The NHS

Last week David Cameron announced that he would launch an initiative to make nurses take better care of patients, with an emphasis on hourly ward rounds by nurses, and with patients (i.e. ordinary members of the public) empowered to assess and inspect hospital standards. At the same time, according to media reports, he emphasised that the majority of nurses were doing a brilliant job. Which, perhaps, is a very good reflection of the almost schizophrenic approach that is adopted toward the NHS - it is a wonderful institution, but it needs to do better because it delivers some appalling care.

Of course initiatives of this type capture the headlines, as do announcements of increased inspections by the NHS regulator. They reassure people that the Government is addressing the problem, is taking action, is on top of things. But what these initiatives don't address is why nurses and doctors at times provide poor care, or care that is plainly abusive. Why do nurses have to be told to do hourly ward rounds? What are they doing instead of being on the ward? Why do we need the public to assess and inspect hospital standards? Why aren't the hospitals doing it themselves?

I guess our difficulty is not with the initiatives - we're all for more public involvement in public services, and people may certainly benefit from seeing nurses more frequently. But, it is the fact that such initiatives don't address the underlying attitudes and problems at their root which is of concern. The Dignity inspections six months ago showed nurses on the wards, but those nurses were ignoring their patients, neglecting their patients, and in some cases falsifying the records of their patients. Why? Unless we address those basic questions we can't realistically expect to see change.

Last week (yes, the same week as Mr Cameron's announcements) the Economist Intelligence Unit published research on healthcare provision for an ageing European population. 80% of health professionals expressed concern about how they would be treated as they grew old. They were sceptical that current policies were comprehensive, realistic or sufficiently funded to address future demand.We can understand their anxieties. The report suggested that an effective strategy needed

• a focus on preventive healthcare 
  
• better integration of health and social care 
  
• Medical training to focus on the future healthcare needs of ageing populations 
  
• Negative attitudes towards older people to be challenged.

Sounds like a plan!