Lord Darzi : offensively inoffensive

Alan, Ara & Gordon

Lord Darzi is a clever guy. Of that there is no possible doubt. He is a highly accomplished, pioneering laparoscopic surgeon. That does not make it intuitively obvious why he should be able to provide what is being trailed by the government as the single most important NHS master plan since 1997. I suspect he has been picked for his voice. There is something enormously relaxing about his mellifluous tone and his gentle Irish cadences. Such a shame, then, that his report is a load of meaningless drivel.

It was always going to be so. This report is, more than anything, about front line NHS services; about what you will get when you walk into your local general practice, or your local accident and emergency department. Lord Darzi knows nothing of general practice. He knows nothing about front line nursing care, or physiotherapy, or of the Community Mental Health Care Team (God help us all). Next the government will be asking Dr Crippen and the Jobbing Doctor to write a report about “Future developments in laporoscopic surgery”.

The best way to cover up lack of knowledge is to brazen it out, to lie. And so Darzi starts with a whopper:

In previous reviews of the NHS, frontline staff have been on the fringes or bystanders. This Review has been different. We and our colleagues in the NHS have been at its core.

Utter bollocks. Frontline staff? Look at the list of the eleven names attached to the report. There is only one GP. The rest are academic or administrative hospital doctors and managers. Not a single representative of the Royal College of Nursing. No psychiatrist. No physiotherapist. No one who can advise Darzi about what is really going on. This is not a consensus report. This is unadulterated Darzi. Count the number of times you see the word "I" in the document.

Darzi is going to tell NICE to make its decisions about new drugs more quickly. The Jobbing Doctor is impressed. We shall see. Dr Crippen is more cynical. I suspect this is sleight of hand. If NICE decides that most “new” drugs are too expensive to be cost effective, we have not progressed.

The report taken as a whole is offensively inoffensive. Colour photos of Ara, Gordon and Allan. Soundbite after soundbite

high quality care for patients and the public

Think about that. What does it mean? Patients and the public? Extraordinary. And so it goes on. There is lots more where that came from:

Change : locally led, patient centred and clinically driven
Quality at the heart of everything we do
Freedom to focus on quality

You begin to lose the will to live as you wade through this morass of focus-group soundbites. Is there any meat on the bone?

Every primary care trust will commission comprehensive wellbeing and prevention services, in partnership with local authorities, with the services offered personalised to meet the specific needs of their local populations.

Our efforts must be focused on six key goals:

• tackling obesity,
• reducing alcohol harm,
• treating drug addiction
• reducing smoking rates
• improving sexual health
• improving mental health.

Don’t eat, don’t drink, don’t smoke, don’t take drugs, don’t have sex and don’t go mad. All good stuff. You can’t fault it, can you? You can’t criticise motherhood and apple pie. Trouble is, you cannot build a health service on soundbites.

The biased BBC just produced a report saying:

The government has been accused of acting like a nanny state in the past over some of its public health initiatives. But the survey of 1,040 people in the UK revealed most wanted ministers to take more responsibility for getting people to make healthier choices. (BBC)

What questions were asked? "Do you mind the government trying to persuade the people to drink less alcohol?" Most might well say "no" to that. But try this question. "Given that we have limited resources, would you spend more money on eradicating MRSA from hospitals even it that meant there was less money to spend on health education?"

In Dr Crippen's experience what most patients want to know is that, when they are ill, they can have quick access to a doctor they trust and to a hospital service that is clean, efficient and free from MRSA. They may not mind being nannied about preventative health care but it is not their main priority. In any case, the drive to improve public health, commendable though it may be, is not best done by doctors. We are not very good at it. We find it boring. Let the epidemiologists, the sociologists, the advertising industry and the nurses concentrate on preventative medical education. Let us concentrate on what we do best. Seeing patients who are ill, diagnosing them and treating them.