Does poor health justify NHS reform?

John Appleby is quite right to challenge the particular statistics
used to justify NHS reform, but he is being a bit harsh on the politicians
by not recognizing a major problem that prevents them talking straight.

The trouble is that telling the truth about why reform is required
would risk alienating the very people who will have to make the needed
improvements. If a government admitted, for example, that some NHS staff
are lazy, incompetent or motivated by something other than the good of
patients, they would face revolt rather than a workforce motivated to
improve. If they claimed that change was impeded by gross management
failure and local empire building by powerful consultants and managers,
they would not achieve much progress. It sometimes seems like the
government believes the NHS is a prelapsarian paradise where no front line
staff commit any sin at all (and were "bureaucrats" or managers probably
fulfill the role of the serpent).

Another problem with using comparative benchmarks as a motivation for
change is that they are the wrong measure. It could be that all health
systems are equally poor. The right metric is how good they could be not
how well they compare to each other. I doubt that mortality rates in
British and French troops were that different during the Crimean War. But
that wasn't a signal that they couldn't be a lot better.

Those of us who observe how the NHS works know it could be a lot
better than it is. We should seek reforms that can drive improvement
whatever constraints prevent governments being honest about how much
improvement is possible.