It is easy to say that all that is needed in the NHS is a culture shift, and then everything will run like clockwork. My own experience as a patient is that one important culture shift has already happened. Twelve years ago, before a quite serious operation, the consultant did not tell me of a life-changing side-effect of the operation. I have to say that the operation was technically wholly successful, but I have not forgiven the surgeon for not being straight with me. I felt that the NHS was great from houseman-level down, but wholly untrustworthy - the registrar had connived in the consultant's deception - at the higher levels.
Two years ago, I had another operation in the same hospital, and this time the consultant - not the same -one took immense pains to explain everything about the op and even gave me the option to back out at the last minute. Clearly, there was a big culture-shift there, and it demonstrates that the NHS can change, at any rate for the benefit of a stroppy articulate middle class white.
For others, I am not too sure. A gardener friend in rural Hampshire had a cancer operation recently. And when he got to talk to the surgeon, on the telephone, he spoke so fast, using so much jargon, that, at the end of it, my friend didn't know whether he was being told that the operation had been successful or not. This is clearly unacceptable, and shows, perhaps, that doctoral user-friendliness may have made some progress towards the haves, but is still a bit iffy towards the have-nots and the passive.
Theoretically, we ought to rely on the Royal Colleges and the GMC to improve this, but professional solidarity is an obstacle. In desperation, I sometimes think that every "have-not" patient needs a "have" mentor, to guide him or her through the NHS maze, and keep the doctors up to the mark!
The pace of change is hotting up across the NHS. Fanny Mitchell, a London-based hospital administrator, believes that staff at all levels are much more prepared to accept change than they were ten years ago. They no longer hide their heads in the sand, but have become more open to suggestions, even though they may feel battered by the changes when they come.
The National Programme for Information Technology is already forcing culture shifts among particular groups. The consultants are challenged by being asked to key in information to Patient Records on computers, rather than scribble on bits of paper. They are jibbing at this furiously. This is understandable, as nobody can learn to type in five minutes. But the real culture shift for consultants is not just learning keyboard skills but making the intellectual jump into seeing why the extra effort is worthwhile. Nor are these techniques new. I was amazed to hear that the average age of Electronic Patient Record systems in London hospitals is 12 years. But it is only in the last year that Alan Milburn provided money for computers in every consultant's surgery. So far, I find that only the younger medics use them. This has to change.
Where a hospital or a consultant has developed advanced systems, it wants to keep them for itself. A group of Parliamentarians visiting a London teaching hospital five years ago, were impressed by the sophistication of a cardio-thoracic monitoring system, and one of the delegation asked the consultant who designed the system, what he was doing to replicate the system in other hospitals. The consultant was surprised by the question. "This is my system; general hospitals would not be able to understand or use it". This mixture of arrogance and protectiveness seemed to the MPs a serious cultural barrier to the spread of IT across the NHS.
What it also did was to engender the idea that the proper way for clinical IT to develop was a series of unrelated "bottom up" pilots. Any "top down" initiative was automatically wrong. The result was a mess of incompatible systems, implemented very slowly, which would not talk to each other. Despite the National Programme for IT, which calls for a very "top down" approach, these attitudes still linger. At a conference in Harrogate at the end of March, a debate between "national" and "local" approaches was only narrowly won by the "national" proponents by 55 per cent to 45 per cent. And this was a conference of health IT people. The medics who are interested in IT, both hospital doctors and GPs, tend to be even more "bottom up" people.
There is a tradition in the NHS for various factions to snipe at the centre. The NHS IT Tsar, Richard Granger, is going to have a lot of trouble from this unruly lot. Last week he called for the "spectators to move from the terraces onto the pitch". I hope they will do so as players, not just to disrupt the game.
