Professor John Spiers is a Research Fellow at the Global Policy Institute, London Metropolitan University. He has also been a Consultant Director of Conservative Central Office Office, and health policy adviser to the Institute of Economic Affairs.
Now that the controversy over publishing the data of surgeon’s results has itself been overtaken by new NHS scandals, it’s worth pausing to consider some of the lessons of the attempt to inform the public about what happens in NHS surgery – and which doctor is Dr Up-to-date and which is Dr Deadwood. Because we have hardly started on finding out what happens to patients.
The newly heralded, much tougher inspectorate for hospitals, headed by Professor Sir Mike Richards, is an important step forward, but it is still not enough. It covers only part of the problem.
Most NHS work is done in GP’s surgeries. But we know much too little about the results here. The errors of surgeons are more obvious than those of GPs and physicians. However, in addition to the data just issued on surgeons, we now need an independent National Inspectorate, with full access to expert advice, to regularly find out what all doctors are doing. Unexpected inspections are essential and effective – as the care home tragedies have highlighted lately, and as errant car drivers know from points, fines, re-training or disqualification. A genuine National Inspectorate should be charged with regularly finding out what all NHS doctors are doing – utilising such indicators as patient's clinical complaints for a start.
Then there is the other issue besides ‘death rates’. For death is not the sole arbiter of clinical quality, competence or its lack. ‘Morbidity’ needs to be investigated, too, and not only for surgeons but in the sphere of GPs and physicians too. Of course death rates are 'obvious' and can be counted (which is why they is used – the death rate is an easy measure). But what of those whose diagnosis is unnecessarily delayed, or who suffer unnecessary discomfort because the disease has been wrongly identified or missed, or are sent by a GP to the wrong specialist (or too late), or who have the wrong leg removed (alas, it happens)? Or are given a drug which causes organ damage and the doctor never notices, or when a patient doesn't get a rudimentary blood test? Death may not supervene, but avoidable damage may.
There are also the serious issues of patients irresponsibly (and avoidably) addicted – to, for example, sleeping tablets – or rendered unnecessarily dependent on mind-altering drugs, or who have allergic or adverse reactions to drugs they never needed. Quite aside from the serious ‘life damage’, these ‘errors’ are very expensive too. It is worth asking this question – why is death alone used to alert us to quality or its absence? It is insufficient in itself if we want medical practice to improve across the board.
As Dr William Pickering has cogently argued, an independent National Inspectorate would regularly and systematically look at clinical practice at every level. It would have real teeth to promptly identify elementary clinical errors. It would correct and shame practitioners whose practice justifies this, and nip serial disasters in the bud. as Dr. Pickering says, this gets to the heart of much daily clinical practice, which is at present entirely unexamined.
The focus on death rates matters certainly, and the professions are now going to have to accept this. However, this focus does avoid the other myriad of types of incompetence which cause damage being examined at all. 'Life damage', apart from death, is no side-show but a nation-wide daily reality. As to the politics of the NHS, the Prime Minister may like a reminder that the party of the consumer is much more likely to continue to form a popular government than opposition parties funded by public service trade unions: the parties of the providers, the defenders of secrecy.