Nurses for Reform Blog

The time has come for me to share with you another paper that I found invaluable while studying for my PhD.

The Private Supply of “Public Goods” in Nineteenth Century Britain by Dr. Stephen Davies gives a fantastic overview of how so-called public goods, such as policing, healthcare and sanitation, were being successfully supplied by the private sector in Georgian and early Victorian Britain.

It goes on to show how the public were hoodwinked in to believing that government knew best and that only the state could provide these services.

We have examples every day of how successful the state has been at providing these so-called “public goods”.  So has the time not come to look back to the late Eighteenth and early Nineteenth Centuries to give us some ideas for the future?

We all know that drug administration error is the nightmare of any registered nurse in charge of patients. I see in Glasgow that Ward sisters are now wearing red sweat shirts while doing the drug round to warn other staff not to distract them while dispensing medications at Gartnavel General Hospital in Glasgow (1).

While innovative, one wonders what the patients think about it. While working as a trainee psychiatric nurse at The Royal Edinburgh Hospital in the mid eighties, I came across some research on colour and its effects on patients by Professor Annie Altschul, Professor of Nursing at Edinburgh University. For psychiatric patients on acute admission wards green was found to be the most restful and therapeutic colour while red signalled danger and distress. I hope the sight of a large red-clad nurse looming towards them doesn’t make some of the patients want to jump out of bed and flee for their lives!

The best way of reducing drug error is the introduction of ePrescribing, or as the Americans term it, computerised physician order entry. Using technologies such as radio-frequency identification (RFID) and wand scanners, coupled with the electronic care record, the identity of the patient and their match to the prescribed dose of the right drug can be ascertained by scanning bar codes or RFID tags. Ann Slee, Director of Pharmaceutical Services at the Royal Liverpool and Broadgreen Hospital is now national clinical lead at NHS Connecting for Health for a large ePrescribing programme to introduce this change nationally in England. It is time for the nursing profession to get behind her and lead in the introduction of ePrescribing in the NHS to reduce avoidable prescribing and drug administration error. The answer is not more red sweat shirts!

(1) HSJ, pp 8, 22^nd February, 2007:

www.hsj.co.uk

Much has been made in the past few days of the news that doctors are no longer going to be allowed to regulate themselves in light of the Harold Shipman inquiry. Apparently, the power of governance is to be moved away from the General Medical Council and into the hands of the NHS and a so-called independent authority.

For me the proposal has raised a number of concerns. Firstly, it is very unlikely that the doctors are going to take this lying down, what are they going to want in return?

Secondly, if the NHS is going to be involved in the policing of doctor’s clinical competence does this really inspire confidence?

And thirdly, if there is going to be an independent organisation established how many seats/places/appointments will the doctors insist be filled by doctors to …ensure appropriate peer review… …monitor clinical competence… or other such weasel words. I am willing to bet that doctors will make up the majority of representatives on theses governing bodies or they will seek regulatory capture by some other means.

However, the real issue here is that the proposals made by Liam Donaldson will not improve the care given by doctors to patients. Nor will it improve public confidence in the medical profession.

The time has come for us to think more imaginatively about how we want our doctors trained and regulated. Why should government and the NHS be involved at all? Do we need the government to tell us which washing machine or car is likely to be more reliable or give us better service? No, a multitude of consumer magazines, websites and television programmes are available to help us with our choice. We talk to our friends and family to canvas their opinion and experiences and we make our decisions not based on an in-depth or expert knowledge of the subject but with an informed choice from the trusted bands available in the market.

Why should our choice of doctor be any different?

Isn’t it about time the Government stopped treating the public like children who are unable to look after themselves and started realising that there is a population of consumers who are willing and able to take responsibility for their own health and healthcare decisions?

In recent days I have spent some time in Central and Eastern Europe. Across the region private healthcare is growing on the back of an ever expanding middle class. After decades of huge Socialist-era failure the whole region is beginning to see a burgeoning range of private health options and brands emerge.

Indeed, I was fascinated to learn that following the manifest failings of the Slovak Republic’s state healthcare system, a system that had all the historic failures of the UK’s NHS, citizens have now been given the opportunity to insure and self fund for key elements of their healthcare.

A law passed in early 2003 means that healthcare providers can now charge Sk 20 per doctor visit, Sk 20 per drug prescription, Sk 20 per kilometre travelled in an ambulance, and Sk 50 per day spent in hospital. While patients continue to receive some medications ‘free of charge’ – many can now be purchased privately.

While Slovakia has more than a hundred hospitals and mental health centres I found it nevertheless unfortunate that private companies are still precluded from obtaining a majority stake in larger hospitals. As a consequence the private sector in provision is unnecessarily limited – for the time being at least – to primary care and the smaller hospitals.

The great thing about Slovakia is that having introduced a range of radical market reforms across several areas of activity – of which healthcare is simply one – the economy is now set to grow at more than 8 per cent a year. Having introduced a highly competitive flat tax regime of just 19 per cent, the country looks to be well on the road to prosperity.

Unlike many state health systems in Western Europe (the UK, Spain and Italy), Slovakia looks as if it is well on the road to developing a sustainable health market that is rooted in the principles of consumer led quality.