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I just want to make something clear.
The army is not a babysitting service, neither is the NHS.
And, by-the-way… the NHS is not the football league.
I know it’s early days and election managers are trying to find their feet. Planners probably don’t, yet, have their manifestoes finalised. Not ready to press ‘enter’ on their desk-top publisher…
… in which case we have to expect a certain amount of froth until we get to the real-ale of the election campaign.
Compulsory military service ended in the UK when a pint of beer cost 54pence and a gallon of petrol was 5 shillings… 1963, when the last serving member was de-mobbed. Isn’t this a policy designed to appeal to electors of a certain age and prospective Reform voters?
Dad’s-kids-Army sending a message to Putin?
Polling is mixed; young Britons strongly oppose a year-long period of mandatory military service for young people. Older Britons are split.
Public service has higher support but I can imagine NHS managers with their heads in their hands.
Like we haven’t got enough to do already; who is going to manage this, police checks, safeguarding and governance issues.
One weekend every month… induction, health and safety training, supervision… a month to forget everything and start again…
… once we have invested in 24 days and they might be useful… they leave. I suppose some might stay?
League tables?
It’s Silly-Boy again. This time hiding behind the £wall in the Sunday Times.
It’s the usual cocktail of confusion and abuse. Most of what he criticises the NHS for is either actually the responsibility of the Department of Health or from a time when the NHS was run in a very different way and politicians had their fingers in it, up to their elbows.
He wants league tables. Allowing the public to chose to be treated elsewhere, other than their local hospital, if it is a poor performer.
League tables were originally Labour’s Alan Milburn’s idea (Having absquatulated to the private sector, he’s tipped for a comeback to run NHSE) he famously identified the 12 'worst performing hospital trusts in England' and said he would fire their chief executives if they could not deliver rapid improvement.
He didn't, he had no power to sack Trust Bosses. Milburn was accused of fiddling the scores and the idea was dumped in 2005, mired in the complexity of trying to measure 44 things.
LaLa Lansley had another go in 2013 but it was scuppered when it emerged doctors would be able to refuse to disclose details under data protection laws.
In March 2020, the Combined Performance Summary was decommissioned. In 2021, Sajid Javid had a go but it fizzled out.
Even Labour’s fanboy, the Confed’s Matthew Taylor, has reservations.
League tables are misleading and for a complex service like the NHS, there are now 150 specialties, are of little value.
For starters...
... how to compute the data? The Monte Carlo technique, bayesian statistics or the development of an absolute standard against which all units are measured?
Dunno…
I’m pretty sure, brains bigger than mine will agree, each has it’s own difficulty and needs specialist skills for analysis and interpretation.
Even under ideal conditions because of the variation in patients, their background health, the clinicians and their approach will never match performance exactly.
An excellent paper, ‘Performance league tables, the NHS deserves better’, by Adab, Rouse, Mohammed and Marshall, is a cuppa builder’s read and makes the point;
‘… league tables attempt to portray … variation by including 95% confidence intervals for each provider's performance…
... the use of this level of confidence for differentiating between a significant and non-significant difference is rarely appropriate…
...it also means that when all providers are offering a similar service in a stable system about 5% (1 in 20) will always be identified as outliers.’
League tables can’t sort out signal from noise. Are we looking for league tables or control charts?
What is Silly-Boy trying to measure?
Satisfaction, longitudinal performance, return for treatment, waiting, food, parking, complaints, thank-you letters, maternity, A&E, discharge?
I doubt he knows.
Declaring this Trust is better than that Trust when it involves endless variation and complexity is like trying to rate which cloud in the sky is the most punctual.
To want the NHS to do well, or better, I am sure is the ambition of everyone working in it and everyone who uses it.
Over my 50 years I have seen bungs, beatings, lists, ratings, stars, charters and rantings… none of it makes a dam-of-difference.
What really improves things? Sustained investment and leaders who create the time and space for good people to do great things…
… and that takes maturity.
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