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Editorial Monday 17 June 2013: The Patient's Charter rides again

There are a finite number of health policy moves, it would seem. Today, the CQC announced a Patient's Charter.

Obviously, it would be unfair to suggest that the Patient's Charter will be strongly in favour of good things and resolutely against bad things.

However, it's probably reasonable to wonder whether it will have more impact on NHS performance than, erm, the Patient's Charter from 1992, courtesy of Virginia 'M&S' Bottomley.

This was a big success, apparently, within just one year.

The Patient's Charter was, brilliantly, updated and strengthened in 1995. As part of that, patients were pronmised good manners, considerate behaviour and privacy.


The 1995 'reboot' Patient's Charter promised new standards:
90 per cent of first outpatient appointments to be carried out within 13 weeks and all before 26 weeks.

Existing 18-month waiting time guarantee for hip, knee and cataract operations to be extended to all operations.

A new one-year waiting time guarantee for coronary artery bypass grafts and associated procedures.

A three-to-four-hour national standard for "trolley waits" - admission to a ward from accident and emergency departments, reduced to two hours from April 1996.

A new standard on hospital food so that patients' dietary needs and preferences are respected and a choice of dishes provided.

A new standard specifying that patients receiving home visits from community nurses must be asked about convenient times and the visit should take place within two hours of that time.

Mmmmmm. In plain French, 'autre temps, autre moeurs', or in plain Latin, 'sic tempora, sic mores'.

The problem with this sort of initiative, as with the NHS Constitution, is that putting together a plausible-seeming piece of paper is much easier than actually delivering and ensuring quality.

In healthcare, quality can't be dictated top-down, although the evidence of successful reduction of both waiting times and HCAIs suggest that stopping appallingly bad practice can be.

Quality is intrinsically local. It's not about Patient's Charters, of whichever vintage. They are bureaucratic fig leaves.