Sunday, July 29, 2012

Will the NHS medal?

I am guessing that many Americans who watched the opening ceremonies of the Olympics were, at best, confused by the presence of National Health Service nurses during the choreography.  Here's a video of a portion of the show:

Indeed, Los Angeles Times sports writer Diane Pucin tweeted, "For the life of me, though, am still baffled by NHS tribute at opening ceremonies. Like a tribute to United Health Care or something in US."

This prompted a response by @swaldman: "Well, maybe, if United Health Care were government-run and a source of national pride."

And another by @MaxwellLeslie: "The NHS is one Britains greatest & most loved Institutions, reinforcing the ignorant American stereotype very well with that tweet."

Remember when Don Berwick was nominated to head up CMS, the US Medicare agency?  One of the strikes against him by conservative opponents was that he had expressed admiration for the British health system.

This is what Don actually said on the occasion of the NHS' 60th birthday:

The National Health Service is one of the truly astounding human endeavors of modern times.  Just look at what you are trying to be: comprehensive, equitable, available to all, free at the point of care, and – more and more – aiming for excellence by world-class standards.  And, because you have chosen to use a nation as the scale and taxation as the funding, the NHS isn’t just technical – it’s political.  It is an arena where the tectonic plates of a society meet: technology, professionalism, macroeconomics, social diversity, and political ambition.  It is a stage on which the polarizing debates of modern social theory play out: between market theorists and social planning, between enlightenment science and post-modern skeptics of science, between utilitarianism and individualism, between the premise that we are all responsible for each other and the premise that we are each responsible for ourselves, between those for whom government is a source of hope and those for whom government is hopeless.  But, even in these debates, you have agreed hold in trust a commons. You are unified, movingly and most nobly, by your nation’s promise to make good on an idea: the idea that health care is a human right.  The NHS is a bridge – a towering bridge – between the rhetoric of justice and the fact of justice.

And then he moved on to say:

Is the NHS perfect?  Far, far from it.

[I]n improving its quality, two facts are true: the NHS is en route, and the NHS has a lot more work ahead. 

How can you do even better?  I have ten suggestions:

And then he went on to outline those, summarized by columnist Ezra Klein, as follows:

Conservatives have convinced themselves that the NHS is a terrible system, which I guess is their right. But insofar as Berwick is actually offering recommendations to government-run health-care systems -- and that's what he's doing here, and what he'll be doing at CMS -- his guiding principles seem fairly inoffensive.

What were those radical suggestions?  Well, as I read them, they would apply just as well to the health system of the United States and every other developed country I have visited:

1.  First, put the patient at the center – at the absolute center of your system of care.
2.  Second, stop restructuring. 
3.  Third, strengthen the local health care systems – community care systems – as a whole.
4. Fourth, to help do that, reinvest in general practice and primary care.
5.  Fifth, please don’t put your faith in market forces. 
6.  Sixth, avoid supply-driven care like the plague. 
7.  Seventh, develop an integrated approach to the assessment, assurance, and improvement of quality. 
8.  Eighth, heal the divide among the professions, the managers, and the government. 
9.  Ninth, train your health care workforce for the future, not the past.
10.  Tenth, and finally, aim for health.

So, my take is like Don's.  Both beloved and berated by the British citizenry, the NHS is a marvelous social experiment that is nowhere near the finish line.  With a most dedicated and caring staff and bureaucratic beyond belief, both, it carries the torch forward.  In the former colonies (the US), we take on the task in a different way, but we face the same issues.  Indeed, as I have noted, "After all, the countries are dealing with the same organisms, both biologically and politically."   The two types of systems have a tendency to converge in many ways, "Suggesting that -- in all systems -- a concerted focus on quality, safety, transparency, and process improvement would be well worthwhile."


colette d said...

Thank you, Paul, for this article. amen.

Anonymous said...

Sadly, our Conservative gov't in the UK is hell bent on changing it considerably to be far more market driven. We're all rather terrified of what we see as the dismantling of the NHS.

