Book Review: Why Reforming the NHS Doesn’t Work – The importance of understanding how good people offer bad care

A few weeks ago I was asked to write a brief book review. The book was by Valerie Isles and takes an intelligent and nuanced view of changVI Scane management in the UK’s National Health Service (NHS). Many books forget how change management affects the patient, this book doesn’t. With this in mind I thought it might be useful to share my review here on my blog.
The author, Valerie Iles, identifies a vicious circle of factors that affect both frontline practitioners and policymakers alike; these include the power of the information age, audit and inspection, the volatility of politics, ‘reason’ and managerialism and the impact of anxiety. So pervasive are these that they are rarely noticed or discussed. In this context it is hard to imagine how anything happens at all – but of course it does, but not in the cause and effect way that many policymakers might expect.
So what do we do that makes a difference to those that we care for? Moving beyond the ‘check list’ paradigm the book offers powerful ideas that will affect practice and thought in how we as a community of caring activists make sense and improve what we do. The author provides an additional perspective to the trends towards the randomised control trial where variables are known and manipulated, the expert consensus, evidence based medicine etc where knowledge appears clear cut and unproblematic. This knowledge is important, but it is not the whole story. This use of this scientific knowledge sits within a complex mesh of the unique person, of history, practice, families and society requiring the application of practical wisdom.
The book concludes with two insightful scenarios that reach beyond the push/pull assumptions of linearity that lies beneath much of public policy. The first, running with the tide is pessimistic. The second, fighting against the prevailing forces offers a more positive outcome. This is not a book without hope, far from it, it should be seen as liberating to those who want to make a positive difference but recognise that this requires collaboration and meaningful attention to what we do on a daily basis at and between all levels.
In short this is a tonic to those tired of the broken promises of mainstream healthcare policy and change. The language is not passive – it is clearly written by someone who cares; perhaps that is the overriding message – we should all care and show that we care.


2 thoughts on “Book Review: Why Reforming the NHS Doesn’t Work – The importance of understanding how good people offer bad care

  1. Thanks. Really insightful and I agree with much of it. My blog is about the situation as it really is and the rebalancing of the media stereotypes. As one nurse said to me “I know the people I trained with are good nurses, so who are these nurses who give crap care!” The book might go some way to answering that.

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