Editor’s blog 7th January 2009: How many CSEs have you got?

As a pint-downing weathergirl and a Tory topless model prepare to fight it out for the voting sub-section (i.e. the really dim bit) of the TV viewing public’s attention in Celebrity Big Brother, the possibility of a public vote improving anything other than a TV company’s profitability may seem remote.

Yet an interesting piece on the BBC News politics section today looked afresh at the legacy of John Major's 'cones hotline' (news.bbc.co.uk/1/hi/uk_politics/7772818.stm). It is a longer legacy than you might imagine.

Its latest iteration will be in the about-to-launch Customer Service Excellence awards, which will aim to involve local people in the setting of standards for public services.

Bradshaw vs. Buckman – seconds out
This is coming in the wake of Hugh Grant-alike (as far as a politician goes) Health Minister Ben Bradshaw’s announcement at the end of last year (www.guardian.co.uk/society/2008/dec/30/doctors-rating-website-nhs) over the initiative to introduce a ‘rate my GP’ function on www.nhs.uk this year, making the BMA grumpy again.

The floppy-fringed minister and ex-journalist wants The Site Formerly Known As NHS Choices to facilitate patient ratings of GPs’ competence and bedside manner online. The Guardian story about this reported that “since April (2008), NHS Choices has given patients the opportunity to post comments on hospitals. Analysis of the first 6,500 comments showed 24% were positive, 27% negative and the rest were balanced or neutral”.

Bradshaw suggested that the existing quality scores “look like the results of an east European election under the Soviet regime”: a stunning comment from a representative of the thriving New Labour democracy which couldn’t even find a candidate willing to stand against Gordon Brown for the party leadership.

Bradshaw also told John Carvel, “Nearly all get 96%, 97% or 98%. That doesn't really give people an idea of whether the practice is better or worse than others in the area”. Helpfully, he added, "I want people to be able to read comments” (Read them? As opposed to what, Ben? Dance them?) He also drew comparisons with Amazon and Trip Advisor websites.

Meanwhile, Dr Laurence Buckman, chairman of the BMA's GPs committee, told the paper that he took the view that “a website on which people can slander or praise irresponsibly is the wrong approach”, raising the interesting concept of responsible slander.

Buckman cited the issue of GPs' proper refusal to prescribe antibiotics for viral infections leading to negative feedback, assuming of course that the GP in question will be correctly distinguishing a virus from an bacterial infection – which of course, most will.

Buckmaning the trend?
Taking us back to the TV voting where we came in, Buckman warned of the temptation for GPs to play the popularity game: "if you want to survive as a GP, you will encourage patients to vote for you. It will be rather like Strictly Come Dancing”. Could this be termed “Buckmaning the trend”?

“I think this has everything to do with consumerism and it has not been thought through well. I am happy for people to praise or criticise their doctor, but this is not the way professionals should interact with their patients. It has a great potential to be misleading."

Public opinion - a good thing or a bad thing?
So is greater patient and public involvement in target-setting and giving feedback on services a good thing or a bad thing?

Think King Canute. Web 2.0 has made the era of deference to professions less tenable again. This movement to public feedback on public services is an inevitable thing - unless we are proposing that medicine and healthcare is actually a faith and thus that we should not, in Bagehot’s phrase on the monarchy, “let daylight in on magic”. I do believe that that is at least in parts a fairly tenable argument, by the way. The NHS has always had a lot in common with cults and religions.

It seems counter-intuitive for doctors – members of a profession whose standing in the court of public opinion has held up far better than bankers, politicians (and it goes without saying, journalists), and which has a more effective trades union than any of the others cited – to be resisting the verdict of a public that repeatedly reports high levels of trust.

Moreover, commentators on health policy over recent years have been almost unanimous in calling an end to the era of centralisation and pointing to the limits of national targets.

Customer Service Excellence awards don’t actually sound too bad to me, provided the definitions are set locally and reflect public needs, not political dogma. Younger readers, if there are any, may not understand the reference to CSEs (the easier exams than GCEs, prior to the wonderful advent of GCSEs meant that all shall have prizes). But at forthcoming conferences, the phrase “how many CSEs did you get?” could be due for a comeback.