Jeremy Laurance: Proof that high standards are the best treatment

Medical Life

One picture can define a premiership. There is that famous shot of Margaret Thatcher, wiping away a tear as she departed No 10 for the last time – betraying an emotion she never showed while in office.

The final moments of Gordon Brown's tenure were captured in an extraordinary image, as he posed for the camera with his family inside No 10, an arm round three-year-old Fraser perched on a desk, moments before stepping out into the street to announce his resignation.

The picture has been much commented on. But one poignant aspect has been missed. Mr Brown described his role as prime minister as "the second most important job I will ever have", after that of husband and father. What is the greatest fear of a father (or mother)? That their children will die before them.

Mr Brown, at 57, is no longer young. Even so, it will be touch and go whether he outlives Fraser, who has cystic fibrosis, the commonest inherited condition in the West. The gene defect that causes the condition thickens secretions throughout the body, making them dry and gluey, and has a lethal effect on the lungs, whose airways fill with sticky mucus.

There is no sign of this in the boisterous child in the photograph. But the future Fraser can look forward to will depend to a critical extent on a neglected but crucial aspect of medical care: expectation.

In the 1950s, a child born with cystic fibrosis lived on average until the age of three. Today, thanks to improvements in care, that has extended to the mid-30s. Most patients are now cared for in specialist centres that have built up years of experience in managing the condition.

Yet there remain, as US surgeon and writer Atul Gawande noted in his 2007 book Better, shocking gaps in performance. The best centre in the US, Fairview Children's Hospital in Minneapolis, had a life expectancy 50 per cent better than the average. It's oldest patient was 67.

What accounts for the difference? The best centres were not using different drugs or treatments – they were just applying them better. Successful treatment of cystic fibrosis requires extraordinary commitment, attention to detail and a refusal to accept second best in order to maintain peak lung function. While the average centre might accept lung function at 75 per cent of normal, at Fairview they were not content with less than 100 per cent. They questioned everything when standards slipped, rather than accepting it as an inevitably by-product of the illness. Expectation was the key.

The treatment Fraser and his fellow patients receives will provide a touchstone for the performance of the NHS. Instead of searching for the easy fix, the miracle cure that will solve a problem, it needs to focus – in these straitened times – on diligence: doing what it has always done but doing it better. As Gawande said, the reality is that most clinics and most doctors will be average. That we must accept. What is troubling is not just being average, but settling for it.

Life and Style
ebookNow available in paperback
ebooks
ebookPart of The Independent’s new eBook series The Great Composers
News
people
News
Amazon's drones were unveiled last year.
business
Arts and Entertainment
Russell Tovey, Myanna Buring and Julian Rhind Tutt star in Banished
tvReview: The latest episode was a smidgen less depressing... but it’s hardly a bonza beach party
Life and Style
Worth shelling out for: Atlantic lobsters are especially meaty
food + drink
Sport
Gareth Bale
footballPaul Scholes on how Real Madrid's Welsh winger would be a perfect fit at Old Trafford if he leaves Spain
Arts and Entertainment
Lily James in ‘Cinderella’
film
  • Get to the point
Latest stories from i100
Have you tried new the Independent Digital Edition apps?

ES Rentals

    Independent Dating
    and  

    By clicking 'Search' you
    are agreeing to our
    Terms of Use.

    iJobs Job Widget
    iJobs General

    Recruitment Genius: Weekend Catering Supervisor - Temporary

    Negotiable: Recruitment Genius: To be responsible for working with the Caterin...

    Ashdown Group: Technical IT Manager - Infrastructure / VMWare - Hertfordshire

    £45000 per annum: Ashdown Group: An established industry leading business is l...

    Ashdown Group: IT Support Engineer - Hertfordshire -Large Established Business

    £22000 - £28000 per annum + study support, gym: Ashdown Group: A large busines...

    Recruitment Genius: Sales Manager

    £35000 - £45000 per annum: Recruitment Genius: This is a unique opportunity to...

    Day In a Page

    The saffron censorship that governs India: Why national pride and religious sentiment trump freedom of expression

    The saffron censorship that governs India

    Zareer Masani reveals why national pride and religious sentiment trump freedom of expression
    Prince Charles' 'black spider' letters to be published 'within weeks'

    Prince Charles' 'black spider' letters to be published 'within weeks'

    Supreme Court rules Dominic Grieve's ministerial veto was invalid
    Distressed Zayn Malik fans are cutting themselves - how did fandom get so dark?

    How did fandom get so dark?

    Grief over Zayn Malik's exit from One Direction seemed amusing until stories of mass 'cutting' emerged. Experts tell Gillian Orr the distress is real, and the girls need support
    The galaxy collisions that shed light on unseen parallel Universe

    The cosmic collisions that have shed light on unseen parallel Universe

    Dark matter study gives scientists insight into mystery of space
    The Swedes are adding a gender-neutral pronoun to their dictionary

    Swedes introduce gender-neutral pronoun

    Why, asks Simon Usborne, must English still struggle awkwardly with the likes of 's/he' and 'they'?
    Disney's mega money-making formula: 'Human' remakes of cartoon classics are part of a lucrative, long-term creative plan

    Disney's mega money-making formula

    'Human' remakes of cartoon classics are part of a lucrative, long-term creative plan
    Lobster has gone mainstream with supermarket bargains for £10 or less - but is it any good?

    Lobster has gone mainstream

    Anthea Gerrie, raised on meaty specimens from the waters around Maine, reveals how to cook up an affordable feast
    Easter 2015: 14 best decorations

    14 best Easter decorations

    Get into the Easter spirit with our pick of accessories, ornaments and tableware
    Paul Scholes column: Gareth Bale would be a perfect fit at Manchester United and could turn them into serious title contenders next season

    Paul Scholes column

    Gareth Bale would be a perfect fit at Manchester United and could turn them into serious title contenders next season
    Inside the Kansas greenhouses where Monsanto is 'playing God' with the future of the planet

    The future of GM

    The greenhouses where Monsanto 'plays God' with the future of the planet
    Britain's mild winters could be numbered: why global warming is leaving UK chillier

    Britain's mild winters could be numbered

    Gulf Stream is slowing down faster than ever, scientists say
    Government gives £250,000 to Independent appeal

    Government gives £250,000 to Independent appeal

    Donation brings total raised by Homeless Veterans campaign to at least £1.25m
    Oh dear, the most borrowed book at Bank of England library doesn't inspire confidence

    The most borrowed book at Bank of England library? Oh dear

    The book's fifth edition is used for Edexcel exams
    Cowslips vs honeysuckle: The hunt for the UK’s favourite wildflower

    Cowslips vs honeysuckle

    It's the hunt for UK’s favourite wildflower
    Child abuse scandal: Did a botched blackmail attempt by South African intelligence help Cyril Smith escape justice?

    Did a botched blackmail attempt help Cyril Smith escape justice?

    A fresh twist reveals the Liberal MP was targeted by the notorious South African intelligence agency Boss