Reviewing the NHS – speaking ill of the dead

Junior doctor Paul Teed says patient satisfaction surveys give an illusion of ‘choice’ in the NHS – but bad reviews don’t create more capacity or employ more staff

April 18, 2013 · 4 min read

An ad for the government’s ‘NHS Choices’ website

In the staff room of the emergency department where I work, reviews left online at www.nhs.uk are often put up on display. The feedback given is invariably positive about staff – but negative about things beyond our control, like the long waiting times.

Satisfaction surveys of hospitals are regarded as unnecessary by the public and should be dropped, according to recent opinion polls – yet now every patient will be asked routinely for feedback on their stay as part of their discharge. The methodology of such surveys is often criticised – but the issue at stake is wider than that. The big question is: what happens when such reviews say the hospital is appalling?

These websites are already full of horror stories about waiting on trolleys in corridors being ignored – yet this does not stop the inexorable rise in accident and emergency department attendances and breaking of four-hour wait targets. Neither do these reviews alter the reality of the lack of preparation for the population growing as health services shrink.

Bad reviews do not create capacity, employ more staff or provide more services if the money is not available or being reduced.

Choice, what choice?

David Cameron is preparing the way for greater ‘choice’ from our health system, but what choices exist if you are acutely unwell? Time for a quick scan of the reviews for different healthcare providers to decide which one suits your needs the most? One hospital has comfier trolleys than another?

Many hospital trusts now offer morbidly live updates online of A+E waiting times, with some even having webcams of the waiting room. But by definition, if you are perusing the internet to decide where the best place to go is, you’re not likely to have the greatest need and therefore will be looking at the longest wait.

Let us be honest about this debate and what the issue of reviewing attempts to normalise and distract from. There is no ‘National’ Health Service; it died quietly and without a state funeral – no protest songs entered the charts. What has come into public discourse is the fight by those who feel they have a claim to its estate.

We do not pretend supermarkets, GP surgeries or high street pharmacies provide a National Pharmacy Service. In the NHS though, there exists a ready-made brand ripe for private companies to exploit, brimming with popular support, guaranteed customers and funding. We are already used to reviewing our purchases online. The only things national about Serco, Care UK and Circle are the donations they (or their shareholders) make to the government parties of the day and the subsequent 8 per cent profit they want to make from our ill health. It has already been demonstrated that if you want a GP out of hours, Serco in Cornwall is not the place to go shopping.

Partners in profit

Then there are the commissioning groups made up of GPs. A General Practice is a private business in itself. Partners share in the profits the practice makes – the more money the practice makes or saves, the more the shareholders (GP partners) take home. This is a taboo subject usually only mentioned by the right wing press, who conveniently ignore the contradiction of supporting privatisation on the one hand and then expressing horror at the profits made on the other.

GPs have been and remain the very fabric of our current system. Are all GPs or practices motivated by profit? Absolutely not, but the market is; its sole function to make a profit for its shareholders. State revenue is yet again recycled into private profit with the inherent risks socialised. It makes little difference if the practice is called ‘North Road Practice’ or Virgin as either way, accountability will not exist. It is that estimated 30 per cent of GPs on commissioning boards have interests in for-profit private healthcare providers.

If we want to give feedback or comment about the NHS, we should first debate whether it is right to speak ill of the dead. I applaud resuscitation attempts, but depending on your criteria, the N in the NHS has already likely passed away. In the stages of grief, aren’t we in collective denial?

Paul Teed is a junior doctor in accident and emergency



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