As part of the NHS’s 60th anniversary celebrations, Donald Berwick, President of the US organisation, the Institute for Healthcare Improvement, made a speech at one of the specially organised conferences. I’ve always been impressed by his writing and his speeches. I first encountered them when I read “Crossing the Quality Chasm” – the book which introduced me to the concept of “complex adaptive systems”, and I thoroughly enjoyed his “Escape Fire” ( a collection of ten of his annual addresses ).
His speech, in praise of the NHS, compared it very favourably to the state of health care in the US. In summary, he said this –
You could have had the American plan. You could have been spending 17% of your gross domestic product and making health care unaffordable as a human right instead of spending 9% and guaranteeing it as a human right. You could have kept your system in fragments and encouraged supply driven demand, instead of making tough choices and planning your supply. You could have made hospitals and specialists, not general practice, your mainstay. You could have obscured accountability, or left it to the invisible hand of the market. You could have a giant insurance industry of claims, rules, and paper pushing instead of using your tax base to provide a single route of finance. You could have protected the wealthy and the well instead of recognising that sick people tend to be poorer and that poor people tend to be sicker, and that any healthcare funding plan that is just must redistribute wealth. Britain, you chose well. As troubled as you may believe the NHS to be, as uncertain its future, as controversial its plans, as negative its press, as contentious its politics, please behold the mess that a less ambitious nation could have chosen.
He then went on to make ten suggestions for improvement. The first, I think was the most important and one that most health care systems haven’t even begun to implement on any significant scale –
Put the patient at the absolute centre of your system of care—In its most authentic form, this rule feels very risky to both professionals and managers, especially at first. It means the active presence of patients, families, and communities in the design, management, assessment, and improvement of care. It means total transparency. It means that patients have their own medical records and that restricted visiting hours are eliminated. It means, “Nothing about me without me.”
Apart from that he recommended strenghtening the Primary Care and Community aspects of the service, stopping the habit of more and more “reforms”, a strong plea NOT to pursue a market-led direction (ie I suspect, to do more like the Scottish NHS than the English one), and paying attention to the training and integration of the diverse employees of the NHS. Finally, he recommended aiming at health itself, not just health care.
He is astute enough to know that “great health care, technically delimited, cannot alone produce great health”. Of course it would be nice if the NHS was structured around trying to improve the health of its users, but the real big changes in health as such will be achieved through political means and societal changes, not health care ones.
I love it here in the good old U.S of A, but I gotta tell you these statements are sad but true.
Dr. Tom Bibey
I think if you compare what both health providers and patients get from a system like Kaiser Permanente with what they get from the NHS, they are SADLY lacking. They are getting it right. Patients have access to their own test results online. They can email their own doctors, order their prescriptions online, send messages instantly to advice nurses etc. Cheaper for everyone. More convenient. Preventative health classes. Classes to show patients how to take responsibility for their own issues.
Becoming a partnership in your own health is the key to wellness.
Well Dr B your own blog shows that the standard of health care in the US can be the best you’d hope for. I know you won’t really buy that statement in relation to your own practice but I mean it. It’s completely clear from your stories and your interaction that you are JUST the kind of Primary Care doctor every health service needs. It’s your caring and considered and intensely human approach which is the foundation of all good health care – in my opinion!
And, Amber, yes, Kaiser Permanente is often cited in the UK as the organisation that gets right what the NHS fails to get right! There is no doubt the NHS could learn a lot from some of their processes and methods. Your examples there are enticing! I do hope the NHS takes those kinds of things on board and implements them in the UK. That would be a big step forward.
I think what you both highlight from your own blogs and your comments here is that what’s important is people (patients and practitioners) and genuinely caring about them. Those are the values we need to develop in our respective health care systems.
[…] Not only will personal information no longer be the sole preserve of the authorities (think also of Donald Berwick’s speech to the NHS where his first recommendation for improvement was this – “Put the patient at the absolute […]
[…] I am sure it is somewhere maybe on the NHS website. This is the closest I have gotten so far. http://heroesnotzombies.wordpress.co…ew-of-the-nhs/ You could have had the American plan. You could have been spending 17% of your gross domestic […]
[…] enjoyed a lot of what he has had to say, and when he praised the NHS at its 60th anniversary he said (amongst other things) this […]