As GP and comedian Dr Phil Hammond once quipped, the NHS is much praised around the world, but never copied.
For a long time the NHS has drawn criticism for being a slightly slow and unwieldy health service, however this has traditionally been balanced with praise for a system which provides equal access to all. Recently though, a more damaging perception of the NHS as a negligent organisation has started to permeate public consciousness. The scandal at the Mid-Staffordshire Foundation Trust late last decade marked a turning point. Since ‘Mid Staffs’, stories have emerged about negligence and malpractice in departments in hospitals up and down the country, from baby deaths in Bristolto cover-ups in Cumbria, a system where efficiency has always been somewhat impeded by the red tape associated with a large, state-run service has, in places, become a system where doctors and nurses feel compelled to misrecord results in order to meet targets, rather than address failures in care.
Given the constant barrage of bad news in the post-Mid Staffs era you could be forgiven for thinking the NHS is ‘broken’, as headlines have shouted. However, there are many well-run hospitals – some with exceptional departments, containing highly talented doctors. The disparity between these hospitals and some of our struggling trusts might be the NHS’s biggest failing, but it also provides hope; some NHS hospitals make the system work, and if some can, why can’t others?
The current picture is one of inconsistent care and postcode lotteries. Despite its mantra, our health service does not provide truly equal access to all; operation success rates vary by >10% depending on where in the country you need surgery, and there remains significant variance in disease outcomes from hospital to hospital, especially when surgery is required. Could the greatest room for improvement in the NHS come from increased communication between successful and unsuccessful departments, so that the latter can learn from the former?
It is no revelation that the NHS is poor at best practice sharing, but this doesn’t change the fact that if teams in leading departments were encouraged to package their models into guidelines and workshops, this would go some way to helping hospitals where standards have slipped address their problems. Failing hospitals have rafts of guidelines, algorithms and care pathways imposed upon them from above, but it is advice from peers that resonates the loudest on wards and in clinics.
Perhaps then, it’s emulation of successful practice within the system that can eventually inspire imitation, and not just praise, from elsewhere.