http://bmj.com/cgi/content/full/324/7330/0/i
BMJ 2002;324 ( 19 January )
Editor's choice
Health systems: where doctors and patients meet
and will probably make our British
readers feel rather uncomfortable. In it Richard Feachem and
colleagues compare the costs and performance of the NHS and Kaiser
Permanente, a Californian health maintenance organisationand show that Kaiser achieves
better performance at roughly the same costs (p 135).
Among the commentaries on this paper is one by Don Berwick in which he
speculates that Kaiser is better at "configuring care according
to the needs of the patients throughout an episode of illness."
Arguably the NHS is the best positioned healthcare system in the
world to achieve the vision of an integrated patient journeyyet, paradoxically, it does not.
Berwick has done much to promote this vision for the NHS for he is a member
of the NHS's Modernisation Board, which has just produced its first
report on the government's plan to modernise the NHS (p 132).
The report marks some progress 597 more critical care beds,
714 more acute beds, 10 000 more nurses, 17% more cardiologistsbut there's still room for
improvement. One area where services have been
"modernised" is cancer, and on p 164
David Kerr and colleagues (including Don Berwick) describe how nine
cancer networks throughout England have used quality improvement
methods to reduce waiting times and improve patients' experiences of
care.
If "socialised medicine" carries a slur, it's not surprising that
the formerly communist countries of eastern Europe have moved fast
to change their systems. Yet an obituary this week pays tribute to
Regine Hildebrandt, a former minister for health and social affairs
of Brandenberg, for trying to preserve what was good in the East
German health system (p 175).
She valued policlinics, where groups of specialists worked together.
"Diabetic patient care was excellent in East Germany, but we
did not have the pumps, the tests, or special diet products. Now we
have all that but the patients can't go to specialists any more, but
to their GPs without specialist knowledge."
Kevin Barraclough might not agree with this analysisbut he does bemoan the loss of diagnostic
skills in general practice (p 179).
"All the skills that are rightly revered . . . listening,
communication, empathyare seriously devalued if major diagnoses
are missed." But maybe he is underestimating his trainees' ability
to assess their own learning needs (p 156)
and forgetting about lifelong learning. Sandy Goldbeck-Wood and Ed
Peile explain how our new section, "Learning in Practice,"
aims to be the place where educationalists and clinicians can help
each other deliver "better educated doctors capable of better
patient care" (p 125).
Footnotes
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Related editorials in BMJ:
Learning in practice: a new section in the BMJ.
Sandra Goldbeck-Wood and Ed Peile
BMJ 2002 324: 125-126.
Other related articles in BMJ:
NEWS ROUNDUP
Modernisation Board identifies progress on NHS Plan.
Susan Mayor
BMJ 2002 324: 132.
PAPERS
Getting more for their dollar: a comparison of the NHS with
California's Kaiser Permanente •
Commentary: Funding is not the only factor • Commentary: Same price, better care • Commentary: Competition made them do it.
Richard G A Feachem, Neelam K
Sekhri, Karen L White, Jennifer Dixon, Donald M Berwick, and Alain C Enthoven
BMJ 2002 324: 135-143.
LEARNING IN PRACTICE
Learning needs assessment: assessing the need.
Janet Grant
BMJ 2002 324: 156-159.
EDUCATION AND DEBATE
Redesigning cancer care.
David Kerr, Helen Bevan, Ben
Gowland, Jean Penny, and Don Berwick
BMJ 2002 324: 164-166.
OBITUARIES
Regine Hildebrandt.
Annette Tuffs
BMJ 2002 324: 174.
PERSONAL VIEWS
Actually, making a diagnosis is quite important.
Kevin Barraclough
BMJ 2002 324: 179.
