Politics and patient care

Abstract

Some patients in hospitals run by the UK's National Health Service (NHS) do not receive adequate pain relief, are not helped to go to the toilet, and are not given enough to eat or drink. These were the stark headlines of a report published last week by the Patients Association, which presented first-hand accounts of the treatment of 16 mostly elderly patients in NHS hospitals. The report, sourced from stories phoned in to the Patients Association's helpline, provided no statistics for the overall quality of care available throughout the NHS, or for how often incidents such as those presented occur. But it adds to a body of reports about serious shortcomings in care in some NHS hospitals. On the back of their report, the Patients Association has launched the CARE Campaign, setting out a challenge to all health services in the UK to ensure that four very basic necessities of care are met: communication with compassion, assistance with toileting, effective pain relief, and adequate nutrition. That the bar is being set so low in a national campaign of this type is cause for concern. Speaking at the launch of the campaign, Linda Patterson, Vice President of the Royal College of Physicians, expressed her worry at the accounts detailed in the report, calling for doctors to take note and act to ensure that all patients receive high quality care. Among her recommendations was that a named consultant should work closely with nurses in charge of wards to lead action from the top. Understandably, the report garnered much media attention, with the Daily Mail newspaper setting up a supportive campaign in which their stated aims are to “end the neglect of the elderly in our hospitals” and “reform England's shameful NHS complaints system”. Such reporting of the issues presented is indicative of much of the media's coverage, extrapolating the findings of a small sample to the entire NHS. However, before such conclusions are made and unnecessary scaremongering takes place, these reports should be subject to further inquiry to assess how systemic the problem is. Nonetheless, the campaign has been given “full support” by the man ultimately in charge of the NHS, the UK's Health Secretary, Andrew Lansley. Coincidentally, the choices of news stories that Lansley and the UK Government have focused on were called into question last week. Colin Pritchard, co-author of a study published last month in the British Journal of Cancer, claimed in media reports that the government were more interested in bad-news stories, using “overhyped media representation, rather than hard comparable evidence” as justification to usher through their radical health-system reform. Pritchard was speaking in relation to his own study, which showed—contrary to the government's repeated criticism of the NHS's record on cancer—that among ten leading countries worldwide, the NHS in England and Wales has helped to achieve the biggest reduction in cancer deaths with the most efficient use of available resources. Also issued last week was a report from the Commonwealth Fund, which analysed surveys from more than 18 000 adults with chronic and serious illnesses, assessing various health-care indicators, including quality of care. This report showed that, compared with ten high-income countries, the UK's health system was among the best in terms of performance and use of available resources. That Lansley chose to cite the Patients Association's report as an example of NHS failings when presenting his reform plans at the Brookings Institute in Washington, DC, USA, despite the Commonwealth Fund's seemingly favourable report on the performance of the NHS, might be seen as substantiation of Pritchard's claims. The announcement last week that an NHS hospital will be handed over to a private company shows that the government's planned reform of the NHS is beginning to take shape. Many, including The Lancet, have voiced concerns about the consequences of opening up the NHS to the private market, warning of compromises to equity of care when pitted directly against profit. With this in mind, use of emotive, but ultimately highly selective evidence from the Patients Association—a lobbying group that receives funding from pharmaceutical, insurance, and private medical companies—to justify the need for reform of the NHS should set alarm bells ringing. Use of selected, humanised, first-hand accounts of instances in which patients have received substandard care should quite rightly be used to attract public attention and spark much-needed debate and inquiry. But, on their own, they are no basis for policy making. Every effort should be made to ensure that such stories are not used to groom public favour for a political (or financial) agenda.