Isam Osman said...

Thanks Paul
A thought provoking article for readers on both sides of the pond.I have often been asked by American friends ,Healthcare workers and Politicians alike ' Is it true that the NHS is this or that ?"
.My answer is always the same."It has inherent and compelling intellectual strengths but also has its challenges and flaws " But like most things it has to strive to improve and modernise whilst retaining its core values (of aspiring for high quality,affordable healthcare free at the point of delivery).In that continual quest we can learn a lot from American colleagues.In the end we are trying to do the same things ,just in a different way.Thats why we are grateful for for the visits and sharing of experiences of people like yourself and other leaders of the American health system.We are also pleased that they also occasionally see one or two things that they would wish to aspire to in the US.
Anyway enough of that! How about that guy Lochte ! I like his style!!

Clare M said...

I am not surprised you were bemused on your side of the pond
- it took some understanding here too!
- but wasn't it a good show?

Seriously - what a shame our politicians didn't read and learn
the "10 commandments" in particular 2,5 and 8 .
Thanks for reminding us .

Anonymous said...

What a great post, with a nice segue from the indeed rather startling Opening Ceremonies mention (but good for you, Brits!) to the always-visionary comments of Dr. Berwick. Those in the US., particularly of a certain political persuasion, who scoff at the NHS really have no idea how broken our American 'system' really is, in every way. Since every country finds providing health care difficult, the humility and learning attitude you so often espouse would be far more constructive.

nonlocal MD

Anonymous said...

It speaks volumes that no politician would ever go into an election proposing change to the fundamentals of the NHS, to do so would be electoral suicide.
Any changes that have been made (and there have been many), have been very discrete and/or carefully spun playererosions that were contrary to the election platforms of those making the changes.

Marilyn said...

I was very moved by this British display of national pride in its health care system. For it to receive such prominence in the Olympic Opening Ceremonies was certainly something wonderful to behold. As an American Nurse of almost 40 years of service, I was quite envious of my British counterparts who got to dance on this international stage. Bravo, "Sisters"!

Nancy Thomas said...

...and do you think the Brits might have been giving us some of our own medicine by saying - try it, you'll like it - or, at least it is better than what you have. Possibly an endorsement of ObamaCare? I thought it was inspirational - as we go into the Olympics with a great chance of holding the most gold medals, why can't we fix our broken healthcare system?

Maybe one day we will have a 4th of July celebration of healthcare - as we recognize our freedom from the system which neither adequately cares for all or is affordable by most...

Anonymous said...

Absolutely delighted to have found this article. Captures the essence of why the NHS was part of the Olympic Opening ceremony and why it is so important to Great Britain. I'd love to think that Danny Boyle has an opportunity to read this, I think he'd love it.

Michael Seres said...

Very interesting blog post. As someone who has been part of the NHS for 30 years I can absolutely say how amazing it is from a medical perspective. Treatment options for those who are really sick are fantastic. Then you get to the heart of the real NHS. Waiting times in the ER are about 4hrs. The staff tell you not to bother coming in on a Monday morning because they spend most of the day dealing with minor injuries to patients who won’t interrupt their weekend to go for treatment but will wait until they have to go to work so that they take time off from that to go to the ER.

Then there is the current 18 week waiting time for knee replacement ops. An approx 10 wait as an inpatient to have a CT scan or MRI and it goes on.

Yes the concept of the NHS was ground breaking and something we are incredibly proud of. Every Englishman is genuinely proud to have the NHS and I am no different. However it was created in 1960s and is now in dire need of overhaul. The labour govt plough money in with no argument and the conservatives would like to part privatise it. So “work in progress” may well be a way of describing it but how many institutions wait 50+ years before progressing. As a medical institution that is totally free for all at the point of entry it is amazing. Ask the patients and the doctors and surgeons working in it and they will perhaps write a slightly different blog post.