No help from the big beasts

Patients are getting a raw deal from the professional institutions in the health service

Dick Vinegar
Smart Healthcare, Monday 14 December 2009 12.20 GMT

When NHS patients look for help, where do they tend to find it?

Not from the august bodies that have been set up over several hundred years to control, supervise and promote the practice of medicine. Not the hospital governors, not the Royal Colleges, not the General Medical Council, not the BMA, not the Patients' Alliance. Not even the local press and MPs. Not, above all, the Nursing and Midwifery Council, which chose to strike off Margaret Haywood for blowing the whistle on appalling conditions at the Royal Sussex Hospital in Brighton (although her appeal was successful). A vulnerable patient like me seems to have nowhere to turn to in the face of this regulatory breakdown across the NHS.

I don't know much about these august bodies, but have suspected for a long time that they are part of the problem not the solution. The one that has the highest profile, and seems to me to betray the most subconscious unreconstructed 19th century attitudes in its public statements, is the BMA. I know it is not a regulator but a trade union, but surely it should pay some attention to the plight of the patients in its members' care.

Instead, what it does is to deplore websites like patientopinion.com and Iwantgreatcare.org, which encourage the patients to answer back. The BMA fears that individual doctors and hospitals will be smeared by anonymous malcontents and other patients from hell. Yeah, OK, there is a remote danger of this, but surely it should welcome these running surveys – costing the NHS nothing – which can give advance warning of which clinicians and hospitals are failing. Or perhaps the BMA is only interested in protecting its medical members?

It seems to me that when statistics based regulation is being shown to be too slow, and whistle blowers are terrorised into silence by management, that these 'healthcare 2.0' websites provide a new desperately needed line of defence for patients.

In March Gordon Brown announced a new NHS initiative for patient feedback, Working together: Public services on your side. Immediately, some panjandrum from the BMA complained that "the consumerist approach being advocated by the government is not well suited to the NHS. Patients are not supermarket customers, and doctors are doing more than providing an easily rated commodity….. There is a risk that this exercise could reduce NHS care to a meaningless popularity contest, encouraging perverse behaviours and an emphasis on the superficial."

I would have thought that there is not enough consumerism in the NHS. The consumer is hardly heard, despite the mantra intoned by all levels across the higher echelons of the NHS that "patient safety is paramount" and "we welcome feedback from patients". Indeed, doctors could learn a lot from some of the customer service practices of supermarkets.

Worse still, the panjandrum's statement betrays contempt for the patient. Of course, every patient realises that the NHS is not a supermarket. He or she expects better, more empathetic service from doctors and nurses than is on offer in a supermarket, and realises that what he gets is more than a commodity. Patients are not stupid

Whatever makes the panjandrum think that if a patient is moved to write a review about treatment from a doctor or hospital that may have saved his life, that he will approach it as a "meaningless popularity contest" and emphasise "the superficial". The very idea is insulting and patronising to the average patient. But it does reveal how far attitudes at the top of the BMA have to move before they reach the 21st century.