Thank you for your many comments on the last blog about chronic and acute primary care, a good debate which has made me think. Favourite comment: ‘minor’ is a retrospective diagnosis. Last week on holiday, but today back in the saddle (cycle club outing this morning while wife at work, obviously, she’s a hospital doctor and it’s Saturday).
Which brings us to the Jeremy Hunt speech.
All the noise is around 7 day working, a great shame as he has picked the wrong battle. It’s based on the statistic, “You are 15% more likely to die if you are admitted on a Sunday compared to being admitted on a Wednesday”.
The minister has not got the difference between absolute risk, 1.3% deaths in 30 days, and relative risk. Where are his advisors? Read the conclusions on NHS Choices, “we don’t really know.”
Sigh. Better look instead at the main thrust of the speech:
“Our focus should be different: not top-down targets but transparency and peer review.
“I want the NHS to be somewhere where you are able to focus on patient care and where you can challenge, learn and improve
“How about ‘more human’ … Because the truth is that decades of building processes around system targets and system objectives, often with the best of intentions, has demoralised staff
“If you help people understand how they are doing against their peers and where they need to improve, in most cases that is exactly what they do. A combination of natural competitiveness and desire to do the best for patients mean rapid change – without a target in sight.
“To power this we need to foster an inquisitive, curious and hungry learning culture.
And finally: “How we can increase take-up of new digital innovations in health?”
Wow. A friend asked whether I had written it. Not guilty, though I have banged on about A&E targets. There’s a logical problem: if targets don’t work then the right thing is not fewer, but none.
Is this all motherhood Jeremy, or do you mean it? Here is the test: abolish the 4 hour A&E and 18 week targets today.
Replace them with measures of median time to treat. Easy to do, achieves your objectives without having to negotiate with the BMA. We could even call it “intelligent transparency” if you wish. This matters to patients, it will stop gaming and drive improvement.
Lansley talked about cutting targets and did nothing. You will have a battle with the NHS establishment, and a howling press, but we are with you, and it’s the right battle.
You will never have a better opportunity.
PS for examples of what people achieve without a target in sight, instead with a method and the right simple measures, try the Dover collection.
Another one last week, in Fife, day 1 the practice manager writes, “The launch day has gone extremely well, with great teamwork”. Day 2, a GP, “I am surprised that after only two days the difference in the frantic pace in the surgery.” A patient, 72, “system unbelievable marvellous”.