Is the NHS getting better or worse?: We need to ask the right questions

doi:10.1136/bmj.328.7431.107

BMJ 2004;328:107 (10 January), doi:10.1136/bmj.328.7431.107

Letter

Is the NHS getting better or worse?

We need to ask the right questions

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

EDITOR—Smith's editorial is entitled "Is the NHS gettingbetter or worse?"¹ Better or worse at what? Maybe one of thereasons we don't have the data to answer the question reliablyis that the question is not well formed. This is a basic startingprinciple of evidence based medicine: to get a clear answeryou need to ask a clear question. What do we want to know?

Maybe asking how much harm is caused by the NHS would be onequestion worth asking. What are the rates of iatrogenic morbidityand mortality? If those figures are shrinking then at leastwe can argue that the NHS is getting better at not subjectingpatients to harm. However, to focus only on the question ofharm, fails to provide us with answers about the positive impactof the NHS.

It's a bit like defining health as the absence of disease. . . . [Full text of this article]

Robert Leckridge, associate specialist, homoeopathic medicine

Glasgow Homoeopathic Hospital, Glasgow G12 0XQ bob.leckridge@virgin.net