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Letting the truth get in the way of a good story

Published: 27 Feb 2014

The NHS will always be cast as the heroic underdog but the private health industry is willing to work together to achieve good.

Things are not always as they seem. For example, David was always going to win the fight with Goliath.

 It turns out that Goliath was (probably) born with a faulty pituitary gland. This rare condition, called acromegaly, causes an overproduction of growth hormone – resulting in, amongst other things, “giant” people with poor eyesight.

That’s why Goliath didn’t notice that “little” David was swinging the right equipment to fire a rock with the force and accuracy of a .45 calibre hand gun.

It’s not just Goliath that gets hard done by in this story. Small, weak, armour-less David is remembered in history as being brave, yes – but also as being lucky.

If you re-read the story, you’ll see that David volunteers – I like to think that David does this because he knows he is a good shot.

What a different story it is when David is a cock-sure assassin and Goliath is a victim of circumstance.
Anyway, the point I want to make is that with stories – there always needs to be a hero and someone has to play the villain.

That brings me on to the private sector versus public sector debate. In order for the NHS to be a goodie, does the private sector have to be a baddie?

I’m sure that 3,000 years ago, on their battlefield, all that mattered is one side won and the other lost. Sometimes I wonder if – today, despite all of the rhetoric, we’ve not moved from that winners and losers mentality.

Getting safe, effective and timely treatment that gets patients to the best possible outcome should be the aim for every single person and organisation involved in delivering healthcare.

There is no doubt that we all would find it easier to do this by working together. Take safety for example – flying is the safest form of transport, regardless of the airline you book with. Statistically you are just as likely to arrive at your destination in one piece irrespective of which of the many airlines you choose – although you might find (arguably) Virgin Atlantic more comfortable than a budget airline.
For this reason, a surgeon (Atul Gawande) asked some aviation experts how they managed to keep flying so safe. Turns out, they used pre-flight checklists. Atul started using pre-surgery checklists and found that they reduced death rates from surgery by 47%. That is worth repeating: 47% less deaths because the surgical team borrowed a technique from a different sector. That is far better than any recent drug innovation.

I’ve worked for the NHS for over 10 years – and still do. For the last year I’ve also worked for a private insurance company and I’ve seen lots of areas where the two can share capabilities and learning. When we look at co-creating services, the whole healthcare system wins. Using financial expertise and commercial flexibility matched with clinical knowhow, we have been able to explore getting patients to better outcomes. We are able to look at making healthcare more effective.

It may not be as neat as creating a surgical checklist, but handing over the data – formatted in an understandable way – should be just as powerful. Especially for the clinical commissioning groups tasked with providing all the care for their population while saving money.

Interestingly, I’m told, creating the checklist wasn’t difficult; the hardest part was and is getting people to use it. Even now, despite robustly proven lower complication and death rates, use of a pre-surgical checklist is not standard practice.

Imagine how hard it is going to be to get people to change their behaviours by showing them a spreadsheet.

That is why, I think, we have to turn this work into compelling stories. For example, we have created a pathway that will get symptomatic women to an accurate diagnosis of breast cancer 99.6% of the time, mostly in a single visit to the hospital. The cost savings associated with this will form the spreadsheet; the spared heartache will be the story.

Like David – the NHS, for obvious reasons, will always be cast as the heroic underdog. But even from the role of tyrannous villain, the private health industry can prove that it is willing to work together and achieve good.

Dr Umang Patel is clinical transformation lead, Aviva UK Health, clinical fellow in paediatrics at Frimley Park Hospital NHS Foundation Trust and clinical leadership fellow at the NHS Leadership Academy

This article is also available on Health Insurance Daily and comments can be made here.

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