit of that, you chuck the baby out with the bathwater. They achieved foundation status, yet their quality of patient care was very bad. A hospital is able to tick all the boxes, yet still utterly fail its patients.

How did we get into this situation? Well, the Stafford problems can be traced back to the reforms of the Conservative government in the early 80s, and the obsession with market forces as an unlimited good. At that time, the health service was in need of reform; it needed to be brought up to date. But the desire to find better ways to manage the day-to-day running of the hospital morphed into a perception that clinical staff - doctors in particular - needed kicking into gear. There was this assumption that came with it, that doctors - and nurses - could not be relied upon to drive clinical efficiency on their own, through sheer professionalism and pride in their work.

The article goes into the political obsession with applying market logic to a public institution which is supposed to save lives, not sell things, and the means hospitals use to fiddle figures, such as moving patients out of A&E (Accident & Emergency, like ER) so they can claim to have driven waiting lists down.

On the subject of healthcare, Vanessa Feltz had a feature on prostate cancer as part of her morning news/discussion programme (London area, 94.9 FM, 9am-noon), and read out an email from some total idiot saying that he didn’t think it was worth having the test which is used to diagnose the disease, because that would mean having to go into an NHS hospital from which you probably wouldn’t come out in one piece. How utterly stupid - of course, most people who go into hospital don’t come out dead because of a superbug infection (and for more on how that story was hyped up by the press and a garden shed laboratory, see here). While the NHS scandals we have had in this country are appalling, and there are issues such as noisy and mixed-sex wards and the ongoing phonecard and parking rip-offs, we still at least have an NHS, and you don’t end up having to sell your house if you need major surgery.

Not testing for prostate cancer because you have no trouble urinating and no other reason to suspect trouble is one thing, but superbugs and bad hospital standards are no reason to bury your head in the sand. Once you have a diagnosis, you can make your choice, of course. I can understand a man not wanting treatment for advanced prostate cancer because it involves surgical or chemical castration, but most men would say that even this is better than being dead. Fear of poor NHS care really is no reason to let cancer take its course, because it only ever takes one course: it spreads throughout your body, leaving you in immense pain, and then kills you.

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