I was pleased to find from the league tables published last week by the Commission for Health Improvement that the hospital which I have been briefly in and out of recently, the Chelsea and Westminster in west London, gained three stars, just like the best French restaurants. However, I didn't need the ratings system to tell me that the Chelsea and Westminster is good. I had already come to that conclusion from the standpoint of a patient.
We all know pretty soon whether an institution is effective. Excellence and inefficiency alike are pervasive throughout an organisation. You cannot have an excellent top management and poor interactions with customers, nor the reverse. It is all of a piece. I have never met the management of the Chelsea and Westminster, but they must be doing quite a lot of things right.
Typical of a London organisation, the Chelsea and Westminster employs many people at all levels whose first language is not English. I couldn't see that this made any difference at all. One of the senior nurses on my floor was Spanish and had come to this country after leaving school. She was sometimes in charge at night. Her language skills were wholly appropriate for the job in hand. Another was Scandinavian. Ditto. One of the heads of department with whom I dealt was Greek.
In its staff and patients, the Chelsea and Westminster is a sort of United Nations. Once or twice I thought I had been transported back in time to the old British Empire when I heard the voice of a pukka English colonel booming from one of the beds. "I say, old boy..." Yet it all works seamlessly.
The tests for hospitals comprise a clinical audit together with an assessment of the hospital's research and education, its patient involvement, information management, staff involvement, training and development. Dr Liam Fox, the shadow Health Secretary, called all this ludicrous. Yet if you consider how the Commission for Health Improvement prepares its tables, you are bound to be struck by its professionalism.
In the case of the Chelsea and Westminster I could see how much had been learnt from recent hospital scandals around the country. Constant checks are made by nurses and doctors that they are dealing with the actual patient as described in their notes. One can hardly take a sip of water without one's name-tag being checked and one's date of birth requested. It is routine that a clear description is given of what is involved in every procedure, however minor. Nobody from nurse to consultant fails in this regard. (I confess here that I learnt quite a lot by eavesdropping on what was said to the other patients in the room. Doctor/patient privacy is far from perfect in open-plan accommodation).
What I found most striking was the cautious attitude to probability and risk. Perhaps the diagnosis of suspected appendicitis, which is what I had, is always difficult. Many other possibilities seemed to crowd round the central appraisal. At all events my doctors were very careful to speak the language of probability. They sounded as if they had had a thorough training in the Oxford school of philosophy where one is taught that one cannot be certain that the sun will rise again tomorrow morning even though it has done so without fail since the beginning of time.
This in turn extended to the assessment of risk; this is shared with the patient. With regard to one procedure I was told that the risks were low, but if the doctors saw something untoward which could be dealt with at the same time, then they would do so even though the chance of something going wrong would have slightly increased - provided I agreed at the outset.
I don't know how one could improve on all this. I am a natural user of the National Health Service. My family has never had private health insurance. We have trusted in the NHS and never, with various members needing a bit of hospital attention from time to time, had the slightest disappointment. Grandmothers died in NHS hospitals at ripe old ages and none the worse for that.
Earlier this year, though, I had a brief and unsatisfactory acquaintance with the private health system. I had developed persistent nose-bleeding, a silly thing. My family doctor said that I should have my nose cauterised and because there would be a long wait, he advised me to go to a private hospital where I would be dealt with straight away. As I was, except that the cauterisation made no difference. An X-ray was taken and something more serious was revealed.
The consultant immediately said that I should come in for an operation in two days time so that an internal examination of the problem could be undertaken. Every instinct told me to refuse. Although I could well afford the cost I swiftly returned to the NHS. It turned out that I merely had severe sinusitis. There was no need for an operation - as would have happened at the private hospital. Drugs were the remedy. My cure was complete.
Thus I saw that private hospitals are like any other transaction-driven business. To make money they must keep doing operations, whether necessary or not. Give me the NHS any day. Even the food at the Chelsea and Westminster, as befits a three-star rating, is tasty.Reuse content