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BMJ. Feb 23, 2002; 324(7335): 491.
PMCID: PMC1122416

28 Minutes to Save the NHS

Nick Steel, Institute of Public Health

BBC Radio 4, Wednesdays at 11 pm, 6 to 27 February 2002

The quality of health care is causing a major crisis throughout the Western world. In the United Kingdom we love to bash the NHS, but have little to compare it with, in the way that Americans can compare managed care with fee-for-service. They moan about the evils of managed care, but are gradually realising, in the words of quality expert Bob Brook from US think tank RAND, that “managed care is not the problem, quality is.”

In Australia, New Zealand, and the United Kingdom, the quality of health care in general practice has almost never been found to meet acceptable standards. Even France and Germany have huge variations in quality, as the fearless travelling NHS overflow patients may be discovering.

What can we do about this terrible state of affairs? New Labour has spawned a host of new agencies with Orwellian names—from the Commission for Health Improvement to the NHS Modernisation Agency—to solve the problem, all so far to no avail. But now the BBC has unleashed its secret weapon in the national drive to improve the NHS—Phil Hammond, David Spicer, Bob Baker, and Pete Hambly's new satirical series, 28 Minutes to Save the NHS.

The central idea is the uncomfortable but essentially plausible one that doctors are human. Not only do they inevitably make mistakes, they may not worry that much about them. “Lighten up about death,” we are urged—the responsibility for medical cock ups lies with the patient who does not ask for enough information, or perhaps the system that allows doctors to practise in such a variable way.

The second episode tells us that the NHS was designed to deliver four treatments: fresh air, Ovaltine, an extra potato, and a sharp tap from sister's pencil. The RAWP (resource allocation working party) formula finally became clear to me: it's tied to the price of pencils and potatoes. We also hear an interview with an alarmingly realistic secretary of state for health, who is unable to say “rationing,” and discover that the next medical scandal after Alder Hey (“pathologists collect pathology specimens”) will be: “surgeons cut you up with knives.”

This series has the potential to achieve more than a host of government agencies can, and may well evolve into the Commission for Health Care Satire, with an official brief to inform an unwilling public that medicine is riddled with uncertainty. I recommend catching the final episode next Wednesday. Be prepared to feel uncomfortable, whether you are a doctor who has ever performed a TUBE (“totally unnecessary breast examination”) or patient who has never inquired about their doctor's competence (“Are you mad?”).

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