'Culture of Continuous Improvement'

The Conservatives have announced that under their leadership, the NHS will be transformed into a free market of competing hospitals, driven by a new focus on performance targets.

I was practicing my shorthand today as Jeremy Paxman was interviewing the Conservative Shadow Health Secretary Andrew Lansley on Newsnight. The title quote was said as Lansley was responding to Paxman's questions about the danger of removing traditional hospital targets.

People would be able to choose which hospital they want to be treated in, Lansley says, by looking at the success rate, the waiting times, or the experience of the hospital in treating major illnesses such as strokes and cancer, rather than just the waiting time.

Waiting times are being fiddled, supposedly; doctors keep appointment slots free during the day so that they can always see patients within 48 hours, and ambulances are left parked outside A & E when it's busy if the staff think that they'll blow the four hour waiting time limit.

Adding a competitive element, the Conservatives think hospitals should improve as they fight for patients. The Tories say that their strategic replacement of hospital targets for the NHS will save 100,000 lives a year.

But how does knowing these 'top- down' targets of a hospital really empower the patient?

What if I lived in London and, unhappy with the waiting time projected to me at my local hospital, I decided to be treated in York? What if my treatment then required frequent and increasingly debilitating visits? I probably couldn't keep going up there and I'd return to my local practice- to the hospital with a worse mortality rate, resigned to the targets.

The reason there isn't a huge, single, centralised hospital in the middle of England that can deliver every single treatment to every single patient in the country under its roof like an enormous supermarket, is because ill people need hospitals nearby.

People want to be near to their homes and families. No- one wants to travel far when they're ill, they just want the local hospital to treat them attentively and to high standards. It's unfair to actively force patients to stimulate hospital improvements through this 'competition'.

The proposed top- down targets will result in a transparent service, but it won't improve it. People will be resigned to the fact that their local hospitals are slow, or badly managed, or offer a bad experience.

Perhaps instead hospitals will replace the school as the new property value stimulus. People will pay more to live in an area with a great school- now they might be looking for great hospitals too.