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Here Be Dragons

The UK's New Government Healthcare Website Is Potentially Classist

The obsession with giving people choice could allow the bourgeoisie to swallow up all the best public hospital services.

by Martin Robbins
Nov 20 2014, 9:12pm

The MyNHS website

This post originally appeared in VICE UK

The latest government initiative to web 2.0 our taxpayer experience is ​MyNHS, a beta-release data "portal" that provides the sick, injured and dying with a load of cute icons that explain exactly how shit the person slicing and dicing their innards is. You can find various ratings for your hospital, your individual surgeon and even see how awful the food is.

At first glance, it ​looks pretty good. You can see mortality rates, patient ratings, staff ratings, cleanliness, inspection ratings, all the statistical goodness you'd expect; but is it actually that useful? When every hospital on the list basically saw at least 85 percent of A&E patients within four hours, do you need the column about waiting times?

Then there's the information that conflicts. The staff at St. Bartholomew's hospital in West Smithfield seem to reckon the place is basically a shit pile. Meanwhile, 96 percent of patients love the hospital, and it has one of the best mortality rates around. Staying in London, St George's is ranked "among the worst" hospitals in the country for infection control and cleanliness, which brings visions of Ebola germs dancing merrily down shit-soaked corridors—except that they also have one of the best mortality rates in the country. Do I really care if the taps are polished if I have a better chance of living?

For individuals the site makes even less sense. Every single cardiac surgeon is ​rated "OK," which makes basically the entire index pointless. There are some surgeons in other areas who "deviate," with a higher mortality rate than their colleagues, but the index doesn't explain why the patients died. Who was actually responsible? Just because someone dies after surgery doesn't mean the surgeon failed—it could be down to any number of other failures at the hospital.

Also, very talented people still tend to fail from time to time. In fact, failing is in some ways could be seen as the definition of being talented. If you don't fail at your job, you're not trying new things and you're not learning. The surgeon who spends his career doing routine heart procedures will probably have a much better mortality rate than the surgeon who pioneers open-heart surgery. So which one would you want spreading your ribs? Yep, me too.

It's not just a hypothetical example either. The Daily Mail ​found just three surgeons with poor mortality rates in the entire index. All three turned out to work either with very high-risk patients or in deprived areas (or both). So great, 98 percent of the index is a pointless repetition of the word "OK," and the only "bad" results are shaming surgeons who actually go out of their way to deal with tough cases.

A few years ago I broke my hand. The fracture was in an awkward position, close to the wrist joint, and consultants at the hospital—Wexham Park, near Slough—decided to insert a pin through the knuckle and up into the hand to reinforce the bones between my little finger and my wrist. When I turned up for the operation, they decided my hand was doing a lot better on its own, so they cancelled it. I was disappointed, because having a metal rod thread implanted in your hand is amazing and I wanted to film it.

But I understood the decision. It was probably right. The guys at Slough were used to dealing with broken hands because Slough is a crime-infested shit-hole, and the people who live there punch each other a lot for various reasons. I was confident that they were giving me the right advice.

Today, I can't be sure. Thanks to this bullshit ranking system, if a surgeon tells me they don't want to stick giant pins in me I don't know if it's genuine advice, or if they're worried about their ranking and making sure some other part of the NHS takes the fall. Jeremy Hunt and his chums have just given surgeons a really great incentive to give patients shitty advice. Thanks, Jeremy.

The government has an obsession with patient choice, even when the choice is completely stupid. This is the government that ​defended homeopathy on the NHS, on the basis that banishing it might restrict people's choices. The fact that the choice was as ludicrous as choosing between a pack of condoms or a sock didn't matter—patient choice seems more important to these ideologues than, say, getting the best treatment.

The thing about offering choices, though, is they favor people who can make choices. It doesn't matter a flying fuck if the hospital ten miles up the road has a better hygiene rating if you're disabled and you don't have an easy way of getting there. Less educated or numerate people—which is a considerable percentage of adults in the UK—may not understand the figures as well as someone with a university education. People with a serious disease or injury may have more important things to worry about than going through a bunch of stats on a website.

If the index was actually useful, it would function as a sort of casual eugenics, rewarding the intelligent, clever and mobile with a better level of care and increasing inequality for those at the bottom of the heap. Fortunately, it's useless.

All any patient needs to know when they go into hospital, assuming they're even conscious, is "Will I receive a good standard of care?" The answer is either yes or no, and if it's a no then the hospital or doctor involved shouldn't be operating on people in the first place.

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Martin Robbins