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Editorial Friday 19 September 2014: The NHS is Russia (and postmodernism), basically

Publish Date/Time: 
09/19/2014 - 09:00

Many people don't really understand the NHS, which might be OK if they didn't also try to run it or make policy about it.

So in the interests of helping people understand it a bit better, I'm going to let you in on a secret: the NHS is Russia, basically.

Notoriously big and populous; notoriously hard to govern; and notoriously difficult to conquer.

Obviously, there are a few minor differences. The NHS doesn't drink vodka for breakfast, or have fairly significant oil reserves.

And it's not as if neo-liberal governments are trying to trash the NHS's economy ... oh, hang on ...

The other half of Gorbachev effect
The changes currently under way to an NHS that has just about survived four successive years of flat funding in the face of rising demand without blowing up the quality (a miraculous achievement, really) are the missing second half of the Gorbachev reforms to the USSR in the 1980s.

These were, you will recall, glasnost (openness) and perestroika (restructuring).

The NHS has tested to destruction the theory that there is a perfect organisational format for running a complex, adaptive universal tax-funded healthcare system through its quasi-autistic obsession with structures and restructuring. Perestroika has been tried, and it has failed to change much other than rearrange the deckchairs, pay good redundancy packages and make stationery printers and signmakers very happy.

So because the NHS is Russia, now we're majoring on glasnost. The direction of travel currently under way (started really by the Keogh-led publication of cardiac surgeons' outcome data, and followed up with the waiting times and healthcare-associated infections and PROMS data) is for increasing glasnost, as typified in today's launch of a new NHS hospital information website.

It won't be perfect, because very little ever is. And it only compares hospitals, for now.

But it's an important acknowledgment that the NHS is not only Russia, but also postmodernism. Postmodernism puts the workings of a thing on the outside: a classic example is the Pompidou Centre in Paris, whose workings as a building are ostentatiously displayed on the outside.

Like most new sensations, glasnost can be a little uncomfortable at first.

Data doesn't solve everything: it needs to be set in an appropriate context. And only when it's used to change things does it acquire the valuable status of information. It also needs clinical and managerial colleagues to trust it, and have faith that it will be used appropriately. Getting smarter about how to run the NHS is much more about a mindset than it is about a data set.

So there you go: the NHS is Russia. And postmodernism. Sort of. For today.

Have a good weekend.