Over the past few years the NHS has been under a joint and sustained attack by the Lib Dem Tory coalition and large private businesses. I have previously written about the way in which these changes to fundamentally important services will negatively affect students.
David Cameron’s most recent bright idea to reform the National Health Service so that “GPs should be subject to patient satisfaction tests” is almost directly modelled on a theory that Vallance Owen (The Chair of the Trustee Board of the Guild of Students) has been propagating for years, that ‘customers’ know better than doctors and nurses with years on academic and real life training in healthcare provision.
Along with the transposing the ‘successful’ usage of games makers in the Olympics into a hospital environment Cameron is looking to introduce a version of Rate My Professor for GPs inviting family and friends to complete questionnaires on their satisfaction of their experiences. Jeremy Hunt the Health Secretary claims that “The new friends and family test will shine a light on standards of care throughout the system and help expose the shocking examples of poor care that have been coming to light much earlier.” The reality is of course more complex – hospital experiences are often traumatic, procedures are complex and hard to understand for lay people. What the government is attempting to institutionalise is a process by which non medical and deeply emotionally implicated evaluators judge the performance of GPs who all have at least 10 years of experience in medicine behind them.
The idea of patient evaluation was originally propagated by Andrew Vallance Owen. He was previously a senior executive of the private healthcare firm BUPA and he now chairs the Department of Health’s PROMs Stakeholder Group and works as a private healthcare consultant. The general thrust of patient reported outcomes measures are a precursor to what Cameron and Hunt are now suggesting; that along with standard performance measures patients should rate aspects of their experiences during their stay in hospital with the aim of improving the standard of care. The focal point is that the patient is that the wise consumer will always know what is best for him/her. Vallance Owen attempts to support PROMs mechanisms by attempting to discredit deference to trained professionals as ‘paternalistic and claims it isn’t helpful to view ‘what doctors do to patients as more important than the outcome as perceived by them.’
As a hugely effective healthcare system it has been difficult for the government or businesses to paint the NHS as in need of an overhaul or dismantling instead there has been a steady stream of propaganda implying that the consumers of healthcare (and other public services) should be entitled to have a choice between services they use. On the surface this liberal logic seems sensible, it might be perfectly sensible to have a choice between Utterly Butterly and Lurpak butter, or Dixons and Comet, each to his own. However the differences between types of healthcare are far more complex than the differences between other types of services and products that might usually be available to consumers.
The simple fact is that the types of procedures and long term monitoring that patients regularly need aren’t simple to comprehend and often the only people that should be making choices about where care should be coming from and in what format it should be delivered are clinical professionals that are trained in the intricacies of each particular illness.
The Illusion of Choice is something that has been spread deeply into most every major piece of policy the Government has crafted during its time in power. For instance the HE white paper and the Brown Review before it were based fundamentally on the idea that students, keen for the best illusive ‘Student Experience’ know the best about what is good for them at university. Module Evaluation Forms and National Student Surveys are constantly thrown at students whilst less and less reliance is placed on academics to deciding on the learning environments and curriculum’s of students. As our own VPE has pointed out this constant barrage of checkpoints and evaluation of professionals detracts from their ability to focus on the task at hand and increases the workload burden for their already stressful work lives. As noted by academics at the Harvard School of Business, overly prescriptive goal setting and monitoring doesn’t work. The added layers of bureaucracy take up time and distract professionals, be it in the NHS or in the HE sector, from applying their expensive training on actually doing their jobs to a high standard.
In short patients opinions should be valued and taken on board in a democratic manner, much as in HE environments. However the opinions of patients shouldn’t be used in a complimentary manner to rigorous medical data obtained by health professionals. A greater reliance on patient reports could lead to increase managerialism and scapegoating or be used as the supporting material to make ‘difficult decisions’ with.
1. Guardian, Patrick Wintour – http://www.guardian.co.uk/society/2013/jan/04/david-cameron-gps-patient-satisfacone might saytion
2. YouGov Poll (page 5) – http://cdn.yougov.com/cumulus_uploads/document/ly9ei68uye/YG-Archives-Pol-ST-results-10-120212.pdf
3. Simon Furse VPE – http://guildofstudentsvpe.wordpress.com/2012/11/28/module-evaluation-questionnaires/
4. Ordonez, D., 2009 – Goals Gone Wild, HBS http://www.hbs.edu/faculty/Publication%20Files/09-083.pdf
5. Vallance Owen, A., 2008 – PROMs promote health gain and patient involvement
http://www.bmj.com/content/336/7640/344.2 & http://chcm.ubc.ca/2010/12/17/vallance-owen/ (55min video)