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The customer may always be right, but only if you run a business

I haven’t got around to reading all twenty-odd thousand words of the Francis Report, but I’m reliably informed by that bloke on Radio Four’s drive-time show that they could all be summed up in three: ‘Put patients first’.

Tell you what, just for a change, let’s not.

I’m filled with the same horror that all of you must be at the harrowing tales that have come out of the woodwork about appalling levels of care at Mid Staffs – just the same way as I was shocked by the Bristol heart scandal, the Alder Hey organ scandal, the Maidstone and Tunbridge Wells C Diff scandal, the Furness maternity scandal and the Bedford hospital mortuary scandal.

As a result of a good deal of vigorous shroud-waving by politicians and media commentators alike, we’ve seen hapless patients put first, front and centre, empowered, included, offered advocates, herded through gateways and occasionally defined as experts. They’ve had their journeys mapped, their experiences enhanced, their care co-ordinated and their narratives explored.

God forbid that they fall for this sanctimonious crap yet again. The net result of all of this? Bugger all of any practical use. A few dozen reports that nobody has read all the way through, a few thousand trees felled and replanted, hundreds of editorial column inches filled with rent-a-quotes and a handful of single-issue political campaigns.

So let’s give up on the concept of an NHS that puts the patient first and above all others. Let’s stop pandering to those who dial 999 when their kid vomits once, or who turn up to A&E with an insect bite. Let’s stop reorganising GPs’ appointment systems to deal with the insecurities of people who, ‘are ill or who believe themselves to be ill’.

We already have a medical provider that puts every patient front and centre, calls them ‘delightful’ and lays on cappuccino in the waiting room. It’s called the private sector.

The NHS simply can’t afford such luxuries. It staggers along, propped up by the altruism of the vast majority of the people who work in it. For years and years, that devotion to duty was rewarded not financially, but in ways that made the staff feel valued. Imagine a hospital where doctors and nurses can park their car a short walk from the main entrance, where the food in the canteen is actually edible, where services exist to make their lives easier rather than harder. Where everybody knows your Christian name but still calls you ‘Dr’ or ‘Sister’ on the premises.

You’re picturing your local private hospital, aren’t you? I’m picturing the NHS centres of excellence where I worked in as a junior in the 1980s.

So stuff the idea that fulfilling patients’ expectations is the be all and end all. Let the pendulum swing back to the professionals’ side for once. Just for fun, let the doctors and nurses run the show.

What did for the patients at Mid Staffs wasn’t a lack of expertise, but a managerial regime designed to take the caring out of curing. When a medical registrar writes that he is forced to spend twice as much time on the paperwork that accompanies every admission than he does examining, investigating and reassuring the patient, then surely it’s obvious that something is wrong. All the interminable risk assessments get in the way of patient care, rather than enhancing it, and they were all generated by a management ethos that aims to cover its corporate backside in the guise of a ‘patient-centred approach’.

How many doctors and nurses passed by on the other side at Mid Staffs and failed to raise concerns about the standard of care? We’ll probably never know. Anybody who wants to know why clinicians were disinclined to point out catastrophic failings on the wards should read through Andrew Bousfield’s Twenty-One Ways to Skin a Whistleblower and wonder what they would do in the same situation.

Until the NHS starts to value its workforce and accept that, now and again, their needs might override those of the patients, nothing’s going to change. Designing systems that include clinicians in day-to-day decision-making – advised, but not dictated to, by patients and their families – will be far more effective in improving patient care than any dictat from on high.

The customer may always be right, but only if you run a business. The NHS is not, never has been and never should be run on a business model. Leave that to the private sector.

Dr Tony Copperfield is a GP in Essex. You can email him at and follow him on Twitter @DocCopperfield.