Transparency is the best way to restore public trust in our NHS

Publishing data on surgeons’ performance can repair the damage done to the service’s reputation by recent scandals

The NHS, the BBC, the police, the banks and even parliament have all suffered significant reputational damage from recent scandals leading to an erosion of public trust in some of the most cherished British institutions. Greater transparency, rather than secrecy, offers the better solution to restoring trust.

The NHS belongs to all of us. I believe that everyone offering services in our NHS has a duty to be able to describe those services and define how good they are. This applies to individuals and organisations. It is the essence of professionalism. If you can’t define how well you are delivering a service, should you be offering it?

Our NHS has more comprehensive data than any other national healthcare system, yet several recent events have demonstrated that it is not used effectively either to inform the public, improve services or spot problems early. This has been a missed opportunity.

In 1977, heart surgeons in the UK were the first in the world to measure institutional and national surgical results, but institutional results were not shared with the public and weren’t always given proper attention by the hospitals.

If they had been, some deaths of children in Bristol in the 1990s might have been prevented and an expensive three-year public enquiry avoided. But they weren’t.

Heart surgeons responded by publishing hospital results in 1998 and individual surgeons’ results in 2006. It wasn’t universally popular. Surgeons worried that they would be penalised in league tables for taking on high-risk cases, that unfair comparisons would be made and that some authorities would take inappropriate action as a result.

These issues remain a risk, but publication of results has undoubtedly focused the minds of heart surgeons in this country whose results are now demonstrably among the best in the world.

Over the next week six other specialities will join cardiac surgeons in publishing individual doctors’ results. Three others will follow soon after.

This is a big step not just for the surgeons and cardiologists but also for the profession and the NHS. It has not been attempted anywhere else in the world, and it illustrates the vision and responsible leadership of the Royal College of Surgeons and surgical speciality societies.

There have been some strange challenges en route. The Data Protection Act dictates that surgeons give their permission to publish their results. In the end all but a handful of surgeons have agreed. We have named those who haven’t and given them the opportunity to explain why.Should we take a gamble on the spiralling cost of care?

Read the original article on The Guardian website here.

Friday 28 June 2013

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Les Mayhew, professor of statistics at Cass Business School, is tapping into the psychology of gambling to find a solution to the social care funding crisis.

“On average, people spend £3 a week on the lottery and it brings in about £5bn a year for good causes, so people of all means and incomes are willing to have a flutter,” he says. “Research shows that people do pay for this kind of ‘gambling’.”

Mayhew’s unexpected answer to the spiralling cost of care is to ask people to take control of their own future by appealing to their inner gambler – saving for their care through a Personal Care Savings Bond.

Just like Premium Bonds, each investment would cost £1 and would place holders in a random draw to win lucrative monthly prizes. But unlike prime minister Harold Macmillan’s hugely popular scheme, first introduced in the 1950s, the bonds will accumulate interest so savers can build up a healthy sum over time to meet the cost of care in later life.

Prize winnings could also be automatically re-invested in care bonds, and uncashed bonds could be inherited by family members after the death of a holder.

The bonds would only be cashed when a needs assessment indicated that care and support was required, and the money could be used to top up existing services provided by the state. Bonds will also meet the cost of preventative support, saving money from the public purse by stopping minor care needs escalating into crises.

“The problem with social care at the moment is that you don’t get any state help until you have reached a critical level. This money would be available earlier, so it could help to de-escalate care needs going forward,” Mayhew says.

The idea could be a hit: one third of the UK population already holds Premium Bonds and the total bond fund currently sits at £45bn. In fact, more bonds have been sold in the last six years that the previous 48 put together.

Importantly, care bonds would not be means tested and would be open to all. For Mayhew, this is a fundamental reform of the care funding system, which has until now relied too heavily on housing equity to cover the rising cost of support, excluding those who do not own a property.

Read the complete article here on The Guardian website

Thurdsay 16th July 2013

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