Time for 'plain speaking' about poor NHS care

Roger Taylor is director of research at Dr Foster Intelligence

The change that is happening to the NHS is not deterioration in the quality of care. It is recognition that poor quality care is no longer acceptable.

The growing number of media reports about catastrophic failures in NHS care seem to point towards a worsening of care, but in actual fact the quality of medical care at NHS hospitals is improving.

Every year more people are helped through illnesses that previously would have harmed, disabled or killed them.

The paradox is that as the NHS gets better at saving lives, failure to provide the highest quality care becomes more and more unacceptable.

There are more people today whose lives have been saved by medicine than in the past. But by the same token, there are more people whose lives have been lost as a result of medical accidents, failure to pay due attention to the patient, failure to provide timely care or failure to follow well-known best practice.

The way that we discuss the issue of failures in hospital care is also changing. In the past, there has been a culture in the NHS, which at best aims to reassure the public and at worst seeks to conceal failings.

That culture has had its day.

The reluctance to speak plainly about the risks to patients has meant that, too often, poor care has been allowed to continue. The desire to support organisations struggling to provide a high standard of care in difficult circumstances has cost patients their lives.

Many figures were quoted in the weekend press about 'excess' deaths - the number of patients who die over and above those who are expected to die. But one figure in particular stood out.

Hilary Cass, President of the Royal College of Paediatrics and Child Health, was quoted by the Guardian: as saying: "In Britain, there are five deaths of children a day - 2,000 a year - that are preventable and unnecessary if our services perform as well as those of Sweden. The country's children are our future. We should do so much better. This is a major crisis."

Part of the difficulty of being open about these issues is the politics that come with it.

Hilary Cass believes that to protect children's lives we need fewer, more specialist hospitals and greater provision of services in the community. That makes a lot of sense medically. Politically it makes none.

Re-configuring hospitals does not win votes. Look what happened when the NHS tried to close the paediatric heart surgery unit in Leeds.

That is why I expect Sir Bruce Keogh this week to start speaking much more plainly about the fact that some of our hospitals are substandard and have been for some time; that NHS managers have faced challenges that they lack the skills to address; that sometimes it has been easier to try to make the best of a bad situation even when we know that patients are being let down; that too often it has been easier to pretend everything is ok even when we know it is not.

If he does this, the public is not likely to thank him for laying out the facts so starkly. It is more comfortable to live with a faith that the doctors and nurses will always do the best for us wherever we are cared for. But there comes a point where the price of maintaining that faith in defiance of the evidence becomes too costly. The lives of two thousand children a year is far too high a price.

Roger Taylor is director of Dr Foster Intelligence