Richard D North

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The Independent Online
My village is a powerhouse. Name any local industry or service, and we have the managers and professionals which run it. Take health: we have three senior surgeons and the chief executive of the local hospitals trust.

This last took rather a pounding last week from the Times and the Telegraph. Both papers scanned the NHS league tables and pronounced Hereford to be amongst the "worst" 10 (the Times) and amongst the trusts which had most deteriorated (the Telegraph). Neither newspaper was being mischievous, but both had called bad performance what was actually very good performance.

One of the measurements of performance gauges how long a person waits in accident and emergency before being assessed for treatment. Hereford, last year, came bottom of the hospitals in Britain because "only" 55 per cent of patients were seen within five minutes. This year the figure is 95 per cent, because the department has seconded a nurse to sit in the waiting-room and make sure people are attended to. The consultant who runs the department doesn't think this is a brilliant way of looking at things, and prefers to stress that 80 per cent of patients are treated within 30 minutes, and 70 per cent within 15 minutes.

Last year, when the figures came out, the local TV station came and camped in his waiting-room to interview the bloodied wounded as they hung about for treatment in the worst unit in Britain. "Unfortunately for the TV people, none of the patients were in the waiting room or the department for long enough to be caught," says the triumphant A & E man.

This year, the Hereford Trust came out badly when the number of patients having to wait more than six months for operations was assessed: the figure was up and led to charges of a deteriorating service. But the statistic had risen because the Trust was so determined to cut the number of people who had waited more than 12 months that something had to give. My neighbour, the chief executive, points out that no one in Herefordshire now has to wait more than nine months for an operation, and they are working towards a six-month maximum.

The papers did not spot that Hereford Trust had won 15 five-star ratings, nor that there are nine more consultants working in the city than was the case two years ago. Hereford's health ought to be good. We have more poor people than might be supposed, but our GPs are not as overwhelmed as major inner city practices can be.

None of this is an outright attack on the value of league tables. They are new and crude, and are better at detecting the "throughput" of patients than the quality of treatment they receive. But these deficiencies can be corrected. Oddly, the Hereford A & E consultant who is critical of the league tables has his own assiduously collected data, which is regarded as trail-blazing by others in the field.

It's weird that an exercise in public information should have allowed the media to draw the wrong conclusion. On the other hand there are real benefits: armed with the tables, the chief executive could give me a snapshot of his Trust's work, which would otherwise have been difficult to bring into focus.

Thus, polite opinion "knows" that the NHS is in decline, and yet almost everyone who is treated by it is full of praise. It's odd that every scrap of bad news is taken to be normal and general, while every bit of good news is sensed to be exceptional and local. So despite the quality of the treatment most of us still get from the health service, we are all convinced that the NHS is in crisis. As a result we all find ourselves believing that everywhere else must be awful. How long before we risk wondering if the entire country is perhaps rather well served?

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