Review

Voices of experience

WHAT’S GONE WRONG WITH HEALTH CARE?
Alison Hill (ed)
King’s Fund, 2001, £14.99

A group of invited, mostly medical, people met at a conference to discuss what should be done to meet the challenges facing the NHS in the 21st century. The conference considered five case studies of patients whose care could at best be called inadequte. They cited the paternalism and ageism of doctors; the bureaucracy of the system; the lack of interpersonal (as opposed to clinical) skills of the professionals involved; the importance of continuity of care; the lack of patient involvement; and the weaknesses of medical education.

The chapter on duties of care – to protect life and health, respect patient autonomy and apply fairness and justice – is well worth reading. The assessment of each patient’s care is revealing, as it spotlights the need for effective coordination, as well as proper care and respect for the patient. Many clinicians would do well to take this on board.

The book title is somewhat misleading. Its content addresses the weaknesses of patient care and not that of the NHS organisation. It deliberately omits the issue of resources and how these are applied. So its conclusions – about empowering patients, eradicating paternalism, improving teamwork and communication – are limited purposely to what health professionals can do.

The proposals for patient-held records, key workers and care plans and the intermediate integrated health centre – none of them new ideas – are all worthy and urgently needed. Both professionals and patients would find the patient experiences and commentaries on them illuminating.

But health care should be delivered effectively and that requires resources, organisation and a change in culture. The conference did not deal with the wider issue of the delivery of health care. So why not hold a further conference to consider the organisational issues of how to ensure the NHS effectively delivers the complex and varied health and people outcomes now required of it?

That would be a real challenge.