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Leader: Comparing the NHS

Leader: Comparing the NHS

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The chair of The Commissioning Review editorial board reflects on how the NHS compares with health systems internationally

Summer is the time for holidays and recharging the batteries. Sadly on my recent family trip to Egypt I contracted awful food poisoning which taught me many lessons. I realised how well regulated and effective our health service is and how different it is in other countries. I was offered any amount of antibiotics and drugs for symptom relief at a price the pharmacist thought I could afford. I only wanted oral rehydration, and had I not been a medical professional, would have been talked into multiple therapies to “cure” me. Little wonder there is antibiotic resistance developing. I worked in Australia in the 1990s where you had to get permission from Canberra to prescribe ciprofloxacin - yet it can be bought freely over the counter in many countries.

The days I spent in bed allowed me to read a fascinating book called First-Rate Madness by Nassir Ghaemi MD, a professor of psychiatry at Tufts University Medical School in Boston. The book uncovers the links between leadership and mental illness. Ghaemi argues the Inverse Law of Sanity: when times are good, and the ship of state only needs to sail straight, mentally healthy people function well as our leaders. It is in tumult, that mentally ill leaders function best. It covered leaders from Napoleon through Ghandi, Churchill, Hitler to Bush and Blair. The book highlights the deep cultural stigma that accompanies mental illness, and may be among our species deepest biases, more so than racism and sexism. Prejudice against mental illness crosses all societies and all historical epochs. Profound intuitive responses and beliefs have grown out of this stigma over millennia and will not change easily or soon. With one in four people having some form of mental illness, it is time to change. Some studies show that physicians attach as much stigma to mental illness as the general population. 

But then again what is normal?

The psychiatrist Roy Grinker – editor of the Archives of General Psychiatry – coined a term for people thought to be ‘normal’. He called them homoclites, a Latinate term he invented to indicate people who ‘follow a common rule.’ Homoclites are described as people who have practically no trouble with those in authority and would abide by the rules even if they considered them unfair. They are the silent majority, the middle of the roaders who want to do well, to do good and to be liked. They don’t put their heads above the parapets but get on with life, their jobs and roll with the punches. I think it could describe the vast majority of the NHS workforce who, every few years have to endure yet another top down reorganisation, but continue to do the best they can for their patients.

With the general election 10 months away, the political football that is the NHS is being inflated for another kick about. Already I am hearing calls to pause progress until we know who the political masters are and their ‘new ideas’ to solve the healthcare crisis. Politicians are all for reconfigurations so long as it is in someone else’s back yard. The endless debate about privatising the NHS must end with proper commissioning on outcomes for patients, not incomes for providers. Patients want quality care supported by health, and with the better care fund partnership working, I believe it can be achieved.

Before his White paper, I asked Andrew Lansley: if GPs are self-employed, hospitals are all foundation trusts and community providers are social enterprises, would anyone be employed by the NHS? His reply was that it did not matter who employed the workers so long as the qualities and values of the NHS were upheld, which are free at the point of delivery irrespective of the ability to pay. Unfortunately we persist in trying to realise a socialist ideology using capitalist business models which will never work. My Egyptian experience has spurred me on to find a workable solution by harnessing the power of clinical commissioning based on needs not wants or the ability to pay. It will take special leadership to avoid being deflected and distracted.

You would have to be crazy not to try. 

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