I appeared on the Radio 4 programme Iconoclasts yesterday evening, advocating the abolition of the NHS. I and the producers were surprised that the emails coming in ran 3 to 2 in favour of abolition. It seems possible that the NHS does not retain the almost religious respect and love that it once did.

I found that when I mentioned what I was doing to people before the programme, their first reaction was surprise or shock. But then they connected with some recent bad experience that they or people they loved had undergone. These were usually delays or cancellations. In one case it was poor nursing and the writing off of an elderly relative.

After the programme had finished, Gerry Robinson, who had maintained thoughout that the NHS, for all its faults, could certainly be reformed, suddenly said he thought we should abolish it. Ed Stourton wished he had said this during the programme. Dr Sam Everington also expressed more misgivings about it off air.

For seven days or so, the programme is available on the 'listen again' facility of the BBC. I hope this link may work: http://www.bbc.co.uk/iplayer/episode/b00tq7x2/Iconoclasts_Series_3_Episode_3/

During the programme Sam referred to some Commonwealth statistics which he claimed showed that the NHS was performing well. This was contrary to all the varied statistics which I have seen over some years so I was surprised and interested.

I have now found at least one paper produced by the Commonwealth Fund, which indeed takes a positive view of the NHS. I had imagined that he had been referring to the Commonwealth of countries. However this is the Commonwealth Fund which is a private foundation with no connection, as far as I know, to the Commonwealth. The paper does not appear in a peer-reviewed journal, as was the research which I cited. It is the publication of a kind of think tank or research organisation.

The rankings in this paper appear to be based primarily on answers to questionaires. They are what people think, not whether or not people are cured.

With great respect to Sam, who is evidently an exceptional GP with terrific energy and ideas, figures based on people's answers to questions are problematical for two reasons:

1. Opinions and ways of doing things are not as important as outcomes.

For example, one item which was measured was:

Physicians reporting it is easy to print out a list of patients who are due or overdue for tests or preventive care

People have different opinions on how doctors should conduct themselves. But in the end, the important thing is whether or not they cure people. Instead of measuring this, the Commonwealth statistics are partly based on deciding their opinion of all the things a doctor ought to do and then ranking those who do not do those things as inferior. This is not an objective way of ranking medical services.

2. When patients are asked questions, or doctors too, perhaps, they may answer on the basis of their expectations. One person may have high expectations and find a certain experience unsatisfactory. Another might have low expectations and be pleased with exactly the same kind of experience. Again, this is unreliably subjective.

Posted by James Bartholomew • Indexed in NHS

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