Is the NHS getting better or worse?: Better to be vaguely right than precisely wrong

doi:10.1136/bmj.328.7431.106-b

BMJ 2004;328:106 (10 January), doi:10.1136/bmj.328.7431.106-b

Letter

Is the NHS getting better or worse?

Better to be vaguely right than precisely wrong

The first 150 words of the full text of this article appear below.

EDITOR—In his editorial Smith asks whether the NHS isgetting better or worse.¹ By falling into the reductionist trapof assuming that the healthcare system can be understood bydissecting it into its component parts, he succeeds in beingprecisely wrong rather than vaguely right.

Underpinning his argument is a belief that the transfer processesthat relate inputs to outputs in each element of health careare well understood. Information is used as feedback that iscompared with a desired state (performance assessment), allowingthe system to be engineered towards the desired objectives byusing incentive manipulation (performance management). He infersthat all we need are enough data, and a "complete, validated,interpretable, and uncontested" picture will be revealed. Thetruth really is out there.