Rethink Health - August 2008
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Darzi Review: A Bridge Too Near
I take my hat off to Lord Darzi. Besides maintaining his clinical role he has been very busy for months now on a deep-rooted review of the NHS. And he has not just come up with more of the same. In the recent past Government has responded to NHS shortcomings with wave after wave of regulation and structural reform – each adding cost, complication and obstacles to real change.
Darzi has tried to transcend that. He has replaced structural change with a re-definition of what the NHS is for. He looks for quality, by which he means clinical effectiveness, patient safety, and a good patient experience. That’s fine, but it does not add up to a definition of the purpose of the NHS. As a specialist surgeon his own role is cut and dried, but that prepares him poorly for seeing the service in the round.
And he cannot escape structural change, of course. Quality will be measured and monitored by indicators devised and reviewed independently by the National Institute for Health and Clinical Excellence (NICE). By 2010, NHS institutions will have to publish Quality Accounts. Regional Quality Boards and Quality Observatories (yes!) will be established. And a National Quality Board will lead national strategy, oversee measurement, advise ministers on clinical priorities, and produce an annual report on the state of quality in the NHS. This cultural shift towards professional responsibility for clinical outcomes is a valuable step outside regulation but it is extra to current management requirements - it does not replace them.
The principal error here is the idea that quality can be measured like quantity. The devil is in the definition. Quality has to be created for each particular situation, and since each situation is different it usually results in novelty. Quality Boards can only assess what they anticipate, not the unexpected but brilliantly creative solution to a particular problem. Thinking outside the box wins no prizes.
This is progress, nevertheless. Darzi admits we need to redefine the NHS. Though he fails to define our target – health - he does open the question wider than since the 1930s. Let’s hope his effort does not sink without trace.
High quality care for all: NHS next stage review final
report. London: Department
of Health, 2008
Backache in Australia: Is It Fluorosis?
A paper recently published in the BMJ set me thinking. It concluded that recovery from backache is taking longer: a third of the patients in the study were not improved within a year.
Much of Australia has been fluoridated for several decades now. English data indicate that we are getting more fluoride than we realise, and most of us do not have it in the water supply. Most of those who do are getting too much, even by Government standards. And an early consequence, not detectable by x-ray, is vague pain and stiffness in joints.
The inference is simple – don’t take fluoride. Buy toothpaste without it – from a Health Shop if necessary. Tea is another rich source. So, I understand, is fish from the Mediterranean.
I’ve put in a Rapid Response about this on the BMJ website.
Blood Pressure: Iron good, Red Meat bad
I don’t recall seeing this anywhere before. A large sample of adults from four countries showed that dietary iron lowers blood pressure, but consumption of red meat raises it. The average effect is quite small, but since the implications coincide with good general dietary advice they are worth respect.
If you feel the need for iron do buy food-state or bio-food iron. If it does not resemble food very closely it is not absorbed or distributed at all well. The Cytoplan products are 4070 and 5575 respectively – when calling remember your discount code. The number and code are in the title of this letter.
Sun and Skin
There’s a respectable body of opinion out there that agrees with me. Whether or not sun causes cancer remains controversial, but I maintain the danger lies in basting pink skin for two weeks under a cloudless summer sky. My own arms and head are permanently bronze, because I rarely cover them up. I relish the benefit – lots of vitamin D, which is a natural chemotherapy.
That Blook
We’re up to Chapter Four, but I’ve made a mess of the website I put it on. The text is now on our own site as News, and the illustrated Chapter Three can be found at http://whatishealth1.spaces.live.com/. I’m sure there are better ways but electrons are mischievous!
Enjoy the summer.